18-0703_PACIFIC POINT DEVELOPMENT PARNTERS, LLC_Bond Release SU2100002432400 PASEO ADELANTO
SAN JUAN CAPISTRANO, CA 92675
(949) 493-1171
(949) 493-1053 FAx
www.sanjuancapistrano.org
July 5, 2018
Ironshore Indemnity, Inc.
725 S. Figueroa, Suite 3375
Los Angeles, CA 90017
Re: Release of Bonds — Pacific Point Development Partners LLC
Dear Sir or Madam:
MEMBERS OF THE CITY COUNCIL
SERGIO FARIAS
KERRY K. FERGUSON
BRIAN L. MARYOTT
PAM PATTERSON, ESQ.
DEREK REEVE
This letter is to inform you that the following bonds issued to Pacific Point Development
Partners, LLC — Off -Site Circulation Subdivision Improvements are officially released as of
July 5, 2018:
BOND NO. PURPOSE BOND AMOUNT
SU21000024 Off -Site Circulation Subdivision Improvements $ 2,571,000.00
The City of San Juan Capistrano hereby fully and forever releases and discharges the
Ironshore Indemnity, Inc. from any and all liability under the abovementioned bond number.
Enclosed please find the original released bond. If you have any questions, please do not
hesitate to call me at (949) 443-6310.
Sincerely,
(tiW'
Christy Jakl, CMC
Assistant City Clerk
Enclosures as noted
cc: Steve May, Public Works and Utilities Director
Joe Parco, City Engineer
George Alvarez, City Engineer
Joe Mankawich, Associate Engineer
San Juan Capistrano: Preserving the Past to Enhance the Future
0 Printed on 100% recycled paper
RELEA 1 19
Date:Premium: $19,283.00
Signature:
City Clerk
City of San Juan Ca no, CA
SUBDIVISION FAITHFUL PERFORMANCE BOND
(GOVERNMENT CODE 66499.2)
Bond No. SUR21000024
Replaces Bond No. SUR20000348
KNOW ALL MEN BY THESE PRESENTS, that Pacific Point Development Partners LLC
(hereafter designated as "Principal"), and ironshore Indemnity Inc. ,
as Surety (hereinafter called "Surety") agree to install and complete certain designated
public improvements as conditioned by City Council Resolution No's. 92-6-16-4 and
03-09-16-06.
WHEREAS, said Principal is required to furnish a bond pursuant to Municipal
Code Section 9-5.101 and 9-5.109 et seq., for the faithful performance to guarantee
certain work, more particularly described as follows:
Off -Site Circ. subdivision improvements within Tract N/A as defined within Amendment #1 and
Reinstatement of the Subdivision Improvement Agreement for Tract N/A
NOW, THEREFORE, we, the Principal and Surety are held firmly bound unto the
City of San Juan Capistrano, (hereafter called "Obligee") in the penal sum of
Two Million Five Hundred Seventy One Thousand Dollars and 00/100 Dollars, ($2,571,000.00 ) lawful money
of the United States, for the payment of which sum well and truly to be made, we bind
ourselves, our heirs, successors, executors and administrators, jointly and severally,
firmly by these presents.
NOW, THEREFORE, the condition of this obligation is such that, if Principal shall
promptly and faithfully perform said improvement obligations within the fully executed
and recorded subdivision improvement agreement, then the obligation shall be null and
void; otherwise it shall remain in full force and effect.
Page 1 of 3
BE IT FURTHER RESOLVED:
1. As a part of the obligation secured hereby, and in addition to the face
amount specified, there shall be included costs and reasonable expenses and fees,
including reasonable attorney's fees, incurred by City in successfully enforcing such
obligation, all to be taxed as costs and included in any judgment rendered.
2. Said Principal, for value received, hereby stipulates and agrees that no
change, extension of time, alteration, or modification of the contract documents or of the
work to be performed thereunder, shall in any way affect its obligations or this bond, and
it does hereby waive notice of any such change, extension of time, alteration, or
modification of the contract documents or of work to be performed thereunder.
IN WITNESS WHEREOF, this instrument has been duly executed by the
Principal herein named on the 19th day of May 5 2015 the name and
corporate seal of each corporate party being hereto affixed and these presents duly
signed by its undersigned representatives pursuant to authority of its governing body.
PRINCIPAL:
Pacific Point Development Partners, LLC
By: _ s
Its: NEINJ
■'1pr i ?. �d S: ,n
SURETY:
Ironshore Indemnity Inc.
