18-1025_PACIFIC POINT DEVELOPMENT PARTNERS, LLC_Bond Release Ironshore Indemnity32400 PASEO ADELANTO
SAN JUAN CAPISTRANO, CA 92675
(949) 493.1171
(949) 493-1053 FAx
www.sanjuancapistrano.org
October 25, 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 tp Pacific Point Development
Partners, LLC — Subdivision Improvements are officially released as of
October 19, 2018:
i Bond Number I Description
inal Amount I Reduced Amount
SUR21000005
Street Subdivision Improvements I
$451,554.00
Tract 15609 as defined within
Amendment #1 and Reinstatement
of the Subdivision Improvement
for Tract 15609 _
SUR21000008
_Agreement
Storm Drain Subdivision
$46,050.00
Improvements Tract 15609 as
defined within Amendment #1 and
Reinstatement of the Subdivision
Improvement Agreement for Tract
15609
SUR21000010
_
Sanitary Sewer Subdivision
$44,293.00
Improvements Tract 15609 as
defined within Amendment #1 and
Reinstatement of the Subdivision
Improvement Agreement for Tract
15609
SUR21000007
Street Subdivision Improvements
$986,932.00
Tract 16752 as defined within
Amendment #1 and Reinstatement
of the Subdivision Improvement
Agreement for Tract 16752
SUR21000009
Storm Drain Subdivision
1 $71,118.00
Improvements Tract 16752 as
defined within Amendment #1 and
Reinstatement of the Subdivision
Improvement Agreement for Tract
1R7R7
$180,621.60
$18,420.00
$9,717.20
$98,693.20
$7,111.80
San Juan Capistrano: Preserving the Past to Enhance the Future
C� Printed on 100% recycled paper
SUR21000014
SU R21000015
SUR21000019
Sanitary Sewer Subdivision
Improvements
Tract 16752 as
defined within
Amendment #1 and
Reinstatement
of the Subdivision
Improvement
Agreement for Tract
16752
Monument
subdivision
improvements
with Tract 15609 as
defined within
Amendment #1 and
Reinstatement
of Subdivision
Improvement
Agreement for Tract
15609
Monument
subdivision
improvements
with Tract 16752 as
defined within
Amendment #1 and
Reinstatement
of Subdivision
Improvement
Agreement for Tract
16752
$85,485.00
15,500.00
38,500.00
$34,194.00
n/a
n/a
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 bonds. If you have any questions, please do not
hesitate to call me at (949) 443-6310.
Sincerely,
C-�w
J
Christy Jakl, CMC
Assistant City Clerk
Enclosures as noted
cc: Steve May, Public Works and Utilities Director
Eric Bauman, Assistant Utilities Director
Joe Parco, City Engineer
George Alvarez, Project Manager
Joe Mankawich, Associate Engineer
RELEASED
Date; Premium: $3,387.00
Signature;
City Clerk
City of San lua lstran , A
SUBDIVISION FAITHFUL PERFORMANCE BOND
(GOVERNMENT CODE 66499.2)
Bond No. SUR21000005
Replaces Bond No. SUR20000317
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:
Street subdivision improvements within Tract 15609 as defined within Amendment #1 and
Reinstatement of the Subdivision Improvement Agreement for Tract 15609
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
Four Hundred Fifty One Thousand Five Hundred Fifty Four Dollars and 00/100 Dollars, ($451,554.00 ) 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 , 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 Paint Development Partners, LLC
By:�
Its:
NJ
SURETY:
Ironshore Indemnity Inc.
cl-
By: Y
Margaret . Ginem , Attorney -in -Fact
Surety Phone No.
C/O WILLIS OF FLORIDA
4211 W. BOY SCOUT BLVD, #1000 Page 2 of 3
TAMPA, FL 33607 9
INQUIRIES: (813)281-2095
(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 § 1189
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 pp )
County fMdfid C )
On i, X before me, w' vL� P r PU1 r G
Dat X71 , i • Hera Insert Name and Title bf 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.
I certify under PENALTY OF PERJURY under the laws
of the State of California that the foregoing paragraph
W. COM is true and correct.
Commission # 2088325 z WITNESS my hand and official seal.
-e: Notary Public - California z „
Orange County A
My Comm ! Ypires Oct 31, 2018 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: _ Document Date:
Number of Pages: Signer(s) Other Than Named Above:
Capacity(ies) Claimed by Signer(s)
Signer's Name: -
El Corporate Officer — Title(s):
❑ Partner — ❑ Limited ❑ General
❑ Individual ❑ Attorney in Fact
❑ Trustee ❑ Guardian or Conservator
F-1 Other_
Signer Is Representing:
Signer's Name: -
El 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
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fOrrDai of ft.,new disclosure
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cetfificOft MAWS only the identity of the
in&viduai wha signed the docutrie..riUO whiefift
.cerfifloate- Ls attached, and not- the truthfulness
amilraty, q *Wy of ftl'-doqujgwt
State of California
�.6unt . of
.oil.,:before ft -I e.,
"ilie s
nsert name and title 'of officer), . peponally app=ed '
ppye pAO to bqthc
.4 �O.Mg ot� jhg'basfs. of sati.1faqory evid 0 whose hamW is/Ot stili bti6ectW
ih,6 - wiftf Iastmment and acknowledged -to me, that helsheithey executed the .same. in his/her/their
,gqt.hoO;ped'papa6ky(i'es),. fid th
pt > y. �is/her/ tip:kWre(s) -on tfielatr�opt ft person(s), or the
104tity, Vb4 b6bW of Nr bi,;h_the Oefsbfi(s) Acted, ekmdted the -instrument,
V'Od6r P, ENkITy, Ov, #MOR -Y 'd Tidpr. TIle ]avis- of the, Swe of Oilworinia tha the fd moing
-paragraph is true and'corita-
WITNES*x hAnd and.officid. Seal,
(Seal)
ACKNOWLEDGEMENT BY SURETY
STATE OF FLORIDA
COUNTY OF HILLSBOROUGH I ss.
On this 19111 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 affix d my official seal on
the date in this certificate first above written
Signature_
Anett Cardinale
rid; ANETT CARDINAL;
Commission # FF 138482
y
r Expires July 28, 2018
Bonded Thru Ttoy Fein Insurance OM85.7o19
This area for Official Notarial Seal
POWER
III- 21000005
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.
N
By,
Dan a L. Sus 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.
` �Nflluryryll�,l�,r,y
AMY L TAYLOR
Notary Public- Stale or Tennessee
Davidson Count'
? M Commission Expires 0"9-16
Amy L. Tay
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
R�
r
Pauls.Gidanu
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."
IRONSNORE iNDEMNITY INC
FINANCIAL STATEMENT SUMMARY
As of December 31, 2014
ASSETS
Bonds
Preferred stocks
Common stocks
Mortgage loans on real estate. first kens
Mortgage loans on real estate; Other than first liens
Properties occupied by the company
Properties held for the production of Income
Properties held for sale
Cash. cash equivalents and short-term Investments
Contract loans
Derivatives
Other invested assets
Receivables for securities
Securities lending reinvested collatera assets
Aggregate wrlte4nsforinvested assets
Subtotals. cash and Invested assets
Title plants less $._ Charged off
Investment Income due and accrued
Uncollected preens ums and agents' balances In the course of collection
Deferred premiums, agen& balances and lnstalimenss booked but deferred and not
yet due
Accrued retrospective premiums
Amounts recoverahtefrom reinsurers
Funds held by or deposited with reinsured companies
Other amounts receivable under reinsurance contracts
Amounts receivaWe 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 equlpmend, Including (health are delivery assets
Net adjustment In assets and liabilities due to forelgn exchange rates
Receivables from parent, subsidiaries and affiliates
health care and other amounts receivable
Aggregate write -Ins for other than Invested assets
Total assets excluding Separate Accounts, Segregated Accounts and Protected Ce►
Accounts
From Separate Accounts. Segregated Accounts and Protected Cell Accounts
LIABILITIES
$179,140,947
tenses
0
Reinsurance payable on paid losses and loss adjustment expenses
31,840,141
Loss adjustme nr exp en s es
0
Commis3lons payable, contingent oommfssfons and oth er similar charges
0
Other expenses (excluding taxes. licenses and fees)
0
Taxes, licenses and fees (excluding 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 withheld or retained by company for account of others
0
Remittances and items not a located
0
Provision for reinsurance
$226,614,039
Net adjustments In assets and kabllltiesdue to foreign exchange rates
0
Draftsouistandinq
$990,960
Payable to parent, subsidiaries and affiliates
$73,567.547
Derivatives
0
Payable for securities
0
Payable fo, i <wiue; Irm;mg
$33,586,257
Liability for amounts held under uninsured plans
0
Aggregate write -Iris for liabilities
0
Total liabilities excluding protected cell liabilities
0
Protected cell liabilities
0
$S,530,837
Total Nabtilitles
0
0
POUCYNOLDERTSSURPLUS
0
Aggregate wnte4ns for special surplus funds
0
0
Common capital stock
$7.12071
preferred appal stock
$347,414,611
Aggregate wriWrrs for other than special surplus
0 Surplus Notes
I WAES 5ML1,414,611 Gross paid In and contributed surplus
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 as of December 31, 2014,
Additionally, I certify that the above financial statements are
M agreement with the Statutory Financial Statements filed with this Texas
Department of Insurance as of the same date.
