17-0905_SIEMENS INDUSTRY, INC_Payment Bond1.2 Pavment Bond (Labor and Materials).
KNOW ALL MEN BY THESE PRESENTS ThAt
Bond Number: 8245-68-61. / 9265280
hereinafter designated as the "City"), by action20 L7, has awarded to
WHEREAS, the City of San Juan C
taken or a resolution passed
apistrano (
October 15th
siemens tndustrv tnc. hereinafter designated as the "Principal," a contract for the work
Oescr¡oem No. 11101 - (the "Project"¡; and
WHEREAS, said Principal is required to furnish a bond in connection with said contract;
providing that if said Principal or any of its Subcontractors shall fail to pay for any materials,
provisions, provender, equipment, or other supplies used in, upon, for or about the performance
of the work contracted to be done, or for any work or labor done thereon of any kind, or for
amounts due under the Unemployment lnsurance Code or for any amounts required to be
deducted, withheld, and paid over to the Employment Development Department from the wages
of employees of said Principal and its Subcontractors with respect to such work or labor the
Surety on this bond will pay for the same to the extent hereinafter set forth.
Federal lnsurance Company and Fidelity
NOW THEREFORE, we, the Principal ¿¡çland Depositcompanyof Maryland as Surety, are held
and firmly bound unto the City in the penal sum of *Dollars 195,898.00 )
lawful money of the United States of America, for the payment of which sum well and truly to be
made, we bind ourselves, our heirs, executors, administrators, successors and assigns, jointly
and SeVerally, firmly by theSe pfeSentS. One Hundred Ninety-Five Thousand Eight Hundred Ninety-Eight and No/Cents
THE CONDITION OF THIS OBLIGATION lS SUCH that if said Principal, his or its
subcontractors, heirs, executors, administrators, successors or assigns, shall fail to pay any of
the persons named in Civil Code Section 9100, fail to pay for any materials, provisions or other
supplies, used in, upon, for or about the performance of the work contracted to be done, or for
any work or labor thereon of any kind, or amounts due under the Unemployment lnsurance
Code with respect to work or labor performed under the contract, or for any amounts required to
be deducted, withheld, and paid over to the Employment Development Department or Franchise
Tax Board from the wages of employees of the contractor and his subcontractors pursuant to
Revenue and Taxation Code Section 18663, with respect to such work and labor the Surety or
Sureties will pay for the same, in an amount not exceeding the sum herein above specified, and
also, in case suit is brought upon this bond, all litigation expenses incurred by the City in such
suit, including reasonable attorneys' fees, court costs, expert witness fees and investigation
expenses.
This bond shall inure to the benefit of any of the persons named in Civil Code Section 9100 so
as to give a right of action to such persons or their assigns in any suit brought upon this bond.
It is further stipulated and agreed that the Surety on this bond shall not be exonerated or
released from the obligation of this bond by any change, extension of time for performance,
addition, alteration or modification in, to, or of any contract, plans, specifications, or agreement
pertaining or relating to any scheme or work of improvement herein above described, or
pertaining or relating to the furnishing of labor, materials, or equipment therefore, nor by any
change or modification of any terms of payment or extension of the time for any payment
pertaining or relating to any scheme or work of improvement herein above described, nor by any
rescission or attempted rescission or attempted rescission of the contract, agreement or bond,
nor by any conditions precedent or subsequent in the bond attempting to limit the right of
recovery of claimants otherwise entitled to recover under any such contract or agreement or
6 1 1 47 .021 00\29379545. 1 -48-OO 61 ,13 - BOND FORMS
under the bond, nor by any fraud practiced by any person other than the claimant seeking to
recover on the bond and that this bond be construed most strongly against the Surety and in
favor of all persons for whose benefit such bond is given, and under no circumstances shall
Surety be released from liability to those for whose benefit such bond has been given, by
reason of any breach of contract between the owner or City and original contractor or on the
part of any obligee named in such bond, but the sole conditions of recovery shall be that
claimant is a person described in Civil Code Section 9100, and has not been paid the full
amount of his claim and that Surety does hereby waive notice of any such change, extension of
time, addition, alteration or modification herein mentioned, including but not limited to the
provisions of sections 2819 and 2845 of the California Civil Code.
lN WITNESS WHEREOF, we have hereunto set our hands and seals this zottr day of
October
(Attach Attorney-in-Fact Certificate)
Siemens lndu lnc
Contractor/
Federal lnsurance Company and Fidelity and Deposit
f-nmnanrr nf [t/larvland
Su
By
-Fact
Brittany D. Clavin, Attorney-ln-Fact
/bV*
ww
tnrr{err-
61 1 47 .021 00U9379545. 1 -49-OO61 13-BONDFORMS
Notary Acknowledgment
A notarv public or other officer comoletinq this certificate
verifies bnlv the identitv of the individual -who sioned the
document t-o which this'certificate is attached, anð not the
truthfulness, accuracy, or validity of that document.
STATE OF CALIFORNIA ,\
COU NTY Or Q-r..fOr¡.fYL0
On before me,Public, personally
appeared \-\,'ü, J,e\noñ who proved to me n the basis of satisfactory
evidence to be the person{sf whose name{alis/a¡e-subscribed to the within instrument and acknowledged to
me that he/sheltlrey executed the same in his/frc#h€,ir-authorized capacity(ies|, and that by his/he#their
signature{rf on the instrument the person(s)l or the entity upon behalf of which the person@ acted, executed
the instrument.