Margaret, . Ginem , Attorney -in -Fact
Surety Phone No. GAO WILLIS OF FLORIDA
X2.11 W: BOY SCOUT BLVD, #1000
TAMPA, FL 33607
INQUIRIES: (813)281-2095
Page 2 of 3
(NOTARIZATION AND SEAL)
(NOTARIZATION AND SEAL)
APPROVED AS TO FORM:
By:
NOTE: Please attach Acknowledgement and Power of Attorney
Page 3 of 3
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE
T.S�:`.:/TN61 •. i� .N .a2N, inN.'Mi.i �i<!. 2/� F5+'. F:�;l.� /:�L '.� s�2 : E H �{.�{.:\{.n"/•.� /'.R[!:�2 +n /:L2. �i+v.C�=ti�vs22. �i�
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 p j
Coun of C, )
On P., before me,
Dale re Insertame and of the Officer
personally appeared _
- Name(s) of Signer(s)
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are
subscribed to the within instrument and acknowledged to me that he/she/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.
W. CORDI
Commission # 2088325 a
<Q a Notary Public - California x
Z
Orange County n
My comm. Expires Oct 31, 2018
I certify under PENALTY OF PERJURY under the laws
of the State of California that the foregoing paragraph
is true and correct.
WITNESS my hand and official seal.
Signature
Signature of Notary Public
Place Notary Seal Above
OPTIONAL
Though this section is optional, completing this information can deter alteration of the document or
fraudulent reattachment of this form to an unintended document.
Description of Attached Document
Title or Type of Document:
Number of Pages: Signer(s)
Document Date:
Other Than Named Above:
Capacity(les) Claimed by Signer(s)
Signer's Name:
❑ Corporate Officer — Title(s):
❑ Partner — ❑ Limited ❑ General
❑ Individual ❑ Attorney in Fact
❑ Trustee ❑ Guardian or Conservator
❑ Other: _
Signer Is Representing: _
Signer's Name: ..
❑ Corporate Officer — Title(s):
❑ Partner — ❑ Limited ❑ General
❑ Individual ❑ Attorney in Fact
❑ Trustee ❑ Guardian or Conservator
❑ Other:
Signer Is Representing:
02014 National Notary Association • www.NationaiNotary.org - 1 -800 -US NOTARY (1-800-876-6827) Item #5907
ACKNOWLEDGEMENT BY SURETY
STATE OF FLORIDA
COUNTY OF HILLSBOROUGH I SS.
On this 19th day of May, 2015 before me, personally came
Margaret A. Ginem, who is personally known to me (or proved
to me on the basis of satisfactory evidence) to be the person
who executed the within Instrument as Attorney -In -Fact on
behalf of Ironshore Indemnity Inc., and acknowledged to me
that he/she executed the within instrument on behalf of said
surety company and was duly authorized to do.
In witness whereof, I have signed and affixed my official seal on
the date in this certificate first above written.
Signature_
Anett Cardinale
rtiJptifv ANETTCARDINALE
Commission # FF 138482
Expires July 28, 2018
Bonded Th. Troy F&n Insurance 800-305.1019
This area for Oficial Notarial Seal
,$fcm 13ill. 1.105.0. arfteflO. -.Sealorig I.A 89 bbil. 1195. of"the 0*11:04e. as Sealoti ON of
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cerfi6mtivedfies.only the idi-,atity-6f the
.certificate. is attached, and not the trUthfulnmi
,�curgq, ot villjlry of jhg;loumeuT.
8tqltd of California
Cbunty of
oil :,wordflac.— -.. I -.-. �(fietc
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3 4 '43ai6cata
XOMe� oil -tho'basis of to wbPSO iiame�(�) is/u& �u
th& withki •fastrmmt and acknowledged to me -that, helshelthey excoutud the sammin-histheritheir,
%id that. by. 4a-; TL6 -irMmfnO:.gt 6.4 pAmotl(s), of tliL-
lelitity 104 b:bkalf Of"AiCMK6 �rkeczdf eid tUiInstrurxient
4ijd6r PENALTY' 6P' 1?1 00 I . he )'a'_w''§ ot tk �Iao of - cAliferilla'. - t
RY �un&r ha the farpgoi4,
paragraph ilstrue and correct-
WnNESS My hAn-d and officikt, wal,
Signafure (Sear:
POWER
III- 21000024
Ironshore Indemnity Inc.
KNOW ALL MEN BY THESE PRESENTS, that IRONSHORE INDEMNITY INC., a Minnesota Corporation, with its principal office in New York, NY does
hereby constitute and appoint: David H. Carr, Anett Cardinale, Margaret A. Ginem its true and lawful Attorney(s)-In-Fact to make, execute, seal and
deliver for, and on its behalf as surety, any and all bonds, undertakings or other writings obligatory in nature of a bond.