WRllam J Gleason
UD YMIf.431SSSf.
Unasslgned funds (surplus)
Surplus as regards policyholders
TOTALS
$63,582,066
0
$10,384,957
$1,020,80S
$5,435,125
$2,383,909
$2,434,392
0
$29,158,576
$58,224287
0
$1,545,075
$12,458,110
0
0
0
0
$4,195,929
$190,811,131
$190,81;131
0
5,000,000
0
$156,938,671
($5,335,190)
$156,603,481
$347,414,611
SUBSCRIBED and sworn to me this"
My comrrdssan expire - 7-/O—/S-
Notary
-/O—/S-
Notary public
Printed Name At_YSSA TURKOVITZ
Notary Public, State of New York
ALYssATURlrovrr2 No. 01TU6044514
Ouelifled in Westchester County
Comlrilssion Expires July 10, 2019
NotatiAlu Wk, State of New York
No.O1TU6044514
Qualified In Westchester County
Coramissfon Expires July 10, 2014
REL SED
Date:
Signature:
City Clerk B IVISION LABOR AND MATERIAL BOND
City of San Jua
iWan
(GOVERNMENT CODE 66499.2)
Bond No. SUR21000005
Replaces Bond No. SUR20000317
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:
Street subdivision improvements within Tract 15609 as defined within Amendment #1 and
Reinstatement of the Subdivision Improvement Agreement for Tract 15609
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
Four Hundred Fifty One Thousand Five Hundred Fifty Four Dollars and 001100 Dollars ($451,554.00 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. �S1
Its: ■-�r�oc'. �(Y�+�-got
SURETY:
Ironshore Indemnity Inc.
(NOTARIZATION AND SEAL)
By: f _ � 4
Margar?A Ginem , Attorney -in -Fact
Surety Phone No.
C/O WILLIS OF FLORIDA
4211 W. BOY SCOUT BLVD,#1000 Page 2 of 3
TAMPA, FL 33607
INQUIRIES: (813)281-2095
APPROVED AS TO FORM:
By:
NOTE: Please attach Acknowledgement and Power of Attorney
Page 3 of 3
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
CIVIL CODE § 1189
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 of
On before me,
Dat
personally appeared
and Title bf 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. CORDI
Commission # 2088325
a�d a Notary Public - California a
Z' Orange County
M 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 0 1656
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
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Oft- - - - - - - - had
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-proyed to.M� ori ft basis, of-safi8fafatory evidon6t to W-tt'.VkSM(s) WhOSd il=e(s) JS/ire sitbxribcd ta
the wiflihi. -iAMiument. and aoknowledged -to me- -that-, h0shelthey oxwuted ihe. same: In histheritheIrl
4.u*Oi edrft Vbrsop(s), -Ot Oic
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ailtity bpbb behalf of whiGh'tfie 06fsoii(s), acfed I', ex'equited thiinstruibbnt
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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 affi ed my official seal on
the date in this certificate first above writte
Signature
Anett Cardinale
This area for Official Notarial Seal
ANETT CA
=
Comm ss on#INALE FF 138482
a=
V
Expires July 28, 2018
'" h°4'
Bonded TMu Troy Fain Insurance 800305-7019
This area for Official Notarial Seal
1:16111►14 A612_1111 CSLi 0 VA
III- 21000005
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.
SEAL
1919
yrk W�
By:
Dane L. Sus 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.
'oh, 8. -��
Amy L. Tayl
Notary PuWk
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 MayZ0 15
o
�� �� i
SEAL
1919 1
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."
—
AMYLTAYLOR
_
_
Notary Public -Slate of Tennessee
—
Davidson County
WCom on Expires 011-09-10
rk
'oh, 8. -��
Amy L. Tayl
Notary PuWk
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 MayZ0 15
o
�� �� i
SEAL
1919 1
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 §NDEMNITY WC
FINANCIAL STATEMENT SUMMARY
As of December 31, 2014
ASSETS
Bonds
Preferred stocks
Common stocks
Mortgage loans on real estate. first lens
Mortgage loans on real estate; Other than first liens
Properties occupled 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
Subtotals. cash and Invested assets
Title plants less $._, Charged off
Investment Income due and accrued
Uncollected promiums and agents' balances in the course of collection
Deferred premiums, agents' balances and Installments booked but deferred and not
yet due
Accrued retrospective premiums
Amounts recoverats a from reinsurers
Funds held by or deposited with reinsured companies
Other amounts receivable under reinsurance contracts
Amounts receivaWe relating to unlmured 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
Net adjustment In assets and liabilities due to foreign exchange rates
Receivables from parent, subsidiaries and affillates
Health are and ether amounts receivable
Aggregate write-ins for atter than invested assets
Total assets excluding Separate Accounts, Segregated Accounts and Protected Cat
Accounts
From Separate Accounts. Segregated Accounts and Protected Cell Accounts
0 Surplus Notes
TOTALS _ $34764141611 Gross paid In and contributed surplus
CERTIFICATE
I certify that the above financial statements to the bestof my
knowledge are a true and accurate reflection of the financcll al
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 the Texas
Department o1 insurance as of the same date,
WHIlarn 1 Gleason
09—VA Treasurer
Unassigned funds jsurplus)
Surplus as regards pollcyholden
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
V
0
0
0
$4,185,928
$190.811,131
$190,811,131
0
5,000,000
0
$156,938,671
($5,33S,1901
$156,603,481
$347,414,611
SUBSCRIBED and mom to me thug' ay
LIABILITIES
$179,140,947
Notary Public
0
Reinsurance payable on paid losses and loss adjustment expenses
31,M,141
Loss adjustment expenses
0
Commissions payable, contingent commissions and other similar charges
0
Other expenses (excluding taxes. licenses and fees)
0
Taxes, licenses and fees (excluding federal and foreign Income taxes)
0
Current federal and foreign Income taxes
0
lila[ Ileferic l tax lilblllty
$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 withheld or retained by company for account of others
0
Rem Iuantes and hems not a'locaitd
0
P1 ovl skin for refnsura nn
$226,614,039
Net adjustments In assets andkablRill esdue toforeign exehangerates
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
tiablRty for amounts held under uninsured plans
0
Aggregate wrlttllufor liabilities
0
Total liabilities excluding protected cell liabilities
0
Protected cell liabllitles
0
$5,530,837
Total Rabtlitles
0
0
POUCYHOLDERSSSURPLUS
0
Aggregate wntrins for special surplus funds
0
0
Common aOtal stock
$7,124r971
Preferred capital stock
$347,414,611
Aggregate wriWris for other than special surplus
0 Surplus Notes
TOTALS _ $34764141611 Gross paid In and contributed surplus
CERTIFICATE
I certify that the above financial statements to the bestof my
knowledge are a true and accurate reflection of the financcll al
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 the Texas
Department o1 insurance as of the same date,
WHIlarn 1 Gleason
09—VA Treasurer
Unassigned funds jsurplus)
Surplus as regards pollcyholden
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
V
0
0
0
$4,185,928
$190.811,131
$190,811,131
0
5,000,000
0
$156,938,671
($5,33S,1901
$156,603,481
$347,414,611
SUBSCRIBED and mom to me thug' ay
Mycommission expires. 7--lo—IT
Notary Public
ALYSSA TUF;KOVITZ
Minted Name
Notary Public, state of New York
No. OITUB044514
AtrSsATvafcQvnx
Oualified in Westchester County
Cufmassion Expires July 10. 2018
Hota LIG $rata of New yarM r
No.01TU6044514
Qualified In Westchester County
Coramisslon Expires luty 10, 2014
RELEA D
Date: Premium: $345.00
Signature:
City Clerk
City of San 3uan apistrano,
SUBDIVISION FAITHFUL PERFORMANCE BOND
(GOVERNMENT CODE 66499.2)
Bond No. SUR21000008
Replaces Bond No. SUR20000318
KNOW ALL MEN BY THESE PRESENTS, that Pacific Point Development Partners, LLC _
(hereafter designated as "Principal"), and Ironshore Indemnity Inc. ,
as Surety (hereinafter called "Surety") agree to install and complete certain designated
public improvements as conditioned by City Council Resolution No's. 92-6-16-4 and
03-09-16-06.