I certify under PENALW OF PERJURY under the laws of the State of California that the foregoing paragraph
is true and correct.
CANDACE GALLAHER
Commisslon # 2117338
ilolary Publlc - Calllornia
orango County
WITNE my han t.
I
OPTIONAL
Though the information below is not requ¡red by law, it may prove valuable fo persons relying on the document
and could prevent fraudulent removal and reattachment of this form to another document.
CAPACITY CLAIMED BY SIGNER DESCRIPTION OF ATTACHED DOCUMENT
lndividual
Corporate Officer
Title or Type of Document
r Partner(s)Limited
General
, Attorney-ln-Fact
: Trustee(s)
, Guardian/Conservator
; Other:
Signer is representin g:
Name Of Person(s) Or Entity(ies)
nt
Than Named Above
NOTE: This acknowledgment is to be completed for Contractor/Principal
6 1 1 47 .02 1 00\29379545. 1 -50-00 61 13 - BOND FORMS
Notary Acknowledgment
A notarv oublic or other officer comoletino this certificate
verifies bnlv tne identitv of the individual "who sioned the
document t'o which this'certificate is attached, anð not the
truthfulness, accuracy, or validity of that document.
Missouri
STATE OF øSùffiORtI&Ax
COUNTY OF st. Louts
On October 2Oth 20_u_, before me,Sandra L. Ham Notary Public, personally
appeared Brittany D. Clavin who proved to me on the basis of sat¡sfactory
ev¡dence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to
me that heishe/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their
signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed
the instrument.
der the laws of the State of California that the foregoing paragraph
IS
WITNESS my hand and officialseal
á
Signature of Notary Public
OPTIONAL
Though the informat¡on below is not required by law, ¡t may prove valuable fo persons rely¡ng on the document
and could prevent fraudulent removal and reattachment of th¡s form to another document.
CAPACITY CLAIMED BY SIGNER DESCRIPTION OF ATTACHED DOCUMENT
¡ , lndividual
¡ ' Corporate Officer
Title(s)Title or Type of Document
1 Partner(s)Limited
General
Two
¡ Attorney-ln-Fact
r Trustee(s)
I Guardian/Conservator
i Other:
Signer is representing:
Name Of Person(s) Or Entity(ies)
Number of Pages
October 20th,2077
Date of Document
Federal lnsurance Company and Fidelity and Deposit
Company of Maryland
Commiss
My Commlsslon
and
0l
2021
Seol
#4¿
NOTE This acknowledgment is to be completed for the Attorney-in-Fact. The Power-of Attorney to
local representatives of the bonding company must also be attached.
END OF PERFORMANCE BOND
6 1 1 47 .O21 00\2937954s. 1 -47-OO 61 13 - BOND FORMS
EHIJEIEI'
Power of Attorney
Federal Insurance Company I Vigilant Insurance Company I Pacific Indemnity Company
Know All by These PreseDts, That FEDERAL INSURANCE COMPANY, an lndiana corÞoration, VIGILANI INSI]RANCE COMPANY, a New ìork corporation, and PACIFIC
INDEMNITY COMPANY, a Wisconsin corporation, do each hereby constitute and appoint Pamela A. Beelman, Cynthia L. Choren, Brittany D. Clavin, Joann R. Frank,
Sandra L. Ham, Heidi A. Notheisen, Karen L. Roiderand Debra C. SchneiderofSt. Louis, Misso
each as their true and lawful Attorney-in-Fact to execute under such designation in their names and to affix their corporate seals to and deliver for and on their behalf as surety
thereon or otherwise, bonds on behalfofcontractors in connection with bids, proposals or contracts to the Commonwealth ofKentucky in an unlimited amount.
It is agreed that the power and authority hereby given to the Attorney-in-Fact cannot be modified or revoked unless prior written personal notice of such intent has been given to
the Commissioner - Department of Highways of the Commonwealth of Kentucky at le ast thirty days prior to the modifìcation or revocation.
In Witness Whereof, saitl FEDERAL INSIIRANCE COMPANY, VIGILANT INSURÁNCE COMPANY, and PACIFIC INDEMNITY COMPÄNY have each executed and attested these
presents and affixed their corporate seals on this 22d day of September, 2O17.
ÈUureTn. eF-Is,\åf #'t^f-o^ k4"-,-,
I [rv;n ltl. (]hL rts. ;\rsist:rnt Sctlctuly
Given under my hand and seals ofsaid Companies
Stcphr.tì trl ilrnay- \iict l)t c:itletrt
atwhitehousestation,NJ,this 20th day Of OCtObef ,2017 .
tur^rufn. e}tmltÊf
ffiffi@
@ffi@
@ffi
STATE OF NEIVJERSEY
CountyofHunterdon ss.
Onthis 22d dayofSeptember,2OlT beforeme,aNotaryPublicofNewJersey,personallycameDawnM.Chloros,tomeknowntobeAssistantSecretaryofFEDERALlNSURANCE
COMPANY, VIGILANT INSURANCE COMPANY. and PACIFIC INDEMNITY COMPANY, the companies which executed the f'oregoing Power of Attorney, and the said Dawn M.
Chloros, being by me duly sworn, did depose and say that she is Assistant Secretary of FEDERAL INSURANCE COMPANY. VIGILANT INSURANCE COMPANY, and PACIFIC
INDEMNITY COMPANY and knows the corporate seals thereof, that the seals affixed to the folegoing Power of Attorney are such corporate seals and were thereto afIìxed by
authority ofsaid Companies; and that she signed said Power ofAttorney âs Assistant Secretary ofsaid Companies by like aurhority; and that she is acquainted with Stephen M.