This authority is made under and by the authority of a resolution which was passed by the Board of Directors of IRONSHORE INDEMNITY INC. on the
22nd day of April, 2013 as follows:
Resolved, that the Director of the Company is hereby authorized to appoint and empower any representative of the company or other person or
persons as Attorney -In -Fact to execute on behalf of the Company any bonds, undertakings, policies, contracts of indemnity or other writings obligatory
in nature of a bond not to exceed $7,500,000 dollars, which the Company might execute through its duly elected officers, and affix the seal of the
Company thereto. Any said execution of such documents by an Attorney -In -Fact shall be as binding upon the Company as if they had been duly
executed and acknowledged by the regularly elected officers of the Company. Any Attorney -In -Fact, so appointed, may be removed for good cause and
the authority so granted may be revoked as specified in the Power of Attorney.
Resolved, that the signature of the Director and the seal of the Company may be affixed by facsimile on any power of attorney granted, and the
signature of the Secretary, and the seal of the Company may be affixed by facsimile to any certificate of any such power and any such power or
certificate bearing such facsimile signature and seal shall be valid and binding on the Company. Any such power so executed and sealed and certificate
so executed and sealed shall, with respect to any bond of undertaking to which it is attached, continue to be valid and binding on the Company.
IN WITNESS THEREOF, IRONSHORE INDEMNITY INC. has caused this instrument to be signed by its Director, and its Corporate Seal to be affixed this
7th day of August, 2013
IRONSHORE INDEMNITY INC.
is -•
r� r
By:
Fla L. Sus n
Director
ACKNOWLEDGEMENT
On this 7th Day of August, 2013, before me, personally came Daniel L. Sussman tome known, who being duly sworn, did depose and say that he is the
Director of Ironshore Indemnity, Inc. , the corporation described in and which executed the above instrument; that he executed said instrument on
behalf of the corporation by authority of his office under the By-laws of said corporation.
J'A' � -i
Amy L Tpy!
Notary Public
CERTIFICATE
I, the undersigned, Secretary of IRONSHORE INDEMNITY INC., a Minnesota Company, DO HEREBY CERTIFY that the original Power of Attorney of
which the foregoing is a true and correct copy, is in full force and effect and has not been revoked and the resolutions as set forth are now in force.
Signed and Sealed at this 191h Day of May20 15
9EAL
1919
Pauls. Gi dano
Secretary
'WARNING: Any person who knowingly and with intent to defraud any insurance company or other person, files and application for insurance or statement of claim
containing any materially false information, or conceals for the purpose of misleading information concerning any fact material thereto, commits a fraudulent
insurance act, which is a crime and subjects such person to criminal and civil penalties."
AMYL TAYLOR
x _ -
Nolary Public- Slateof Tennessee
x % «exw
Davidson County
My Commission Expires 01.09-16
J'A' � -i
Amy L Tpy!
Notary Public
CERTIFICATE
I, the undersigned, Secretary of IRONSHORE INDEMNITY INC., a Minnesota Company, DO HEREBY CERTIFY that the original Power of Attorney of
which the foregoing is a true and correct copy, is in full force and effect and has not been revoked and the resolutions as set forth are now in force.
Signed and Sealed at this 191h Day of May20 15
9EAL
1919
Pauls. Gi dano
Secretary
'WARNING: Any person who knowingly and with intent to defraud any insurance company or other person, files and application for insurance or statement of claim
containing any materially false information, or conceals for the purpose of misleading information concerning any fact material thereto, commits a fraudulent
insurance act, which is a crime and subjects such person to criminal and civil penalties."
IRONSHORE MDEMNITY IHC
FINANCIAL STATEMENT SUMMARY
As of December 31, 2014
ASSETS
bonds
Preferred stocks
Common stocks
Mortgage loans on real estate: First tens
Mortgage loans on real estate; Other than first Iles
Properties occupied by the company
Properties held for the production of Income
Properties held for We
Cash. cash equivalents and short-term investments
Contract loam
Derivatives
Other Invested assets
Receivables for securities
Securities lending reinvested collateral assets
Aggregate wrltLAns forinvested assets
Subtotals. cash and Invested assets
Title plants less $_ Changed off
Investment Income due and accrued
Uncollected preirrums and agents' balances in the course of collection
Deterred premiums, agenW balances and Installments booked but deferred and not
yet due
Accrued retrospective premiums
Amounts recoverablefrom reinsurers
Funds held by or deposited with reinsured companies
Other amounts receivable under reinsurance contracts
Amounts receivable relating to uninsured plans
Current federal and foreign income tax recoverable and Interest thereon
Net deferred tax asset
Guaranty funds receivable or on deposit
Furniture and equipment, including health are delivery assets
Netadjustment In assets and liabilities due to foreign exchange rates
Receivables from parent, subsidiaries and affiliates
Health are and other amounts receivable
Aggregate wrtte-Ins for other than Invested assets
Total assets excluding Separate Accounts, Segregated Accounts and Protected Cee.