WHEREAS, said Principal is required to furnish a bond pursuant to Municipal
Code Section 9-5.101 and 9-5.109 et seq., for the faithful performance to guarantee
certain work, more particularly described as follows:
Storm Drain subdivision improvements within Tract 15609 as defined within Amendment #1 and
Reinstatement of the Subdivision Improvement A reement for Tract 15609
NOW, THEREFORE, we, the Principal and Surety are held firmly bound unto the
City of San Juan Capistrano, (hereafter called "Obligee") in the penal sum of
Fortv Six Thousand Fiftv Dollars and 00/100
Dollars, ($d6,050.00 ) 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 , 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 Paint Development Partners, LLC
By: oS
Its: c► S
SURETY:
Ironshore Indemnity Inc.
By:
Margarekg, Ginem , Attorney -in -Fact
Surety Phone No.
C/O WILLIS OF FLORIDA
4211 W. BOY SCOUT BLVD, #1000
TAMPA, FL 33607 Page 2 of 3
INQUIRIES: (813)281-2095
(NOTARIZATION AND SEAL)
(NOTARIZATION AND SEAL)
APPROVED AS TO FORM:
NOTE: Please attach Acknowledgement and Power of Attorney
Page 3 of 3
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189
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 6
/] )
County of [ )
On before me,
Date Ins N e and Title 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.
I certify under PENALTY OF PERJURY under the laws
of the State of California that the foregoing paragraph
W. CORDI is true and correct.
r4Mh06Commission # 2088325 WITNESS my hand and official seal.
-+ Notary Public - California a
Z Orange County &VOL
My Comm. Expires Oct 31, 2018 u 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
F-1 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
kill W$0. ar=$s. :Sections- 11 9 arid 119 w
.5 of UAL tu& and 'Sec.tic 0 of th
0byCm.%C*.Cok. y4atilioo 'ne-below,,pbysi.cA foriliat, of iie iiew- disclosure
Wticqjs-_anexWnple,,.for purafi�u*atup.
p -m
publicriotat
cerfi&ate verifies only the
identity6f the
individual who. 4pd, the dootne-ritA0 which. -6k
,certificate, is atfa6ed, and not the truthfulness;
Accuracy': ot v*dj-ty of tb
8iqtd of (aIifbmi - a
C .
,.�tmty of
oft -,,.Wqrb The,
'f 4
"insert name and title 0 sof pp who
rove t on'tho.ba-5ts- of sat isfAqoryevidoxioo whose hiiroe(s} IS141t 5ai7soribeato,
'th 6' wftid. Ifi§trument and acknowledged to mu that: heishetthey mccuted the -same, -in his(her/their.
Waciiy.(ics), 4mdthat by �isffi4/ihpW Apa�tqre.(s) '011 tfi_ -of the
-eiitity, bpbi� behalf of ,wOWM6 the 41asttxrntnt.
f -4ijd6r _PENA&14-fo
d. AtO California t�at th,� ftoiq-
OF. �W, kY '�.Ti 0 th - e jaws o tk $t
paragraph is true and .corm
WUNESS mg hAnd an',d officIg seat.
Signature (Sea])-
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 n
Signature
Anett Cardinale
ANETT CARDINALE
_.;Commission # FF 138482
h .AP
= Expires July 28, 2018
Bonded Thru Troy Fein Insurance 800.395.7019
This area for Official Notarial Seal
III- 21000008
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.
:F�dlio �
a,
SEAL Ir
a1019-
By:
Dane k. sus sWn
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.
.`'OU, � L
Amy L Tay
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
6 "1}
SH9
Paul 5. 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."
_ -
AMY L TAYLOR
Notary Pum- Swo of Tons
Davidson County
My Commisslon Expires 01-09-16
k �•^'
.`'OU, � L
Amy L Tay
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
6 "1}
SH9
Paul 5. 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 INC
FINANCIAL STATEMENT SUMMARY
As of December 31, 2014
ASSETS
Bonds
Preferred stocks
Common stocks
Mortgage loans on real estate. Rrst lens
Mortgage loans on real estate; Ot1w than first (lens
Properties occupied by the company
Properties held for the production of income
Properties held for Wo
Cash, cash equivalents and short-term investments
Contract loans
Derivatives
Other invested assets
Receivables for securities
Securities lending reinvested collateral assets
Aggregate *rite Ins for Invrstcd Z00%
Subtotals. ash and Invested assets
Tide plants less $_ Charged off
Investment Income due and accrued
Uncollected premsums and agents' balances in the course of collection
Deferred premiums, agents' balances and Installments booked but deferred and not
yetdue
Accrued retrospective premiums
Amounts recoveraMe from reinsures
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
Nat defo, ed lax asset
LIABILITIES
$179,140,947
Inoses
0
Reinsurance payable on paid tosses and lass adjustment expenses
31,840,141
toss adjustment expenses
0
Commissions payable, contingent commissions and other similar charges
0
Other expenses (excluding taxes. licenses and fees)
0
Taxes, Ncanses and fees (excluding federal and foreign Income taxes)
0
Current federal and foreign Income taxes
0
Net drlerren lax tMwIliv
$15,63,951
Unearned premiums
0
Advance premium
0
Ceded reinsurance premiums payable (net of ceding commissions)
0
Funds held by company under relnsuranccetreaties
D
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 habilltiesdue 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
Uablilty for amounts held under uninsured plans
0
Aggregate write-ins for llablif les
0
Total liabilities excluding protected can liabilities
D
Protected cell Ilabllltirs
0
$5,530,837
Total liabilities
CERTIFICATE
I certify that the above financial statements to the bestof my
knowledge are a true and accurate reflection of the financial
condition of the Company as of December 31, 2014,
AddMonelly, 1 certify that the above financial statements are
In agreement with the Statutory Financial Statements filed with the Texas
Department of Insurance as of the some date,
WNIlam 1 Gleason
MMP$ Trealvrar_
Unassigned funds{surplus)
Surpus 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
$155,938,671
($5,335,190)
$156,603,481
$347,414,611
SUBSCRIBED and swum to me thls'day of
Mycomndssian expires, 7-10—/T
Notary Public
Pr[zhted Name AIXSSA TURKOVITZ
Notary Public, state of Now York
No. 01 TU6044514
j1'LYMA71JUMV rZ _ - Ouelffied in Westchester County
Cfl1TinV"icn Expires July 10, 2018
�:�Iw$taseofN+swYoek _
No. 01711.1604,11514
Qualified In Westchester County
Commission Expires July 10, 2014
0
Guaranty funds receivable or on deposit
Furniture and equipment, Including health are delivery assets
D
POUCYNOLDEFWS WFIPLUS
Net adjustment In assets and liabilities due to foWgn exchange rates
0
Aggregate wnte-Ins for special surplus funds
Receivables from parent, subsidiaries and affiliates
0
Health care and other amounts receivable
D
Common capital stock
Aggregate wrte4ns for other than Invested assets
$7,124,971
preferred appal stock
Total assets excluding Separate Accounts, Segregated Accounts and Protected Cel
$347,414,611Aggregate
write ns forother than spacial surplus
Accounts
From Separate Accounts, Segregated Accounts and Protected Cell Accounts
0
Surplus Notes
TOTALS
$.347,414,611
Gross paid In and contnbuted surplus
CERTIFICATE
I certify that the above financial statements to the bestof my
knowledge are a true and accurate reflection of the financial
condition of the Company as of December 31, 2014,
AddMonelly, 1 certify that the above financial statements are
In agreement with the Statutory Financial Statements filed with the Texas
Department of Insurance as of the some date,
WNIlam 1 Gleason
MMP$ Trealvrar_
Unassigned funds{surplus)
Surpus 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
$155,938,671
($5,335,190)
$156,603,481
$347,414,611
SUBSCRIBED and swum to me thls'day of
Mycomndssian expires, 7-10—/T
Notary Public
Pr[zhted Name AIXSSA TURKOVITZ
Notary Public, state of Now York
No. 01 TU6044514
j1'LYMA71JUMV rZ _ - Ouelffied in Westchester County
Cfl1TinV"icn Expires July 10, 2018
�:�Iw$taseofN+swYoek _
No. 01711.1604,11514
Qualified In Westchester County
Commission Expires July 10, 2014
RELEA a Ole,
Date:
'Signature:
City Clerk
city of san duan apistrar DIVISION LABOR AND MATERIAL BOND
(GOVERNMENT CODE 66499.2)
Bond No. SUR21000008
Replaces Bond No. SUR20000318
KNOW ALL MEN BY THESE PRESENTS, that Pacific Point Development Partners Lt_c
(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:
Storm Drain subdivision improvements within Tract 15609 as defined within Amendment #1 and
Reinstatement of the Subdivision Improvement Agreement for Tract 15609
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
Forty Six Thousand Fifty Dollars and 00/100 Dollars ($46,050.00 ) 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
By: k �,_:; I
Its: .� •'Zvd r'b�
SURETY:
Ironshore Indemnity Inc.