I Ianey, and knows him to be Vice President of said Companies; and that the signature of Stephen M. I laney, subscribed to said Power of Attorney is in the genuine handwr¡ting of
Stephen M. Haney, and was thereto subscribed by authority ofsaid Companies and in deponent's presence.
Notarial Seal
NOTARY PUBLIC OF NEW JERSEY
Nô.2S18ô0ô
Cffiñlrdon Ërplı8 Jlly 10, 2019
Norery Publlc
CERTIFICATION
Resolutions adopted by the Boards ofDirectors ofFEDERAL INSURANCE COMPANY, VICILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY on August 30, 2Ol6:
entered ìnto in the ordinary course ofbusiness (each a "Written Commitment ):
seal of the Companyorotheruise.
(2) Each duly appointed attorney-in-fâct of the Company is hereby authorized to execute any \{ritten Comitment for and on beha¡f of the Company, under the seal of the Company or
othevise, to the extent that such action is authorized by the grant oflrcwets prcvided for in such person's written appointment as such attorney-in-fact.
in-fact of the Company with full power and authority to execu¡e, for ând on behalf of the Company, under the seâl of the Company or othewise, such Written Comitments of the
written Comitments.
Company the authority to execute, for and on behalf of the Company, under the Companys seal or otheruise, such written Comitmenls of the Compâny âs âre specifìed in such
writtendelegation,whichspecification may be by general typeor clasof lvritten Commitme¡rts or bl'specificationofoneormoreparticularWrittenCo¡mitments.
fa6imile on such written Colmitment or written appointment or delegation.
the Company, and such Resolution shaìl not limit or othevise âffect the exercise ofany such power or âuthority otheruise validlygranted or vested."
I, Dawn M. Chloros, Assistant Secrctary of FEDERAL INSURANCE COMPANY, VIGILANI' INSTIRANCE COMPANY, and PACIFIC INDEMNTIY COMPANY (the "Companies") do hereby
certify that
(i) the foregoing Resolutions adopted by the Board ofDirectors ofthe Companies are true, correct and in full force and effect,(iD the Companies are duly licensed and authorized to transact surety business in all 50 of the United States of America and the District of Columbia and are
authorized by the U,S. Treasury Department: further, Federal and Vigilant are licensed in the U.S. Virgin Islands, and Federal is licensed in Guam, Puerto Rico,
and each ofthe Provinces ofCanada except Prince Edward Island; and
(iii) the foregoing Power ofAttorney is true, correct and in full force and effect.
Form 15¡0- 01928- U KY HWY (rev. 12-16)
I)rvjn Il. (llì k nr É.,\rsist¡n t Str:r'etl¡¡ f'
IN THE EVENT YOU WISH TO NOTIFY US OF A CLAIùI, VERIFY THE ÀUTHENTICITY OF THIS BOND OR NOTIFYUS OFANY OTHER MATTER, PLEASE CONTACTUS AT:
TelenhônelqoRlqo?-?¿ql FâylqoÂ)qôl-16q6 p-mril.crrrctvørhilhhcom
FEDERAL INSURANCE COMPANY
STATEMENT OF ASSETS, LIABILITIES AND SURPLUS TO POLICYHOLDERS
Statutory Basis
DECEMBER 31,2016
(in thousands of dollars)
ASSEÏS
LIABILITIES
AND
SUBPLUS TO POLICYHOLDERS
Cash and Short Term lnvestments..
United States Government, State and
$ (86,eeo)Outstanding Losses and Loss Expenses..... $
Unearned Premiums......
Ceded Reinsurance Premiums Payable.......
11,482,308
2,723,875
566,868
29,339
1,144,976
Municipal Bonds 8,135,311
5,471,330
130,689
'1,289,903
Other Bonds.Provision for Reinsurance
Stocks
Other lnvested Assets
TOTAL INVESTM ENTS ...........,14,940,243 TOTAL LIABILITIES 15,947,366
lnvestments in Affiliates:
Chubb lnvestment Holdings, lnc. ..............
Pacif ic lndemnity Company......
Executive Risk lndemnity 1nc.....................
Great Northern lnsurance Company .........
3,727,406
2,926,619
1,250,965
504,162
319,s05
277,361
214,956
162,929
163,668
70,204
1 ,5'1 0,1 07
1,303,050
Capital Stock............
Paid-ln Surplus.........
20,980
3,106,809
8,296,020Unassigned Funds
Vigilant lnsurance Company
Chubb European lnvestment Holdings, SLP.
Chubb Gustom lnsurance Company..........
Chubb National lnsurance Company .........
Chubb lndemnity lnsurance Company.......
Other Aff iliates ...................
SURPLUS TO POLICYHOLDERS.............11,423,809
Premiums Receivable
Other Assets
TOTAL LIABILITIES AND SURPLUS
TOTAL ADMITTED ASSETS ...$zt 371 175 TO POLICYHOLDERS.$ 27,371,175
lnvestments are valued in accordance with requirements of the National Association of lnsurance Commissioners.
At December 3'1 , 201 6, investments with a carrying value of $565,702,495 were deposited with government authorities
as required by law.