Accounts
From Separate Accounts, Segregated Accounts and Protected Cell Accounts
0 Surplus Notes
TOTALS $347,414,611 Gross paid In and contributed surplus
Ewrowivo"ir"I
CERTIFICATE
1 certify that the above financial statements to the best -al my
knowledge are a true and accurate reflection of the finaiclal
condition of the Company as of December 31, 2014,
Additionally, I certify that the above financial statements are
In agreement with the Statutory Financial Statements filed with tho Texas
Department of Insurance as of the same date,
William J Gleason
SYR, V"i�.IreastISt.
Unassigned funds (surplus)
Surplus as regards policyholders
TOTALS
SUBSCRIBED and sworn tome Ndsy day of MNYr ,'!1 / 5
Mycommissmon expirer_ 7-/(J—/T
$63,582,066
0
$10,384,957
$1,020,805
$5,435,126
$2,383,909
$2,434,392
0
$29,158,576
$58,222,187
0
$1,545,075
$12,458,110
0
0
0
0
$4,185,929
$190,811,131
$190,811,131
0
5,000,000
0
$156,938,671
($5,335,190)
$156,603,481
$347,414,611
Notary Pubnc
Printed Name A1_YSSA TURKOVITZ
Notary Public, State of New York
No. Oi TU6044514
ALYSSATURI CIVFTZ — -_ Qualifled 1n Westchester County
Commieslfm fires July 10, 2018
Tic btic. Stets of New York
C
No.01TU6044514
Qualified In Westchester County
Coramissim Exphes July 10, 2014
LIABILITIES
$179,140,947
losses
0
Reinsurance payable on paid losses and loss adjustment expenses
31,640,141
Loss adjustment expenses
0
Commissions payable, contingent commissions and other similar charges
0
Other expenses texciudingtaxes. 8censes and fees)
0
Taxes, licenses and fees (exdudmg federal and foreign income taxes)
0
Current federal and foreign income taxes
0
Net deferred tax liability
$15,632,951
Unearned premiums
0
Advance premium
0
Ceded reinsurance premiums payable (net of coding commissions)
0
Funds held by company under reinsurance trestles
0
Amounts withheld or retained by company for account of others
0
Remittances and Items not allocated
0
Provision for reinsurance
$226,614,039
Net adjustments in assets and tabilltles due toforeign exchange rates
0
Drafts outstanding
$990,960
Payable to parent subsidiaries and affiliates
$73,567,547
Derivatives
0
Payable for securities
0
Payable for securities lending
$33,586,257
Liability for amounts held under uninsured plans
0
Aggregate wrltrins for liabilities
0
Total liabilities excluding protected call liabilities
0
PrauciM rnH Irabl6Sles
0
$5,530,837
TotaiNabditles
0
0
POLICYHOLDEIti S SURPLUS
0
Aggregatevmte-ins for special surplus funds
0
0
Common coal stock
$7,124,971
Preferred capital stock
$347,414,611
Aggregate wrlWns for other than special surplus
0 Surplus Notes
TOTALS $347,414,611 Gross paid In and contributed surplus
Ewrowivo"ir"I
CERTIFICATE
1 certify that the above financial statements to the best -al my
knowledge are a true and accurate reflection of the finaiclal
condition of the Company as of December 31, 2014,
Additionally, I certify that the above financial statements are
In agreement with the Statutory Financial Statements filed with tho Texas
Department of Insurance as of the same date,
William J Gleason
SYR, V"i�.IreastISt.