By: `
Margaret5K Ginem , Attorney -in -Fact
Surety Phone No.
C/O WILLIS OF FLORIDA
4211 W. BOY SCOUT BLVD, #1000 Page 2 of 3
TAMPA, FL 33607
INQUIRIES: (813)281-2095
(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 § 1189
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 r )
County of �` MIS
�jOn before me, �'v �iv ,
Date ((� MT
Name and Title of the Officer
personally appeared �r �l �� V ID
�d 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.
I certify under PENALTY OF PERJURY under the laws
of the State of California that the foregoing paragraph
W 001301is true and correct.
Commission #► 2088325 WITNESS my hand and official seal.
Notary Public - California 2
Orange County n
My Comm. Expires Oct 31, 2018 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: Document Date:
Number of Pages: _ _ Signer(s) Other Than Named Above: .
Capacity(ies) 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
5;u;tte: lilt. 110$0, amehds. Sebt! rig. 1-:10 ala :)1,95' -6fiho OAR -code- -an au tho
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-400ce; ig-,a_M. example; forpur-PpAesof ioug6mtim-
cerdbmti verifies -only the id6ntity'6f the
_indi.Vl1d.ua.1 who" igned the da. OtnOtAo whiefiAls
r
er.ti_f Eoatc is afta6hed, and not the tnithfulnessi
p.ppWgy, ot validity of rb #doqupoent
.8taw of California.
.Runty of
Oft ine,
iilse name and. title Of-officer3,personally ;ippmed who
-d' to Sul*d6dw
sa�gfactocy, cy; Onpp �4,tbvkpftson(g) Whose harrie�(�) Wax6.
�le_4.to A�q Ot� �hd. iasis, of
%6 wWfi6,ihstr=enL and acknowledged to mw -that: helshelthey excouted the same.: in his/her/their
;L4b'c6zed'DapaeHy(lO),, 990 012X 1 y )iiOOrfte* dpgtgie(�) -On'Tfie Mtruoiopt ire
.�6 Verson(s), Or the
tittity 4)-oit behalf ofwhfDhA6 06rs0fi(> ).acted, executed th&Instanent
lJoqi1ify, V*r P, ENAIM('0. #MWRY i.nder the )'a*§ of 6&� stats Qf, cAll' . toma� th4t -t]16- bOOTriA
paragraph is true anScorrect
WITNESS my brand aiiad officiiit scat,
Sigattire (Sea]):
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.
'r
Signature
Anett Cardinale
R
ti ANETT CARDINALExpires July 8F2018 482 Bonded Thru
Troy Fein Insurance 800-305-7019
This area for Official Notarial Seal
POWER OF
III- 21000008
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
220
d 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.
r
By:
Dan a L, Suss 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.
46(�f
Amy L Tay
Notary Pubilc
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 May 20 15
ZV
PauIS.Gi dans
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."
_
AMY L TAYLOR
- -
Notary Public- Slaleor Tennessee
-
Davidson County
My Commission Expires 01-0310
46(�f
Amy L Tay
Notary Pubilc
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 May 20 15
ZV
PauIS.Gi dans
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 INDEMNITY INC
FLYANCIAL STATEMENT SUMMARY
As of December 31, 2014
ASSETS
Bonds
Preferred stocks
Common storks
Mortgage loans on real estate: first tens
Mortgage loans on real estate; Other than first liens
Properties occupied by the company
Properties held for the production of Income
Properties held for sale
Cash. cash equivalents and short-term investments
Contract loans
Derivatives
Other invested assets
Receivables for securities
Securities lending reinvested collateral assets
Agg negate wrtr c•Ins (of invested assets
Subtotals. cosh and Invested assets
Title plants less $_ Charged off
Investment Income due and accrued
Uncollected prermums and agents' balances In the course of collection
Deferred premiums, agents' 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 receivalse 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
Net adjustment In assets and liabilities due to foreign exchange rates
iimcl abitefrom parent, subsidies ries a rid aHlllaties
Health are and other amounts receivable
Aggregate write -Ins for other than Invested assets
Total assets excluding Separate Accounts, Segregated Accounts and Protected Cek
Accounts
From Separate Accounts_ Segregated Accounts and Protected Cell Accounts
LIABILITIES
$179,140,947 Lenses
0
Reinsurance payable on paid losses and loss adjustment expenses
31,840,141
loss adjustment expenses
0
Commissions payable, contingent commissions and other similar charges
0
other axperrses (excluding taxes. licenses and feasl
0
Taxes, licenses and fees (excluding 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)
o
Funds held by company under reinsurance treaties
0
Amounts withheld or retained by company for account of others
0
Remittances and items not ellocated
0
Provision for reinsurance
$226,614,039
Net adjustments In assets and tabllltles due to foreign exchange rates
0
Drafts outstanding
$994960
Payable to parent, subsidiaries and affiliates
$73,567,547
Derivatives
0
Payable for securities
0
Payable for securitle3 lending
$33,586,257
Ustillityfor amounts held under uninsured plans
0
Aggregate write -Ins for liabilities
0
Total liabilities excluding protected call liabilities
0
Protected all liabilities
0
$5,530,837
Told. Rabrlities
0
0
POUCYNOLDERS'SSVRPLUS
0
Aggregate wntrinsfor specialsurplus funds
0
0
Common spial stock
$7,124,971
Preferred capital stock
$347,414,511
Aggregate write-ins for other than special surplus
0 Surplus Notes
TOTALS 3n7 41a 611 Gross paid In and contributed surplus
lid
CERTIFICATE r
I certify that the above financial statements to the but of my
knowledge area true and accurate refection of the financial
condition of the Company es of December 31, 2014,
Addltlonally, I certify that the above financial statements are
in agreement with the Statutory Financial Statements filed with the Texas
Department of Insurance as of the same date,
Unassigned funds (surplus),
Surplus as regards policyholders
$63,582,066
0
$10,384,957
$1,020,805
$5,435,125
$2,383,909
$2,434,392
0
$29,158,576
$58,222,187
0
$1,545,075
$12,458,110
0
0
0
0
$4,185928
$190,811,131
$190,811,131
0
5,000,000
0
$156,936,671
($5,33S,190)
$156,603,481
TOTALS $347,414,611
SUBSCRIBED and swomtomethtsy'd.4,.1 Hq �iGr%rJ
Mycorrrrnlastanexpirer '%/O—/SS
Notary Public
Printed Name
ALYSSATURK(rM _��----
4141401.1—, lei -
bile. State of New York
No.01TU6044514
WRtiamJ Gleason Cluallfled In Wes"estes County
M,YP, & Treasuref- Conrmisslon Expires July 10, 2014
ALYSSA TURKOVI1Z
Notary Public, State of Now York
No. 01TU6044514
Ouelffied in Westchester County
K:er udElsiof1 Expires July 10, 2018
RELEASED lc� j2o[S
Date:
Signature; �-
City Clerk apistra , CA
City of San Ju
SUBDIVISION FAITHFUL PERFORMANCE BOND
(GOVERNMENT CODE 66499.2)
Premium: $225.00
Bond No. SUR21000010
Replaces Bond No. SUR20000319
KNOW ALL MEN BY THESE PRESENTS, that Pacific Point Develo ment 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:
SanitarySewer subdivision improvements within Tract 15609 as defined within Amendment #1 and
Reinstatement of the Subdivision Improvement Agreement for Tract 15609
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
Four Thousand Two Hundred Ninety Three Dollars and 00/100 Dollars, ($24,293.00 ) 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 , 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:
�6n,S 1
Its: Z,,J
SURETY:
Ironshore Indemnity Inc.
By: �-'C . 4
Margaret A. inem , Attorney -in -Fact
Surety Phone No.
C/O WILLIS OF FLORIDA
4211 W BOY SCOUT BLVD, 91000
TAMPA, FL 33507 Page 2 of 3
INQUIRIES: (813)281-2095
(NOTARIZATION AND SEAL)
(NOTARIZATION AND SEAL)
APPROVED AS TO FORM:
By � �
NOTE: Please attach Acknowledgement and Power of Attorney
Page 3 of 3
CALIFORNIA• • • •
uv� F�:r. e!c.¢.5.:!aE.v.:!yE!a..f�:.i1:.=�.!.�.. .iv ii �.ix.:::�:�:.r;:!'c.:.:!:�:.ze!c:: rc<.,,:r si: s\{. •F•.�2/:� .L�{.:2</:�N��':s�f
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 of ``
On I l before me,
Date A ! • I .
personally appeared
(Ar V1 W Y21jL.-
and Tide 4 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. CORDI
COmmISSlon # 2088325
Notary Public - cxliiornla a
` ❑range County
My Coram. Expires 00 61. 201a
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 1
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
F-1 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
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asci: roy, or Vaadcity pf 914r.404umenT.