State, County & City of New York, - ss
Dawn M. Chloros, Assistant Secretary of the Federal lnsurance Company
being duly sworn, deposes and says that the foregoing Statement of Assets, Liabilities and Surplus to Policyholders of said
Federal lnsurance Company on December 31 , 2016 is true and correct and is a true abstract of the Annual Statement of said
Company as filed with the Secretary of the Treasury of the United States for the 12 months ending December 31, 2016.
Subscribed and sworn to before me
this March 3,2017.
Ryurr-m.0).1¡^fif
JEANETTE SHIPSEY
Notary Public, State of New York
No.02SH5074142
Qualified ¡n Nassau County
Assistant Secretary
Notary Public
Commission March 1 201 9
Form 1 5-10-03134 (Rev- 3/14
ZURICH AMERICAN INSURANCE COMPANY
COLONIAL AMERICAN CASUALTY AND SURETY COMPANY
FIDELITY AND DEPOSIT COMPANY OF MARYLAND
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS: That the ZUzuCH AMERICAN INSURANCE COMPANY, a corporation of the State of New
York, the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, a corporation of the State of Maryland, and the FIDELITY
AND DEPOSIT COMPANY OF MARYLAND a corporation of the State of Maryland (herein collectively called the "Companies"), by
Thomas O. McClellan, Vice President, in pursuance of authority granted by Article V, Section 8, of the By-Laws of said Companies, which
are set forth on the reverse side hereof and are hereby certified to be in full force and effect on the date hereof, do hereby nominate,
constitute, and appoint Brittany D. Clavin of St. Louis, Missouri , its true and lawful agent and Attorney-
in-Fact, to make, execute, seal and deliver, for, and on its behalfas surety, and as its act and deed: any and all bonds and undertakings,
and the execution ofsuch bonds or undertakings in pursuance ofthese presents, shall be as binding upon said Companies, as fully and amply,
to all intents and purposes, as if they had been duly executed and acknowledged by the regularly elected offìcers of the ZURICH
AMERICAN INSURANCE COMPANY at its office in New York, New York., the regularly elected officers of the COLONIAL
AMEzuCAN CASUALTY AND SURETY COMPANY at its office in Owings Mills, Maryland., and the regularly elected offìcers of the
FIDELITY AND DEPOSIT COMPANY OF MARYLAND at its office in Owings Mills, Maryland., in their own proper persons.
The said Vice President does hereby certif! that the extract set forth on the reverse side hereofis a true copy ofArticle V, Section 8, of
the By-Laws of said Companies, and is now in force.
IN WITNESS WHEREOF, the said Vice-President has hereunto subscribed his/her names and affixed the Corporate Seals of the said
ZURICH AMERICAN INSURANCE COMPANY, COLONIAL AMBRICAN CASUALTY AND SURETY COMPANY, and
FIDELITY AND DEPOSIT COMPANY OF MARYLAND, this l4th day of October, A.D. 2015.
ffi@@
- Ø (). "WfáÉ'(
ATTEST:
ZURICH AMERICAN INSURANCE COMPANY
COLONIAL AMERICAN CASUALTY AND SURETY COMPANY
FIDELITY AND DEPOSIT COMPANY OF MARYLAND
Í,; Ã &"",{-
By: Thomas O. McClellan
Vice President
By: Eric D. Barnes
Secretary
4..r.¿""*"- a". /J*,^^J
State of Maryland
County of Baltimore
Onthisl4th dayofOctober,4.D.2015, beforethesubscriber,aNotaryPublicoftheStateofMaryland,dulycommissionedandqualified,ThomasO.
McClellan, Vice President and Eric D. Barnes, Secretary ofthe Companies, to me personally known to be the individuals and officers described in and who
executed the preceding instrument, and acknowledged the execution ofsame, and being by me duly swom, deposeth and saith, that he/she is the said officer of
the Company aforesaid, and that the seals affixed to the preceding instrument are the Corporate Seals ofsaid Companies, and that the said Corporate Seals and
the signature as such officer were duly affixed and subscribed to the said instrument by the authority and direction ofthe said Corporations.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my Official Seal the day and year first above written.
^..'l;Ìl i::í;í...
ir'iì;ì!(¡¡\? ;:t'.
1
ì'ii\ -r !1:ttt.. / -(r.r.,,;*i,N
By: Constance A. Dunn, Notary Public
My Commission Expires: July 9,2019
EXTRACT FROM BY-LAWS OF THE COMPANIES
"Article V, Section 8, Attorneys-in-Fact. The Chief Executive Officer, the President, or any Executive Vice President or Vice President
may, by written instrument under the attested corporate seal, appoint attomeys-in-fact with authority to execute bonds, policies,
recognizances, stipulations, undertakings, or other like instruments on behalf of the Company, and may authorize any officer or any such
attorney-in-fact to affix the corporate seal thereto; and may with or without cause modifu of revoke any such appointment or authority at any
time."
CERTIFICATE
I, the undersigned, Vice President of the ZURICH AMERICAN INSURANCE COMPANY, the COLONIAL AMERICAN
CASUALTY AND SURETY COMPANY, and the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, do hereby certify that the
foregoing Power ofAttorney is still in full force and effect on the date ofthis certificate; and I do further certify that Article V, Section 8, of
the By-Laws of the Companies is still in force.
This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of
Directors of the ZURICH AMEzuCAN INSURANCE COMPANY at a meeting duly called and held on the l5th day of December 1998.