Unassigned funds (surplus)
Surplus as regards policyholders
TOTALS
SUBSCRIBED and sworn tome Ndsy day of MNYr ,'!1 / 5
Mycommissmon expirer_ 7-/(J—/T
$63,582,066
0
$10,384,957
$1,020,805
$5,435,126
$2,383,909
$2,434,392
0
$29,158,576
$58,222,187
0
$1,545,075
$12,458,110
0
0
0
0
$4,185,929
$190,811,131
$190,811,131
0
5,000,000
0
$156,938,671
($5,335,190)
$156,603,481
$347,414,611
Notary Pubnc
Printed Name A1_YSSA TURKOVITZ
Notary Public, State of New York
No. Oi TU6044514
ALYSSATURI CIVFTZ — -_ Qualifled 1n Westchester County
Commieslfm fires July 10, 2018
Tic btic. Stets of New York
C
No.01TU6044514
Qualified In Westchester County
Coramissim Exphes July 10, 2014
RELEA ED 10
Date; t
Signature:
City Clerk _
SUBDIVISION LABOR AND MATMAL'abtffiffP15
Crano. [:A
(GOVERNMENT CODE 66499.2)
Bond No. SUR21000024
Replaces Bond No. SUR20000348
KNOW ALL MEN BY THESE PRESENTS, that Pacific Point Development Partners, LLC
(hereafter designated as "Principal"), and Ironshore Indemnity Inc.
as Surety (hereinafter called "Surety") agree to install and complete certain designated
public improvements as conditioned by City Council Resolution No's. 92-6-16-4 and
03-09-16-06.
WHEREAS, said Principal is required to furnish a bond pursuant to Municipal
Code Section 9-5.101 and 9-5.109 et seq., for the faithful performance to guarantee
certain work, more particularly described as follows:
Off -Site Circ. subdivision improvements within Tract N/A as defined within Amendment #1 and
Reinstatement of the Subdivision Improvement Agreement for Tract N/A
NOW, THEREFORE, we the Principal and Surety are held firmly bound unto the
City of San Juan Capistrano, (hereafter called "Obligee") in the penal sum of
Two Million Five Hundred Seventy One Thousand Dollars and 00/100 Dollars ($ 2.571.000.00 ) lawful
money of the United States, for the payment of which sum well and truly to be made, we
bind ourselves, our heirs, successors, executors and administrators, jointly and
severally, firmly by these presents.
NOW, THEREFORE, the condition of this obligation is such that if the above
bound Principal, his or its heirs, executors, administrators, successors or assigns, shal
in all things stand to and abide by and well and truly keep and perform the covenants,
conditions and provisions per City Council Resolution No's. 92-6-16-04 and 03-09-16-
06, on his or their part, to be kept and performed at the time and in the manner therein
specified, and in all respects according to their true intent and meaning, and shall
indemnify and save harmless the City, its offers, agents and employees as therein
stipulated, and, as necessary enter into a Subdivision Agreement, then this obligation
shall become null and void; otherwise it shall be and remain in full force and effect.
Page 1 of 3
BE IT FURTHER RESOLVED:
1. As a part of the obligation secured hereby, and in addition to the face
amount specified therefore, there shall be included costs and reasonable expenses and
fees, including reasonable attorney's fees, incurred by City in successfully enforcing
such obligation, all to be taxed as costs and included in any judgment rendered.
2. Said Principal hereby stipulates and agrees that no change, extension of
time, alteration, or modification of the terms of the agreement or of the work to be
performed thereunder, shall in any way affect its obligations or this bond, and it does
hereby waive notice of any such change, extension of time, alteration or modification of
the terms of the agreement or of the work or to the specifications.
IN WITNESS WHEREOF, this instrument has been duly executed by the
Principal herein named on the 19th day of May , 2015 , the name and
corporate seal of each corporate party being hereto affixed and these presents duly
signed by its undersigned representatives pursuant to authority of its governing body.
PRINCIPAL:
Pacific Point Development Partners, LLC
(NOTARIZATION AND SEAL)
By:
Y
Its:.tel' c�i O\V'y
i�_
SURETY:
Ironshore Indemnity Inc.
(NOTARIZATION AND SEAL)
By:
Margare A. Ginem , Attorney -In -Fact
CIO WILLIS OF FLORIDA
Surety Phone No. 4211 W. BOY SCOUT BLVD, 01000
TAMPA, FL 33607
INQUIRIES: (813)281-2095
Page 2 of 3
APPROVED AS TO FORM:
By:
NOTE: Please attach Acknowledgement and Power of Attorney
Page 3 of 3
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT •.
'N.� .N .A - .T�•✓a{ r �2 :r r :.r/,+Y. -:.Kir :ic�'1i. "c.s�cr'F..'a:i: x .: r.:. r a:[. s. .v. .
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
County ofym
�(
On I A IFAIII before me,
Date f1h personally appeared
and Title of the Officer
Name(s) of Signer(s)
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are
subscribed to the within instrument and acknowledged to me that he/she/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.
W. CORGI
Commission # 2098325
zIQ
Notary Public - CaliforniazOrange County
My Comm, Ex Tres Oct 31, 2019
I certify under PENALTY OF PERJURY under the laws
of the State of California that the foregoing paragraph
is true and correct.