Sold of Ciliforhia_
..ounty. of
Oh _befor6 me,
iiisert name and title defficerl personally appeored
provedtoMg on Ag basis. o Fsatisfkaoy. cvidch�e tp'�q,Ahq p6xsqri(q Whose hwd�(i) iS/4T6-swmd6a ta
the withiri id!satunent_ and acknowledged to mw that: belshelthey executed iho.same Im histher/their
4~7ned'.ca par ciiy(O), "d ft� b UrAhek 49otpre(i) -on. tfie'Wtufaot ftio Vtrsbn.(8),. a thq
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paragraph'
,s true and'zormt
WUNESS*Y�hAnd AM. 6fficiail seat,
Si - pahirc. (Sea)),
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 affi d my official seal on
the date in this certificate first above writte .
Signature
ulll-� f - -
Anett Cardinale
MY
ALE
138482
20 18.. masa v
This area for Official Notarial Seal
POWER OF
III- 21000010
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
�T IRONSHORE INDEMNITY INC.
d' �7P1
BEAL � r
1919
f
By♦
4an a L, Sus 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.
�� -(A�L
Amy L. T9yl
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
eEAL '
1919
Paul S.eduno�
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 T1,YLDF2
Notary Pubk- Stale of Tennessee
= rn
David— County
My Commission Expires 01-09-16
�� -(A�L
Amy L. T9yl
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
eEAL '
1919
Paul S.eduno�
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."
IRONSHOAE iNDEMNrTY INC
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 liens
Properties occupied by the company
Properties held for the production of Income
Properties held for We
Cash. cash equivalents and short-term Investments
Contract bans
Derivatives
Other invested assets
Receivables for securities
Securities lending reinvested colpterai assets
Aggregate wrlte4nsfor4nvested assets
Subtotals. cash and Invested assets
Title plants less $.., Charged off
Investment Income due and accrued
Uncollected premums and agents' balances in the course of collection
Deferred premiums, agents' balances and Installments booked but deferred and not
yetdue
Accrued retrospective premiums
Amounts recoverabie 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 defened tax asset
Guaranty funds receivable or on deposit
Furniture and equipment, Including health ore delivery assets
Net adjustment In assets and liabilities due to foreign exchange rates
Recelvables from parent, subsidiaries and affiliates
Health are and other amounts receivable
Aggregate wMe-Ins for other than Invested assets
Total assets excluding Separate Accounts, Segregated Accounts and Protected Cat
Accounts
From Separate Accounts- Segregated Accounts and Proteded Cell Accounts
0 Surplus Notes
' OTALY 5347 414.6,11 Gross paid In and contributed surplus
CERTIFICATE I
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 as of December 31, 2014,
AddMonafly, I certity that the above financial statements are
in agreement with the Statutory Financial Statements filed with the Texas
Department of Insurance as of the same date,
William J Beason
CE9. YP 6S.Ir985kLF1_
Unassigned funds (surplus)
Surisus as regards policyholders
TOTALS
$63,582,066
a
$10,384,957
$1,020,805
$5,435,126
$2,383,909
$2,434,392
0
$29,158,576
$58,224187
0
$1,545,075
$12,458,110
D
0
0
0
$4,185,929
$190,811,131
$190,811,131
0
5,000,000
0
$156,938,671
($5,335,1901
$156,603,481
$347,414,611
SUBSCRIBED and swom to me thlsyfday
My commdaskin explrer 7- /O -/ Jr
Notary Public
ALYSSA TURiCOVITZ
Printed Name Notary Public, State of New York
No. 01 TU6044514
ALY55ATLJt1(OI M _ - OualfBed In Westchester County
Comfy aWon Expires July 10, 2018
M1G Slate of New York
No.01TU6044514
Qualified In Westchester County
Comralssfon Expires July 10, 2014
LIABILITIES
$179,140,947
lossp
0
Reinsurance payable on paid losses and loss adjustment expenses
31,840,141
Loss adjustment expenses
0
Commisslons payable, contingent commissions and other similar charges
0
Other expenses (Wuding taxes. licenses and fees)
0
Taxes, licenses and fees (excluding federal and foreign Income taxes(
0
Current federal and foreign Income taxes
0
Net deferred tax Ila hl tity
$15,632„951
unearned premiums
0
Advance premium
0
Ceded rainsurance premiums payable (net of ceding commissions(
0
Funds held by company under reinsurance treaties
0
Amounts withheld or retained by company for account of others
0
Remittences and items not gloated
0
Provision for reinsurance
$226,614,039
Net adjustments in assets and tabilltlesdue 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
LJablllty for amounts held under uninsured plans
0
Aggregate write -iris for liabilities
0
Total liabilities excluding protected cell liabilities
0
Pr yle<•trd i ell Iraww;&s
0
$5,530,837
TotalBabllities
0
0
POUCYNOIDEAS S SiSRPWS
0
Aggregate write -Ins for special surplus funds
0
0
Common ap&tal stock
$7,124,971
preferred capital stock
5347,414,611
Aggregate write -ns for other than special surplus
0 Surplus Notes
' OTALY 5347 414.6,11 Gross paid In and contributed surplus
CERTIFICATE I
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 as of December 31, 2014,
AddMonafly, I certity that the above financial statements are
in agreement with the Statutory Financial Statements filed with the Texas
Department of Insurance as of the same date,
William J Beason
CE9. YP 6S.Ir985kLF1_
Unassigned funds (surplus)
Surisus as regards policyholders
TOTALS
$63,582,066
a
$10,384,957
$1,020,805
$5,435,126
$2,383,909
$2,434,392
0
$29,158,576
$58,224187
0
$1,545,075
$12,458,110
D
0
0
0
$4,185,929
$190,811,131
$190,811,131
0
5,000,000
0
$156,938,671
($5,335,1901
$156,603,481
$347,414,611
SUBSCRIBED and swom to me thlsyfday
My commdaskin explrer 7- /O -/ Jr
Notary Public
ALYSSA TURiCOVITZ
Printed Name Notary Public, State of New York
No. 01 TU6044514
ALY55ATLJt1(OI M _ - OualfBed In Westchester County
Comfy aWon Expires July 10, 2018
M1G Slate of New York
No.01TU6044514
Qualified In Westchester County
Comralssfon Expires July 10, 2014
RELEASED
Date:
�7
Signature:
City Clerk
City of San ]u aplstrano, QBDIVISION LABOR AND MATERIAL BOND
(GOVERNMENT CODE 66499.2)
Bond No. SUR21000010
Replaces Bond No. SUR20000319
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:
Sanitary Sewer subdivision improvements within Tract 15609 as defined within Amendment #1 and
Reinstatement of the Subdivision Improvement Agreement for Tract 15609
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
Twenty Four Thousand Two Hundred Ninety Three Dollars and 00/100 Dollars (24,293.00 ) 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 —1 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:
Its: vi�'\_
SURETY:
Ironshore Indemnity Inc.
(NOTARIZATION AND SEAL)
By: �f f
Margare . Ginem , Attorney -in -Fact
Surety Phone No.
C/O WILLIS OF FLORIDA
4211 W. BOY SCOUT BLVD, #1000 page 2 of 3
TAMPA, FL 33607
,NQUIRIES: (813)281-2095
APPROVED AS TO FORM:
NOTE: Please attach Acknowledgement and Power of Attorney
Page 3 of 3
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189
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
Caun of
�A cI I/t•P
r
On
Date
personally appeared
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. COR01
Commission #t 2088325
Notary Public - California z
Orange County n
M COrriM. Expires Oct31, 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. I A &(-66
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: Document Date:
Number of Pages: 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.NationaiNotary.org • 1 -800 -US NOTARY (1-800-876-6827) Item #5907
t. 3ill 105..0.=ii �eotiong. I . 4
1195: Vf"*e: 0.134 Code, and Section
9-20. -d h
A formai hel.ne.w. disclosure
o aidt
�qice; stxanpk-,dor pur
pg§e4pf fflusiratiui
A hdts public of other bfi def c;uWPIOting this:
cerfifRzate verifies only the identity 'of the
indlffiduahxhQ-'signed the doptaenttp whidL.ibi%
,cerdfioata is. attached, and not the truthfulness;
y, OT *0i4ty 4 thaNdCUMML
8b California.of C
C.6u.nty. of
0 . ft.:before me,hew
insert name -and title of - officer j,'Personally g'ppeareO
ptovyedto if ot),th'bag ' is of sat ' isfa:qory. evideod to jshrLrd_sukserjbca to
ite witiliri .%strunent- and acknowledged -to mer that: helshelthey executed the.same: In- hismer/their
atk*OpE,d . opacli . vbrson(s),: at the
y(io),. ftd that, b aw s) on rufno:p '6,b
yr �16 t t
-orktity upon behalf of,whiph'the vefsofi(§),nted, ekecoted tfi&,!rxstn=6nt
P' th':� �Mo, ofcidlfbrn' - that ft fft- goiji
f -4ij&r PENALT�` R nderrthe )a -w§
parag,raph'i"S true MjdrCorMCf.