RESOLVED: "That the signature of the President or a Vice President and the attesting signature of a Secretary or an Assistant Secretary
and the Seal of the Company may be affrxed by facsimile on any Power of Attorney...Any such Power or any certihcate thereof bearing such
facsimile signature and seal shall be valid and binding on the Company."
This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of
Directors of the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at a meeting duly called and held on the 5th day of
May, 1994, and the following resolution of the Board of Directors of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at a
meeting duly called and held on the l0th day of May, 1990.
RESOLVED: "That the facsimile or mechanically reproduced seal of the company and facsimile or mechanically reproduced signature
of any Vice-President, Secretary, or Assistant Secretary of the Company, whether made heretofore or hereafter, wherever appearing upon a
certified copy ofany power ofattorney issued by the Company, shall be valid and binding upon the Company with the same force and effect
as though manually affixed.
IN TESTIMONY WHEREOF, I have hereunto subscribed my name and affixed the corporate seals of the said Companies,
this 20th day of October 2017
@ffi @
Æ"-¿¿
Ì).*/'
By: Gerald F. Haley, Vice President
F'IDELITY ^AIqD I}EPOSNT COMPANY
60 0 Red Brc ot er"¿.,IIrYåT,ffi i'e* Mills, MD 2 1 I 1 7
Statement of Financial Condition
As Of December 31,2015
ASSETS
Bonds
Stocks
Cash and Short Term Invostmenfs.........
Reinsurance Recoverable ......
Ceded Reinsurance Premiums Payable
Secudties Lending Collateral Liabilþ
Capital Stock, PaidUp $ 5,ooo,ooo
164,696,179Surptus
Surplus as regards Policyholders.
Other Accounts Receivable.... 19,935,944
TOTALADMII"TEDASSETS $ 210,1gS,g23
LIABILITTES, SURPLUS AND OTIIER F'UNDS
Reserve for Taxes and Expenses $ 46A36
I 142,878,497
22,315,096
337,835
24,731,,651
40,456,309
0
169,696,779
g zla,lgsign
Secretary of the FIDELÌTY ¿No DeposIT COMPANY oF MARyLeno, do hereby
a correct exhibit of the assots and liabilities of the said Company on the 3 I st
TorArLrABrLrrrES.............. $ 40,502J45
TOTAL
Securities car¡ied at $57,996,983 in the above statement are deposited with various states as required by law.
Seculities canied on the basis prescribed by the National Association of Insurance Commissioners. On the basis of
market quotations for all bonds and stocks owned, the Cornpany's total admitted assets at December 31, 2015 would
be 82L2,I37 ,'195 and surplus as regards policyholders $171,635,049.
I, DENNIS F. IGRRIGAN, Corporate
cettify that the foregoing statement is
day of December;2015.
State of Illinois \
City of Schau*Urrg f, SS:
Subscribed and swom to, beforc mc, aNotary Publio of the State of lllinois, in the City of Schaumburg this lsth day of March,20t6.
Corporate Sectetary
Nalary Public
SURETY RIDER
To be attached to and form a parl of
Bond No. 8245-68-61 / 9265280
dated
effective
r0/7s/2017
(MONTH-DAY.YEAR)
S¡emens lndustry lnc.
(PRTNCTPAL)
Federal lnsurance Company and Fidelity and Deposit Company of Maryland
executed by , as Principal,
and by , as Surety,
in favor of City of San Juan Capistrano
(oBLIGEE)
in consideration of lhe mutual agreements herein contained the Principal and the Surety hereby consenl to changing
The bond number from: B24s-68-61 /s26s2$o
To: az¿s-oa-21 / 926s2go
Nothing herein contained shall vary, alter or extend any provision or condition of this bond excepl as herein expressly stated.
This rider
is effective
TOhs/20t7
(MONTH-DAY-YEAR)
Oclober 25,2017
(MONTH-DAY.YEAR)
Signed and Sealed
Siemens lndustry lnc.
lnsurance and Fidelity and Deposit Company of Maryland
By:
Brittany D. Clav¡n,
s-0443/GEEF 10/99
ACKNOWLEDGMENT BY SURETY
STA'I-E
OF Missouri
City of St, Louis ss.
On this 25th dayof October 2017 , bel'ore mc pcrsonally
appeared Brittany D. Clavin , lcrown to me to be the Attorney-in-Fact of
Federal Insurance Company and Fidelity and Deposit Company of Maryland
, the corporalion
that executed the within instrument, ancl acknowledgcd to me that such corporation exccutcd tlte same .
IN M/I'INESS WHEREOF, I have hereurto set my hand and affixed my official seal, at my o{ïìce in the aforesaid
County, the day and ycar in this certificate fìrst above writtetr.
L. Ham
My Comnrission Expires: 0UlB/2021
(Seal)
Notary Public in the SLate of Missouri
County of St. Louis
Commissiort #12450177
Seol
2021
te of
Louls
oloN
c n
s-0230/GEEF 2/98
EHIJEIEI'
Power of Attorney
FederallnsuranceCompanylVigilantlnsuranceCompanylPacificlndemnityCompany
Know AII by These Ptesents, That FEDERAL INSIJRANCE COMPANY, an Indiana corporation, VIGILAITT INSURANCE COMPANY, a New York corporarion, and PACIFIC
INDEMNITYCOMPANY,aWisconsincorporation,doeachherebyconstituteandappoint Pamela A. Beelman, Cynthia L. Choren, Brittany D. Clavin, Joann R. Frank,
Sandra L. Ham, Heìdi A. Notheisen, Karen L. Roider and Debra C. Schneider of St. Louis, Missou
thereon or otherwise, bonds on behalfofcontractors in connection with bids, proposals or contracts to the Commonwealth ofl(entucky in an unlimited amount.