WITNESS my hand and official seal.
Signature
Signature of Notary Public
Place Notary Seal Above
OPTIONAL
Though this section is optional, completing this information can deter alteration of the document or
fraudulent reattachment of this form to an unintended document.
Description of Attached Document
Title or Type of Document:
Number of Pages:
Document Date:
Signer(s) Other Than Named Above:
Capacity(les) Claimed by Signer(s)
Signer's Name:
❑ Corporate Officer — Title(s):
❑ Partner — ❑ Limited ❑ General
❑ Individual ❑ Attorney in Fact
❑ Trustee ❑ Guardian or Conservator
❑ Other:
Signer Is Representing:
Signer's Name:
❑ Corporate Officer — Title(s):
❑ Partner — ❑ Limited ❑ General
❑ Individual ❑ Attorney in Fact
❑ Trustee ❑ Guardian or Conservator
❑ Other:
Signer Is Representing:
02014 National Notary Association • www.NationalNotary.org • 1 -800 -US NOTARY (1-800-876-6827) Item #5907
ACKNOWLEDGEMENT BY SURETY
STATE OF FLORIDA
COUNTY OF HILLSBOROUGH I SS.
On this 19th day of May, 2015 before me, personally came
Margaret A. Ginem, who is personally known to me (or proved
to me on the basis of satisfactory evidence) to be the person
who executed the within Instrument as Attorney -In -Fact on
behalf of Ironshore Indemnity Inc., and acknowledged to me
that he/she executed the within instrument on behalf of said
surety company and was duly authorized to do.
In witness whereof, I have signed and affixed my official seal on
the date in this certificate first above writte .
Signature
Anett Cardinale
ANETT CARDINALE
_ . commission # FF 138482
l Expires July 28, 2018
rjJf ' 90ndedThruTroy FWi 1l.=no.800.3B5.70f0
This area for Official Notarial Seal
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tp 99. ot'tho. bans. of saiisfictoty, evidoO to bwthb,.PeM6�( ) iohos�q i
'the withiri -hjstr=ent. and acknowledged -to me, . that helshelthey executed the same. in- .his/herltheir
p#orii40paefiy(i"), -aod that by )iwh(T -sigbame(ro 'on,:thy -M'.'S'trvfnot the vjbrsopw'or the
efitity. tipoh. &*Alf of-whiph the person(x),40ed, ek6mited tli( Irtsfiuin6nt
fY'UYj&r PENA ftrlbe )'&'W''§ of StAto of CAlifom
para&ra0h, i' true andcorrecl-
WUNESS mg hW and official SeRL
Signafiire. Seal).
Ironshore Indemnity Inc.
KNOW ALL MEN BY THESE PRESENTS, that IRONSHORE INDEMNITY INC., a Minnesota Corporation, with its principal office in New York, NY does
hereby constitute and appoint: David H. Carr, Anett Cardinale, Margaret A. Ginem its true and lawful Attorney(s)-In-Fact to make, execute, seal and
deliver for, and on its behalf as surety, any and all bonds, undertakings or other writings obligatory in nature of a bond.
This authority is made under and by the authority of a resolution which was passed by the Board of Directors of IRONSHORE INDEMNITY INC. on the
22nd day of April, 2013 as follows:
Resolved, that the Director of the Company is hereby authorized to appoint and empower any representative of the company or other person or
persons as Attorney -In -Fact to execute on behalf of the Company any bonds, undertakings, policies, contracts of indemnity or other writings obligatory
in nature of a bond not to exceed $7,500,000 dollars, which the Company might execute through its duly elected officers, and affix the seal of the
Company thereto. Any said execution of such documents by an Attorney -In -Fact shall be as binding upon the Company as if they had been duly
executed and acknowledged by the regularly elected officers of the Company. Any Attorney -In -Fact, so appointed, may be removed for good cause and
the authority so granted may be revoked as specified in the Power of Attorney.
Resolved, that the signature of the Director and the seal of the Company may be affixed by facsimile on any power of attorney granted, and the
signature of the Secretary, and the seal of the Company may be affixed by facsimile to any certificate of any such power and any such power or
certificate bearing such facsimile signature and seal shall be valid and binding on the Company. Any such power so executed and sealed and certificate
so executed and sealed shall, with respect to any bond of undertaking to which it is attached, continue to be valid and binding on the Company.
IN WITNESS THEREOF, IRONSHORE INDEMNITY INC. has caused this instrument to be signed by its Director, and its Corporate Seal to be affixed this
7th day of August, 2013
IRONSHORE INDEMNITY INC.