WITNESS.**-hAn4 anxi.Oficlait. seail'..
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.
r
Signature
Anett Cardinale
AWL '' . ANETT CARDINALE
`iotCommission # FF 138482
Expires July 28, 2018
,rR Banded Thru Troy Fain Insurance 800.385.7o1B
Wallis" a
This area for Official Notarial Seal
POWER OF
III- 21000010
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
22ad 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.
o�'�irir p:
uuc y
ayl
Dasl a L.5uss n
Director
ACKNOWLEDGEMENT
On this 7ch 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.
AMYL TAYLOR
Nolary Publlc- Slate of Tennessee
- r DavlGson County
My Commission Eryires 01-09-16
JIA,L /LBz
Amy L. Tay
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 May ZD 15
Imo'
uA�
Pauls. &i darn
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."
IRONSNORE ,NDEMNRY INC
FINANCIAL STATEMENT SUMMARY
As of December 31, 2014
ASSETS
Bonds
Preferred stocks
Common stocks
Mortgage loans on real estate:lxrst lens
Mortgage loans on real estate: Other than first liens
Propertles occupied by the company
Properties held for the production of income
Properties held for sale
Cash, cash equivalents and short-term investments
Contract loans
Derivatives
Other invested assets
Receivables for securities
Securities tending reinvested collateral assets
Aggregate write -Ins forinvested assets
Subtotals. cash and Invested assets
Title plants less $_ Charged off
Investment Income due and accrued
Uncollected prem;ums and agents' balanus in the course of collection
Deferred premiums, agents' balances and Installments booked but deferred and not
yetdue
Accrued retrospective premiums
Amounts recoverabte from reinsurers
Funds held by or deposited with reinsured companies
Other amounts receivable under reinsurance contracts
Amounts receivabte relating to uninsured plans
Current federal and foreign income tax recoverable and interest thereon
Net defened tax asset
Guaranty funds receivable or on deposit
Furniture and equipment, Including health are delivery assets
Net adjustment In assets and liabilities due to fore,gn exchange rates
Receivables from parent, subsidiaries and affiliates
Health care and other +mounts receivable
Aggregate write-ins for other than Invested assets
Total assets excluding Separate Accounts, Segregated Accounts and Protected CO.
Accounts
From Separate Accounts. Segregated Accounts and Protected cell Accounts
0 Surplus Notes
TOTALS $347,414,611 Gross paid in and oontnbuted surplus
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 as of December 31, 2014,
Additionally, I certify that the above financial statements are
in agreement with the Statutory Finandal Statements filed with tho Texas
Department of Insurance as of the same date,
William J Gleason
�{LYP.�Irc,21ti[ec.
$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
Unassigned fundstsurplus} ($5,335,190)
Surprus as regards policyholders $156,603,481
TOTALS $347,414,611
SUBSCRIBED and swomtome thlsY•dayofM've O%rj
LIABILITIES
$179,140.947
losses
0
Reinsurance payable on paid losses and loss adjustment expenses
31,840,141
loss adjustment expenses
0
Commissions payable, contingent commissions and other similar charges
0
Other expenses (excluding taxes. licenses and fees)
0
Taxes, licenses and fees (excluding federal and foreign income taxes)
0
Current federal and foreign Moonie taxes
0
Net deferred tax liability
$15,632,9S3
Unearned premiums
0
Advance premium
0
Ceded reinsurance premiums payable (net of ceding commissions)
0
Funds held by company under reinsurance treaties
0
Amounts vathrield or rely wd by comowr{ for account ut cLhers
0
Remittances and items not allocated
D
Provision for reinsurance
$226,614,039
Net adjustments In assets and liabilities due to foreign exchange rates
0
Draftsoutsbnding
$990,960
Payable to parent subsidiaries and affiliates
$73,567,547
Derivatives
0
Payablefor securities
0
Payable for securities lending
$33,586,257
Liability foramounts held under uninsured plans
0
Aggregate wrlte-Insfor liabilities
0
Total liabilities excluding protected cell liabilities
0
PFOlected Ceil l w bl 1 1 lits
0
$5,530,837
Total Babilities
0
0
POUCYHOLDERS°SSURPLUS
0
Aggregate vmte-lnsforspeclalsurplus funds
0
0
Common capital stock
$7,124,971
preferred capital stock
$347,414,611
Aggregate write; ns for other than special surplus
0 Surplus Notes
TOTALS $347,414,611 Gross paid in and oontnbuted surplus
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 as of December 31, 2014,
Additionally, I certify that the above financial statements are
in agreement with the Statutory Finandal Statements filed with tho Texas
Department of Insurance as of the same date,
William J Gleason
�{LYP.�Irc,21ti[ec.
$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
Unassigned fundstsurplus} ($5,335,190)
Surprus as regards policyholders $156,603,481
TOTALS $347,414,611
SUBSCRIBED and swomtome thlsY•dayofM've O%rj
My commissen expires -7-lo—IT
Notary Public
At.YSSA TURieovriz
Printed Name
Notary Public, State of New York
No.01TU6044514
Quallfled in Westchester County
tacxnfrlilwiarl Expires July 10, 2018
bllc,$[ataoiNewYork��- t
No.01TU6044514
Qualified In Westchester County
Commission Expires July 10, 2014
RELEASED��
V Premium: $225.00
Date:
Signature:
City Clerk
City of San 3uan apistran 'A
SUBDIVISION FAITHFUL PERFORMANCE BOND
(GOVERNMENT CODE 66499.2)
Bond No. SUR21000015
Replaces Bond No. SUR20000321
KNOW ALL MEN BY THESE PRESENTS, that Pacific Point Development Partners, LLC
(hereafter designated as "Principal"), and Ironsliore 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:
Monument subdivision improvements within Tract 15609 as defined within Amendment #1 and
Reinstatement of the Subdivision Improvement Aqreement for Tract 15609
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
Fifteen Thousand Five Hundred Dollars and 00/100 Dollars, ($15,500.00 ) 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 Mav , 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: 0S' -
Its: 1��� : z S �VAA &nc
IQ I
SURETY:
Ironshore Indemnity Inc.
By: /
/ 2ee:���
Margareg. Ginem , Attorney -in -Fact
Surety Phone No.
C/O WILLIS OF FLORIDA
4211 W. BOY SCOUT BLVD, #1000
TAMPA, FL 33607 Page 2 of 3
INQUIRIES: (813)281-2095
(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 § 1189
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
Count of rrin�
On
Dade
personally appeared
- -------1-/ --- - J - - -- 1-/
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.
I certify under PENALTY OF PERJURY under the laws
of the State of California that the foregoing paragraph
W. CORDI is true and correct.
Commission # 2086325 WITNESS my hand and official seal.
.r Notary Public • CelHornia
Onnps y _
Comm. Ex freses Oc oct 31, 2018 Signature, �l _
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
rl 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
Semfd 13111050, mtwi(fs gecti* ris. 11 0. w1d. 195 of ilid: CIVU tca&- wid 90�.Jiw 90 -of tho
. I . format'of
'pf -lbsime
naocq.js-iw exWple-,, for purp-pses of ijjustrafiup,
A ftofaty p0lic or other offidef 60ifi&tina
certificate verifies only the id6ntity -of the
inai.V'td , A Whcr signed the. doom0t.tq wbkhW_A
certifloate. is atfached7 and not the truthfulncss�
"Accuracy; or vilidwy Pf fwdoouyiem
-%td of California.
County. of
Oh
,ihsert name and title of officeO, PemonAlly appeared mho
-proyW foXg. oil tbo'bagt's. of-satis6voTy. evideneb to W, p;W 06 (g]. Whwe siz*ribbs %
ItL6 Wffitiri- -Wtr=ent. and acknowled&ed -to �mwlhat helshefthqy executed the same-- In- his/her/their,
4gOgqjgd_ igapadi . y. h is#iojd* '4P4WTe(O 'On VArsOjI
"the
-entity tip -oil. ljdhgff of.w which -the 06es6h(s). acted, executed ftinstrura6vL
T bF, Jaws -o 66, St #e of, C liforn" - tho the fefego�ig
V*r P:FNM_TY- IRR I
parafTaph is true and correct,
WUNESS i4}14nd and 6fficid- s-.aL
Signattine (seal),
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
ANEji CARDINALE
Comm # FF 138482
ExCirss July 28, 2D18 7O1B
Bonded TWu Tm' Faln Viuusnea
This area for Official Notarial Seal
POWER OF ATTORN
III- 21000015
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
22"d 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.
' IrMN
d� �r
r'
~ By:
oan a 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.