It is agreed that the power and authority hereby given to the Attorney-in-Fact cannot be modified or revoked unless prior written personal notice of such intent has been given to
the Commissioner - Department ofHighways ofthe Commonwealth ofKentucky at least thirty days prior to the modification or revocation.
In Witness Whereof, said FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY have each executed and artesred rhese
presents and afïìxed their corporate seals on this 22d day of Septembe¡ 2017,
Ètrsrr--fn. eh"foÀ.Êf
[]¡r¡¡r¡ il'T, (lh kl|t s. Assist:rn t Strrettr|y Sle¡rhcn i\'.I. lhncy. Vict Prtritlcnf
STATE OF NEWJERSEY
County of Hunterdon
Onthis 22d dayofseptember,2OlT beforeme,aNotaryPublicofNewJersey,personallycameDawnM.Chloros,tomeknowntobeAssistantSecretaryofFEDERALINSURANCE
COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY. the companies which executed the foregoing Power of Attorney, and the said Dawn M.
Chloros, being by me duly sworn, did depose and say that she is Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC
INDEMNITY COMPANY and knows the corporate seals thereof, that the seals afÏìxed to the foregoing Power of Attorney are such corporate seals and were thereto affìxed by
authority of said Companies; and that she signed said Power of Attomey as Assistant Secretary of said Companies by like authority; and that she is acquainted with Stephen M,
Haney, and knows him to be Vice President ofsaid Companies; and that the signature ofStephen M. llaney, subscribed to said Power ofAttorney is in the genuine handwrit¡ng of
Stephen M. Haney, and was thereto subscribed by authority ofsaid Companies and in deponent's presence.
Notarial Seal
I(AÏHEñINË J. A!€IAAR
NOTARY PUBLIC OF IIEW JERSEI
No. ?810S06
CffiriÍ8Ëlúr Êxplßê July lG, 20tg
Norâry
CERTIFICATION
Resolutions adopted by the Boards ofDirectors ofFEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY on Augusr 30,2016:
entered into in the ordinarycourse ofbusiness (each a "Writlen Commitment')l
0) Each of the Chairman, the President and the Vice Presidents of the Company is hereby authorized to execute anywritten Commitment for and on behalfofthe Company, under the
seâl of the Company or otheruise.
(2) Each duly appointed attorney-in-fact ofthe Company is hereby authorized to execute any written Comitment for and on behalfofthe Company, under the seal ofthe Company or
otheMise, to the extent that such action is author¡zed by the grant ofpowers provided for in such person's written appointment as such atbrney-in-{act.
(3) Each of the Chairmn, the President and the Vice Presidents of the Compânyis hereby authorized, for and on behalfofthe Compâny, to appoint in wúring âny person the âttorney-
in-fact of the Company with full power and authority to execute, for and on behalf of the Company, under the seal of the Company or otheNise, such Written Comitments of the
Company æ maybe specified in such witten appointment, which specification may be by general q,pe or clas of Written Commitments or by specification of one or more particuÌar
Written Colmitments.
(4) Each of the Chaiman, the President and the vice Presidents of theCompanyisherebyauthodzed.forildonbehalfoftheCompâny,todelegateinwritingtoanyotheromcerofrhe
Company the âuthority to execute, for and on behalf of the Company, under the Companys seâl or otheNise, such Written Comitments of the Company as are specified in such
writtendelegation,whichspecification may be by general typeor clasof written Comitments or byspecificationofoneormoreparticularWrittenComitments.
fasimile on such Written Comitment orwiltten appointment or delegation,
the Compâny, and such Resolution shall not limit or otheMise âff€ct the exercise ofany such power or authority otheryise validly grânted or vested."
I, Dawn M. Chloros, Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSTjRANCE COMPANY, and PACIFIC INDEMNITY COMPANY (rhe "Companies") do hereby
cenify that
(D the foregoing Resolutions adopted by the Board ofDirectors ofthe Companies are true, colrect and in full force and effect,
(iD the Companies are duly licensed and authorized to transact surety business in all 5O of the United States of America and the District of Columbia and are
åuthorized by the U.S. Treasury Department; further, Federal and Vigilant are licensed in the U.S. Virgin Islands, and Federal is licensed in Guam, Puerro Rico,
and each ofthe Provinces ofCanada except Prince Edward Isìand; and
(iii) the foregoing Power ofAttorney is true, correct and in full force and effect.
Civen under my hand and seals ofsaid Companies at whitehouse station, NJ, this 25th day Of OCtObef , 2017 .
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Form 15-10- 01928- U ft HWI (rev. 12-16)
lÌrv¡r tr|. (ll¡loltn. ,\ssist¡nt SLuetirr'ç'
IN THE EVENT YOU WISH TO NOTIFY US OF A CLAIN'I, VERIFY THE AUTHENTICITY OF THIS BOND OR NOTIFY US OFANY OTHER MA'I"TER, PLEASE CONTACTUS AT:
Telephone (908) 903- 3493 Fax (908) 9O3- 3656 e-mail: surew(ôchubb.com
FEDERAL INSURANCE COMPANY
STATEMENT OF ASSETS, LIABILITIES AND SURPLUS TO POLICYHOLDERS
Statutory Basis
DECEMBER 31,2016
(in thousands of dollars)
ASSEIS
LIABILITIES
AND
SU RPLUS TO POLICYHOLDERS
Cash and Short Term lnvestments..