S
SEAL
1919 i +
By,
Dan a l.5uss n
Director
ACKNOWLEDGEMENT
On this 7th Day of August, 2013, before me, personally came Daniel L. Sussman to me known, who being duly sworn, did depose and say that he is the
Director of Ironshore Indemnity, Inc. , the corporation described in and which executed the above instrument; that he executed said instrument on
behalf of the corporation by authority of his office under the By-laws of said corporation.
�" �, .4tiv
Amy L. Tey]
Notary Public
CERTIFICATE
I, the undersigned, Secretary of IRONSHORE INDEMNITY INC., a Minnesota Company, DO HEREBY CERTIFY that the original Power of Attorney of
which the foregoing is a true and correct copy, is in full force and effect and has not been revoked and the resolutions as set forth are now in force.
Signed and Sealed at this 19th Day of May20 15
t
L
�EALOf
1919
L
PauIS.G dano
Secretary
"WARNING: Any person who knowingly and with intent to defraud any insurance company or other person, files and application for insurance or statement of claim
containing any materially false information, or conceals for the purpose of misleading information concerning any fact material thereto, commits a fraudulent
insurance act, which is a crime and subjects such person to criminal and civil penalties."
_AMYL
TAYLOR
_
Notary Public- Slate of Tennessee
?
Davidson County
14
My CDmn.lDn E%p'ves 01.09-16
�" �, .4tiv
Amy L. Tey]
Notary Public
CERTIFICATE
I, the undersigned, Secretary of IRONSHORE INDEMNITY INC., a Minnesota Company, DO HEREBY CERTIFY that the original Power of Attorney of
which the foregoing is a true and correct copy, is in full force and effect and has not been revoked and the resolutions as set forth are now in force.
Signed and Sealed at this 19th Day of May20 15
t
L
�EALOf
1919
L
PauIS.G dano
Secretary
"WARNING: Any person who knowingly and with intent to defraud any insurance company or other person, files and application for insurance or statement of claim
containing any materially false information, or conceals for the purpose of misleading information concerning any fact material thereto, commits a fraudulent
insurance act, which is a crime and subjects such person to criminal and civil penalties."
IRONSHORE MDEMNITY INC
FINANCIAL STATEMENT SUMMARY
As of December 31, 2014
ASSETS
Bonds
Preferred stocks
Common stocks
Mortgage loans on real estate: First liens
Mortgage Irons on red estate; Other than first Hens
Properties occupied by the company
Properties held for the production of income
Properties held for We
Cash. cash equivalents and short-term investments
Contract loans
Derivatives
Other invested assets
Receivables for securities
Securities lending reinvested collateral assets
Aggregate write -Ins forinvested assets
sub] c,rais L]Ih nn6 Inv ell ni 1C10%
Title plants less $._. Charged off
Investment Income due and accrued
Uncollected prenrums and agents' balances in the course of collection
Deferred premiums, agent& balances and Installments booked but deferred and not
yet due
Accrued retrospective premiums
Amounts recoverable from reinsurers
Funds held by or deposited with reinsured companies
Other amounts receivable under reinsurance contracts
Amounts receivable relating to uninsured plans
Current federal and foreign Income tax recoverable and interest thereon
Net deferred tax asset
CERTIFICATE
I certify that the above financial statements to the bestof my
knowledge are a true and accurate reflection of the financial
condition of the Company es of December 31, 2014,
Additionally, I certify that the above financial statements aro
In agreementwlth the Statutory Financial Statements filed with the Trxa.
Department of Insurance as of the same date,
William J Gleason
VQF YP—&Tt�elvi9f..