� n1�ry
aAl •,4
ARTY L TAYLOR
- =
Notary Publlc- 6fale of Tennessee
-
Davidson County
A
rig/•" r•
My Commission Expire.01-09 16
Amy L Tayi
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 tsm Day of May 20 15
r,..
Paul s.6Od..)
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."
19ONSHORE SNDEMNITY INC
FINANCIAL STATEMENT SUMMARY
As of December 31, 2014
ASSETS
Bonds
Preferred stocks
Common stocks
Mortgage loans on real estate. First tens
MmEgage loans on rral es tate: Other than Il rst Hens
Properties occupied by the company
Properties held for the production of income
Properties held for sate
Cash. cash equivalents and short-term investments
Contrad loans
Derivatives
Other invested assets
Receivables for securities
Securities lending reinvested coilaterat assets
Aggregate write4nsforinvested assets
Subtotals. cash and Invested assets
Title plants less S._ Charged oft
Investment Income due and accrued
Uncollected pre mums and agents' balances in the course of collection
Deferred premiums, agents' balances and Installments booked but deferred and not
yetdue
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
Guaranty funds receivable or on deposit
Furniture and equipment, including health pre delivery assets
Net adjustment In assets and liabilities due to fordgn exchange rates
Receivables from parent, subsidiaries and affiliates
Health care and other amounts receivable
Aggregate write-ins fa other than invested assets
Total assets excluding Separate Accounts, Segregated Accounts and Protected Cat
Accounts
from Separate Accounts, Segregated Accounts and Protected Cell Accounts
0 Surplus Notes
r01'AI-S $347,414,611 Gross paid In and contributed surplus
CERTIFICATE
I certify that the above financial statements to the best of my
knowledge are a true and accurate reflection of the llnamial
condition of the Company as of December 31, 2014,
Additionally, I certifythatthe above financial statements are
in agreement with the Statutory Financial Statements filed with the Texas
Department of Insurance as of the same date,
William J Gleason
t FQ, V P & Trwyf S 1.
Unassigned fundstsurplus)
Suwus 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
$1,545,07S
$11,458,130
0
0
0
0
$4,185,928
$190,811,131
$190,811,131
0
5,000,000
0
$156,938,671
($5133S1190)
$156,603,481
$347,414,611
SUBSCRIBED and swum to me this ,day of Mfjyi
My comasissWri expires: 7-/O—/v
Noury pubnc
Minted Name ALYSSA TUAKOVRZ
Notary Public, State of New York
_ No. OITU6044,514
ALniTURK°� — - Oualffled in Westchester County
CmMlmon E*rW July 10, 2018
No�Wk. Stow vl New Y0r% ,rr
No.01TU6044S14
Quanfied In Westchester County
Con sudssksn Expires July 10, 2014
UABIUTIES
$179,140,947
1"*
0
Reinsurance payable on paid bases and loss adjustment expenses
31,840,141
toss adjustment expenses
0
Commissions payable, contingent commissions and other similar charges
0
other expenses (excluding taxes. licenses and fees)
0
Taxes, licenses and fees (excluding federal and foreign Income taxes)
0
Current federal and foreign income taxes
0
Nat deferred tax Itablrrry
$15,632,951
Unearned premiums
0
Advance premium
0
Ceded reinsurance premiums payable (net of ceding commissions)
0
Funds field by company under reinsurance treaties
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 tabllitles due to foreign exchange rates
0
Draft% 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
Uablllty for amounts held under uninsured plans
0
Aggregale wrlrrins for IlabRtties
0
Total liabilities excluding protected rr0lVabllhies
0
Protected cell liabilities
0
$5,530,837
Total liabilities
0
0
POUCYHOLDERSSSURPLUS
0
Aggregate wnte-ins for special surplus funds
0
0
Common capital stock
$7,124,971
preferred capital stack
$347,414,611
Aggregate writeznn for other than special surplus
0 Surplus Notes
r01'AI-S $347,414,611 Gross paid In and contributed surplus
CERTIFICATE
I certify that the above financial statements to the best of my
knowledge are a true and accurate reflection of the llnamial
condition of the Company as of December 31, 2014,
Additionally, I certifythatthe above financial statements are
in agreement with the Statutory Financial Statements filed with the Texas
Department of Insurance as of the same date,
William J Gleason
t FQ, V P & Trwyf S 1.
Unassigned fundstsurplus)
Suwus 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
$1,545,07S
$11,458,130
0
0
0
0
$4,185,928
$190,811,131
$190,811,131
0
5,000,000
0
$156,938,671
($5133S1190)
$156,603,481
$347,414,611
SUBSCRIBED and swum to me this ,day of Mfjyi
My comasissWri expires: 7-/O—/v
Noury pubnc
Minted Name ALYSSA TUAKOVRZ
Notary Public, State of New York
_ No. OITU6044,514
ALniTURK°� — - Oualffled in Westchester County
CmMlmon E*rW July 10, 2018
No�Wk. Stow vl New Y0r% ,rr
No.01TU6044S14
Quanfied In Westchester County
Con sudssksn Expires July 10, 2014
RELEASED
Date:
r
Signature:
City Clerk
City of San Ju pistra
iIVISION LABOR AND MATERIAL BOND
(GOVERNMENT CODE 66499.2)
Bond No. SUR21000015
Replaces Bond No. SUR20000321
KNOW ALL MEN BY THESE PRESENTS, that Pacific Point Development Partners, LLC
(hereafter designated as "Principal"), and Ironshore Indemnity Inc.
El
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:
Monument subdivision improvements within Tract 15609 as defined within Amendment #1 and
Reinstatement of the Subdivision Improvement Agreement for Tract 15609
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
Fifteen Thousand Five Hundred Dollars and 00/100
Dollars ($15.500.00 ) 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 Mav , 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: _ C�
Its:NJ
SURETY:
Ironshore Indemnity Inc.
r
By.
Margar A. Ginem , Attorney -in -Fact
Surety Phone No.
C/O WILLIS OF FLORIDA
4211 W. BOY SCOUT BLVD, #1000 Page 2 of 3
TAMPA, FL 33607
INQUIRIES: (813)281-2095
(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 § 1189
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 of (�AYYAr
'
On ft—wil I
Date
personally appeared
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
Commkelon # 2088325
4bNotary Public - California z.
Orange County n
My Comm. Expires Oct 31, 2018 J
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: - Document Date:
Number of Pages: 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.NationaiNotary.org - 1 -800 -US NOTARY (1-800-876-6627) Item #5907
:Sections. 13M 1,050, &neft 0 '.199 maid Il Civil W.4 ea Oii g�of tho
Oiuy *,Co4e,tblag�tonoiag-
eapAbjk,;'TlYo, 0� pbygicAforraiof ttie-nuvVdisqjosure
-UOUCeis-ap,mapple". f(?T put pws ofiaustmom-
p
UIic of other dfic 6oih&fing thls.-.
Cerfficate verifies oaly the identitY'of the
w
-individual who,'81igned, the doOplot , t0 . hidl,
A
.Certificate. is atfa6hed, an I d not -the trtiffulnessi pL,�y .- ot * a 10ity f 4f tb
at. dootijAmi-
5W.-bf Califoriii.a.
C.minty. of
Ota J)*rd fne,
'ibsert name anis title 6fofflcer),,'personally ippeored Who.
00'.ve'basis fsatiOaaotyevid!eAeOto
X0 Xq'oO,tlrq o
,&-6, wAhJd -ihslyusuent and acknowledged -to me that: hOshelthqy executed the . Se-
�i n. h7tslh er/th eiar,
4qtlyoogd'opaeity(jes),_ jtpO tliaitb .. (S),:,I# Oie
_y. )iiq/�qAr_jr Agbatpre(�) i*:jW ItistmiRojit fie V.ersbp
-eijtjty.,tipmi. l3ehialf of�,Ailph'66 Oefth(t), A cute ain
Md, executed t 4 sh-m6nt.
1.. teA if,y". ti>ider PENALTY OF' P"JN, �,`Ry d Ti dO -#1e I -of e.Stao Or CA 1 1forrXii - $4t the kne go idg.
paragraph- i's true and correct-
WTTNES&Tily hAn4 aiid..of icial
seaL
Sig.ri-Wrie,
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 .
t
Signature_
Anett Cardinale
ANETT CARDINALE
Commission # FF 138482
Expires July 28, 2018
'tR Bonded Thru Troy Fein Insurance 900.385-7019
This area for Oficial Notarial Seal
III- 21000015
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.
o�
(9EALEAM1
..- By:
Dane L. Suss 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.