United States Government, State and
$ (86,eeo)Outstanding Losses and Loss Expenses..... $
Unearned Premiums......
Ceded Reinsurance Premiums Payable.......
Provision for Beinsurance .................
Other Liabilities....................
11,482,308
2,723,875
566,868
29,339
1,144,976
Municipal Bonds 8,135,311
5,471,330
130,689
1,289,903
Other Bonds.
Stocks..........
Other lnvested Assets........
TOÏAL INVESÏMENÏS 14,940,243 TOTAL LIABILITIES '15,947,366
lnvestments in Affiliates:
Chubb lnvestment Holdings, lnc. ...............3,727,406
2,926,619
1,250,965
504,162
319,505
277,361
214,956
162,929
163,668
70,204
1 ,510,107
1,303,050
Capital Stock 20,980
3,106,809
8,296,020
Pacific lndemnity Company Paid-ln Surplus.........
Executive Risk lndemnity 1nc.....................
Great Northern lnsurance Company .........
Vigilant lnsurance Company......
Chubb European lnvestment Holdings, SLP
Chubb Custom lnsurance Company.........
Chubb National lnsurance Company ........
Chubb lndemnity lnsurance Company......
Unassigned Funds
SURPLUS TO POLICYHOLDERS.............1'1,423,809
Other Affiliates
Premiums Receivable
Other Assets
TOTAL ADMITTED ASSETS $ 27,371,175
TOTAL LIABILITIES AND SURPLUS
TO POL|CYHOLDERS........ ç 27,371,175
lnvestments are valued in accordance with requirements of the National Association of lnsurance Commissioners.
At December 31, 2016, investments with a carrying value of $565,702,495 were deposited with government authorities
as required by law.
State, County & City of New York, - ss:
Dawn M. Chloros, Assistant Secretary of the Federal lnsurance Company
being duly sworn, deposes and says that the foregoing Statement of Assets, Liabilities and Surplus to Policyholders of said
Federal lnsurance Company on December 31, 2016 is true and correct and is a true abstract of the Annual Statement of said
Company as filed with the Secretary of the Treasury of the United States for the '12 months ending December 31 , 201 6.
Subscribed and sworn to before me
this March 3,2017.
R$.uNTn,0NnÀfif
JEANETTE SHIPSEY
Notary Public, State of New York
No.02SH5074142
Qualified in Nassau County
Assistant Secretary
Notary Public
Commission March 1 201 I
Form 15-10-031 3A (Rev-3/14
ZURICH AMERICAN INSURANCE COMPANY
COLONIÄL AMERICAN CASUALTY AND SURETY COMPANY
FIDELITY AND DEPOSIT COMPANY OF MARYLAND
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS: That the ZURICH AMERICAN INSURANCE COMPANY, a corporation of the State ofNew
York, the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, a corporation of the State of Maryland, and the FIDELITY
AND DEPOSIT COMPANY OF MARYLAND a corporation of the State of Maryland (herein collectively called the "Companies"), by
Thomas O, McClellan, Vice President, in pursuance of authority granted by Article V, Section 8, of the By-Laws of said Companies, which
are set forth on the reverse side hereof and are hereby certified to be in full force and effect on the date hereof, do hereby nominate,
constitute, and appoint Brittany D. Clavin of St. Louis, Missouri , its true and lawful agent and Attorney-
in-Fact, to make, execute, seal and deliver, for, and on its behalfas surety, and as its act and deed: any and all bonds and undertakings,
and the execution of such bonds or undertakings in pursuance ofthese presents, shall be as binding upon said Companies, as fully and amply,
to all intents and purposes, as if they had been duly executed and acknowledged by the regularly elected officers of the ZURICH
AMERICAN INSURANCE COMPANY at its office in New York, New York., the regularly elected officers of the COLONIAL
AMERICAN CASUALTY AND SURETY COMPANY at its offìce in Owings Mills, Maryland., and the regularly elected officers of the
FIDELITY AND DEPOSIT COMPANY OF MARYLAND at its ofhce in Owings Mills, Maryland., in their own proper persons.
The said Vice President does hereby certiÍ! that the extract set forth on the reverse side hereof is a true copy ofArticle V, Section 8, of
the By-Laws of said Companies, and is now in force.
IN WITNESS WHEREOF, the said Vice-President has hereunto subscribed his/her names and affixed the Corporate Seals of the said
ZURJCH AMERICAN INSURANCE COMPANY, COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and
FIDELITY AND DEPOSIT COMPANY OF MARYLAND, this l4th day of October, A.D. 2015.
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ATTEST:
ZURICH AMERICAN INSURANCE COMPANY
COLONIAL AMERICAN CASUALTY AND SURETY COMPANY
FIDELITY AND DEPOSIT COMPANY OF MARYLAND
fr"a A #4"-{*
By: Thomas O. McClellan
Vice President
By: Eric D. Barnes
Secretary
State of Maryland
County of Baltimore
On this 14th day of October, A.D. 2015, before the subscriber, a Notary Public of the State of Maryland, duly commissioned and qualified, Thomas O.