Unassigned fundsjsurplus)
Surytus as regards policyholders
TOTALS
$63,582,066
0
$10,384,957
$1,020,805
$5,435,126
$2,383,909
$2,434,392
0
$29,158,576
$58,222,187
0
$1,545,075
$12,458,110
0
0
0
0
$4.185.928
$190,811,131
$190,811,131
0
5,000,000
0
$156,938,671
($5,335,190)
$156,603,481
$347,414,611
SUBSCRIBED and sworn tomethis'dayof%�%j�y�
Myconnrr as4n expires: -7-/V—/T
Notary Public
[hinted Name ALYSSA TURKOVITZ
Notwy Public, State of New York
No. 01TU6044514
ALY MTURKO x ❑uallfled in Westchester County
•� Is�LGc.� Cofnmissi Expires July 10, 2016
N bflc, State of New York r
No.01TU6044514
Quallfied In Westchester County
Commission Expires July 10, 2014
LIABILITIES
$179,140.947
lases
0
Reinsurance payable on paid losses and loss adjustment expenses
31,840,141
toss adjustment expenses
0
Commissions payable, contingent commissions and other similar charges
0
Other expenses (exclu ling taxes. licenses and fees)
0
Taxes, licenses and fees (exdudmg federal and foreign Income taxes)
0
Current federal and foreign income taxes
0
Net deferred tax liability
$15,632,951
Unearned premiums
0
Advance premium
0
Ceded reinsurance premiums payable (net of ceding commissions)
0
Funds held by company under reinsurance treaties
0
Amounts withheldor retained by company for account of others
0
Remittances and Items not Bloated
0
Provision for reinsurance
$226,614,039
Net adjustments In assets and kabllltles due to foreign exchange rates
0
Draftsoutstandlnil
$990.960
Payable to parent, subsidiaries end affiliates
$73,567,547
Derivatives
0
Payable for securities
0
Payable for securities lending
$33,58y257
Liability for amounts held under uninsured plans
0
Aggregate write -IIs for liabilities
0
Total nablllties excluding protected cell Ilabllldes
0
Protected cell liabilities
0
$5,530,837
Totatilabilities
CERTIFICATE
I certify that the above financial statements to the bestof my
knowledge are a true and accurate reflection of the financial
condition of the Company es of December 31, 2014,
Additionally, I certify that the above financial statements aro
In agreementwlth the Statutory Financial Statements filed with the Trxa.
Department of Insurance as of the same date,
William J Gleason
VQF YP—&Tt�elvi9f..
Unassigned fundsjsurplus)
Surytus as regards policyholders
TOTALS
$63,582,066
0
$10,384,957
$1,020,805
$5,435,126
$2,383,909
$2,434,392
0
$29,158,576
$58,222,187
0
$1,545,075
$12,458,110
0
0
0
0
$4.185.928
$190,811,131
$190,811,131
0
5,000,000
0
$156,938,671
($5,335,190)
$156,603,481
$347,414,611
SUBSCRIBED and sworn tomethis'dayof%�%j�y�
Myconnrr as4n expires: -7-/V—/T
Notary Public
[hinted Name ALYSSA TURKOVITZ
Notwy Public, State of New York
No. 01TU6044514
ALY MTURKO x ❑uallfled in Westchester County
•� Is�LGc.� Cofnmissi Expires July 10, 2016
N bflc, State of New York r
No.01TU6044514
Quallfied In Westchester County
Commission Expires July 10, 2014
0
Guaranty funds receivable or on deposit
Furniture and equipment, Including health are delivery assets
0
POUCYHOLDERYSSURPLUS
Netadjustment In assets and liabilities due to foW.Sn exchange rates
0
Aggregate wnte-Ins for special surplus funds
Receivables from parent„ subsidiaries and affiliates
0
Health are and other amounts receivable
0
Common appal stock
Aggregate write-ins for other than invested assets
$7,124,971
Preferred capital stock
Total assets excluding Separate Accounts, Segregated Accounts and Protected Cult
$347,414,511
Aggregate write+nsfor other than special surplus
Accounts
From Separate Accounts Segregated Accounts and Protected Cell Accounts
0
Surplus Notes
TOTALS f
S3d7.414,611
Gross paid In and oontnbutedsurplus
CERTIFICATE
I certify that the above financial statements to the bestof my
knowledge are a true and accurate reflection of the financial
condition of the Company es of December 31, 2014,
Additionally, I certify that the above financial statements aro
In agreementwlth the Statutory Financial Statements filed with the Trxa.
Department of Insurance as of the same date,
William J Gleason
VQF YP—&Tt�elvi9f..
Unassigned fundsjsurplus)
Surytus as regards policyholders
TOTALS
$63,582,066
0
$10,384,957
$1,020,805
$5,435,126
$2,383,909
$2,434,392
0
$29,158,576
$58,222,187
0
$1,545,075
$12,458,110
0
0
0
0
$4.185.928
$190,811,131
$190,811,131
0
5,000,000
0
$156,938,671
($5,335,190)
$156,603,481
$347,414,611
SUBSCRIBED and sworn tomethis'dayof%�%j�y�
Myconnrr as4n expires: -7-/V—/T
Notary Public
[hinted Name ALYSSA TURKOVITZ
Notwy Public, State of New York
No. 01TU6044514
ALY MTURKO x ❑uallfled in Westchester County
•� Is�LGc.� Cofnmissi Expires July 10, 2016
N bflc, State of New York r
No.01TU6044514
Quallfied In Westchester County
Commission Expires July 10, 2014