McClellan, Vice President and Eric D. Barnes, Secretary of the Companies, to me personally known to be the individuals and officers described in and who
executed the preceding instrument, and acknowledged the execution ofsame, and being by me duly sworn, deposeth and saith, that he/she is the said officer of
the Company aforesaid, and that the seals affixed to the preceding instrument are the Corporate Seals of said Companies, and that the said Corporate Seals and
the signature as such officer were duly affixed and subscribed to the said instrument by the authority and direction ofthe said Corporations.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my Official Seal the day and year first above written.
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By: Constance A. Dunn, Notary Public
My Commission Expires: July 9,2019
EXTRACT FROM BY-LAWS OF THE COMPANIES
"Article V, Section 8, Attomevs-in-Fact. The Chief Executive Officer, the President, or any Executive Vice President or Vice President
may, by written instrument under the attested corporate seal, appoint attomeys-in-fact with authority to execute bonds, policies,
recognizances, stipulations, undertakings, or other like instruments on behalf of the Company, and may authorize any offìcer or any such
attorney-in-fact to affix the corporate seal thereto; and may with or without cause modif, ofrevoke any such appointment or authority at any
time."
CERTIFICATE
I, the undersigned, Vice President of the ZURICH AMERICAN INSURANCE COMPANY, the COLONIAL AMERICAN
CASUALTY AND SURETY COMPANY, and the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, do hereby certify that the
foregoing Power ofAttorney is still in full force and effect on the date ofthis certificate; and I do further certi$ that Article V, Section 8, of
the By-Laws of the Companies is still in force.
This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of
Directors of the ZURICH AMERICAN INSURANCE COMPANY at a meeting duly called and held on the 15th day of December 1998.
RESOLVED: "ThatthesignatureofthePresidentoraVicePresidentandtheattestingsignatureofaSecretaryoranAssistantSecretary
and the Seal of the Company may be affixed by facsimile on any Power of Attorney...Any such Power or any certificate thereof bearing such
facsimile signature and seal shall be valid and binding on the Company."
This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of
Directors of the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at a meeting duly called and held on the 5th day of
May, 1994, and the following resolution of the Board of Directors of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at a
meeting duly called and held on the lOth day of May, 1990.
RESOLVED: "That the facsimile or mechanically reproduced seal of the company and facsimile or mechanically reproduced signature
of any Vice-President, Secretary, or Assistant Secretary of the Company, whether made heretofore or hereafter, wherever appearing upon a
certified copy of any power of attorney issued by the Company, shall be valid and binding upon the Company with the same force and effect
as though manually affixed.
IN TESTIMONY WHEREOF, I have hereunto subscribed my name and affixed the corporate seals of the said Companies,
this 25th day of October 2017
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By: Gerald F. Haley, Vice President
F'IDELTTY ANü} I}EPOSNT COMPANY
OFMARYLAND
600 Red Brook Blvd., Suite 600, Owings Mills, MD 21117
Statement of FinancÍal Condition
As Of Dccember 31,2015
ASSETS
Bonds
Stocks
Cash and Short Termlnvestmerits..
Reinsurance Recoverable ...,..
Other Accounts Receivable...,
TOTAL ADMI1TED ASSETS
LIABILITTES, SUR}LUS AND OTIIER F'UNDS
Reserve for Taxes and Expenses ..........,... $
Ceded Reinsurance Premiums Payable
Secuiities Lending Collateral Liability
TOTAL LIABILITIES
g 142,878,497
22,315,096
337,835
24,731,651
19,935,844
$ 210J9S,923
46,436
40,456349
0
$ 40,502,745
Capital Stock, PaidUp ....,...,....,,....... $
Surplus
5,000,000
164,696,178
Surplus as rogards Policyholders.... 769,696,778
TOTAT I 210,199,923
Securities carried at $57,996,983 in the above statement are deposited with various states as requíred by law.
Secul'ities canied on the basis prescribed by the National Associafion of Insurance Commissioners. On the basis of
market quotations for all bonds and stocks owned, the Cornpany's total admitted assets at December 31, 2015 woulci
be $2I2,I37,'195 and surplus as regards policyholders $171,635,049.
I, DENNIS F. IGRRIGAN, Corporate Secretary of the FIDELITY AND DEposIT CoMpANy oF MARvLAND, do hereby
certifi that the foregoing statemenf is a corect exhibit of the assets and liabilities of the saïd Company on the 3lst
day ofDecembeq 2015.
Corporate Secrctary
State of Illinois
City of Schaumburg SS
Subscribed and sworn to, before me, a Notary ?ublic ofthe State oflllinois, in thc City ofschaumburg, this l5th day ofMarch, 2016.
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- SlatB ol llllnols
lrxpires
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Notary Public
ACKNOWLEDGMENT
A notary public or other officer completing this
certificate verifies only the identity of the individual
who signed the document to which this certificate is
attached, and not the truthfulness, accuracy, or
validity of that document.
State of California
RiversideCounty of )
on October 30th, 20L7 before me,Candace Gallaher - Notary Public
(insert name and title of the officer)
personally appeared Michael Hutchens
who proved to me on the basis of satisfactory evidence to be the personþf whose name(9 is/arer
subscribed to the within instrument and acknowledged to me that helshelthey executed the same in
his/herlttreir authorized capacity(ieeÌíand that by his/herltheir signature($on the instrument the
person{¿lí or the entity upon behalf of which the person(,s)'acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing
paragraph is true and corect.
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CAI{DACE GALLAHER
WITNESS hand and official Comml¡slon # 2117338
l{olary Publlc' Calllornia
Onnge CounlY
Comm.Jul 19
Signature (Seal)