TAn�,
-,,•
AMY L YAYLUA
Notary Publlc- Stale of Tennessee
- =
n�
Davidson County
My Commission Expires 01-09-16
,�, ,`-fid
Amy L. Te
Notary Publlc
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
I La a4f0 �
�iy,ppTp� 1
Paul S. Gf 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 INDEMNITY INC
FINANCIAL STATEMENT SUMMARY
As of December 3% 2014
ASSETS
Bonds
Preferred stocks
Common stocks
Mortgage loans on real estate: First Ivens
Mortgage Irons on real estate; Other than first liens
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 tending reinvested collateral assets
Aggregate write -Ins forinvested assets
Subtotals, cash and Invested assets
Tale plants less $. Charged off
Investment Income due and accrued
Uncollected prenmums and agents' balances in the course of collection
Deferred premiums, agents' 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
Guaranty funds receivable or on deposit
Furniture and equipment, including health care delivery esseU
Net adjustment In assets and Ilabillfies due to foreign exchange rates
Receivables from parent, subsidiaries and affiliates
Healthcare and other -mounts receivable
Aggregate write-ins for other than Invested assets
Total assets excluding Separate Accounts, Segregated Accounts and Protected Cot
Accounts
From Separate Accounts, Segregated Accounts and Protected Cell Accounts
0 Surplus Nates
T OTA15 347.x14 Al l Gross paid In and contnbuted surplus
CERTIFICATE
I certify that the above financial statements to the best df my
knowledge area true and accurate reflection of the financM.
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 the Texas
Deportment of Insurance as of the same date.
William J Gleason
Unassigned funds(surplus)
Surpus as regards policyholders
TOTALS
SUBSCRIBED and swam tome thls%�d,ofHv,
My commtsxcn expires: 7-/o—/T
Notarypublic
Printed Name
ALYSSATURKOVi12
7
c,St I ir+r
+aa b1lySrneolNewYork )
No.OITU6044514
Qualified In Westchester County
Commission Expires July 30, 2014
$63,582,066
a
$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
$1.90,811,131
$190,811,131
0
5,000,000
0
$156,938,671
($5,335,190)
$156,603,481
$347,414,611
ALYSSA TURKOVITZ
Notary Public, State of New York
No. 01TU6044514
OualHied In Westchester County
Commission Expires July 10, 2018
LIABILITIES
$179,140,947
0
Reinsurance payable on paid Mosses and loss adjustment expenses
31rW,141
toss adjustment expenses
0
Commissions payable, contingent commissions and other similar charges
0
Olherexpensas (exdudingtaxes.licenses and fees)
0
Taxes, licenses and fees (exdudm8 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 withheld or retained by company for account of others
0
Remittances and Items not &located
0
Provision for reinsurance
$226,614,039
Net adjustments In assets and Labllltlesdue 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
liablllty for amounts held under uninsured plans
0
Aggregate wrlte-Imfor liabilities
(I
Total Mobilities excluding protected cog Ilabillbes
0
Protected call liabilities
0
$5,530,837
Total liabilities
0
0
POLICriOLDERS'S SURPLUS
0
Aggregate write -Ins for special surplus funds
0
0
Common capital stock
$7,124,971
Preferred appal stock
$347,414,611
Aggregate wrltearo for other than special surplus
0 Surplus Nates
T OTA15 347.x14 Al l Gross paid In and contnbuted surplus
CERTIFICATE
I certify that the above financial statements to the best df my
knowledge area true and accurate reflection of the financM.
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 the Texas
Deportment of Insurance as of the same date.
William J Gleason
Unassigned funds(surplus)
Surpus as regards policyholders
TOTALS
SUBSCRIBED and swam tome thls%�d,ofHv,
My commtsxcn expires: 7-/o—/T
Notarypublic
Printed Name
ALYSSATURKOVi12
7
c,St I ir+r
+aa b1lySrneolNewYork )
No.OITU6044514
Qualified In Westchester County
Commission Expires July 30, 2014
$63,582,066
a
$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
$1.90,811,131
$190,811,131
0
5,000,000
0
$156,938,671
($5,335,190)
$156,603,481
$347,414,611
ALYSSA TURKOVITZ
Notary Public, State of New York
No. 01TU6044514
OualHied In Westchester County
Commission Expires July 10, 2018
RELEASED �uLC1 Premium: $7,402.00
Date: 0 ISL
Signature:— G
City Clerk
city of San Juan a�i�tr�nSUBDIVISION FAITHFUL PERFORMANCE BOND
(GOVERNMENT CODE 66499.2)
Bond No. SUR21000007
Replaces Bond No. SUR20000342
KNOW ALL MEN BY THESE PRESENTS, that Pacific Paint 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:
Street subdivision improvements within Tract 16752 as defined within Amendment #1 and
Reinstatement of the Subdivision Improvement Agreement for Tract 16752
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
Nine Hundred Eighty Six Thousand Nine Hundred Thi Two Dollars and 00/100 Dollars, ($9$6.932.00 ) 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 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:
SURETY:
Ironshore Indemnity Inc.
Ry:
Margar . Ginem , Attorney -In -Fact
C/O WILLIS OF FLORIDA
Surety Phone No. 4211 W. BOY SCOUT BLVD,#1000
TAMPA, FL 33607
INQUIRIES: (813)281-2095
Page 2of3
(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 § 1189
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 CaliforniMA
County f
On before me,
Dat .0, Here
� I(j,
personally appeared
Name(s) of Signer(s)
RTA
k/
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
Notary Public - California
z Orange County
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 - k�E6
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 .
n6 6 (7-- ( –'—
Signature
Anett Cardinale
ti:P,Y rk••., ANETT CARDINALE
Commission # FF 13B4B2
Expires July 28, 2018
� HaMiad lku Troy Fain Inwrines E90.305.1019
This area for Official Notarial Seal
`Set . 13W i"O. 01 4AiCii0--$e(tjQjig 1199 ap -of ihei: C.' L!CQ(f6- U4 Set,, 90 -bf tho
.ji. jVI
QoVerpi4e.W. Code, yejgoo uoi.aMs. pqblir__'ThebeWw�-physical format pf.Oic,. hewd.isqj-osure
A., liot.W, _Ofi0 1 . I icer doidpioin_dtfii*..
c or of her Offide CP
ceiiiFica* verifies only the identity of the
-individuai who.'iped the d'D&UXMTit.tO WbidhibU
S
.certificata.isaftaehed and not the tnithUness-
40*46y, 0 VOICO.ty pf 01#44umem-
8tw. Pf C-aliforn.i.a.
�C
..bfinty of
oil ttb,
iL=t name and fitie dofficeO, pemnally appeared A0
p basis. pypd �O mg ow* bas.o
,&6.,wjthjrj �insirmea. and acknowledged -to -me, that-, hdshefthqy executed tho.sarne:'In- histher/their-
aft )yOtjZqd'Vr. e" I tnifn p C
4cijy(je�), and ffiat. by, -�jsjjtq ix4pAturew -qa'tfi Ms 0 t #ie. V rson(s),:'Or Tie
_eiwtyupb�. 6ehAif of,,A1,W6e, Oeesbt*). �fpd, ekeqAed thOinstru6brit
4itify''006r he laws Sof 66� stag Qf Califomi-a tot the &iegoiri%
paTagraph i"s true and correa-
WUNESS-My_hAnd u.4.6fficid�Seal.
POWER OF
III- 21000007
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.
N
i
By:
aan a L, Sus 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.
Y 4 ren,,
AMY L TAYLOR
_ ?
Notary Public- Stale of Tennessee
•
Davidson County
�,..``++^����� ``,,.��
My Commission Expires 0109-16
�" 1_44�t
Amy L. Tayl
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
ren;
p � sr•A�
1 1919
h�yptRf
2ul. Go 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."
IRONSNORE INDEMNITY INC
FINANCIAL STATEMENT SUMMARY
As of December 31, 2014
ASSETS
0
UABIum
Bonds
$179,140,947
Icasa
$63,582,066
Preferred stocks
0
Reinsurance payable on paid losses and loss adjustment expenses
0
Common stocks
31,840,141
less adjustment expenses
$10,384,957
Mortgage loans on real estate: Jtrst @ens
0
Commissions payable, contingent commissions and other similar charges
$1,020,805
Mortgage Irons on real estate; other than first liens
0
Other expenses (excluding taxes. licenses and fees)
$5,435,125
Properties occupied by the company
0
Taxes„ licenses and fees (excluding federal and foreign income taxes)
$2,383,909
Properties held for the production of income
0
Current federal and foreign Income taxes
$2,434,392
Properties held for sale
0
Net defet red tax liability
0
Cash. cash &WIvalentsand short-term investments
$15,632,951
Unearned premiums
$29,158,576
Contract loans
0
Advance premium
$1S6,938,671
Derivatives
0
Ceded reinsurance premiums payable (net of ceding commissions)
$58,222,187
Other invested assets
0
Funds held by company under reinsurance treaties
0
Receivables for securities
0
Amounts withheld or retained by company for account of other
$347,414,611
Securities lending reinvested collateral assets
0
Rrmlltances and nems not a'located
4)%5
Apyrtgate W Ac ins FOr„zvPV ed ass['lS
D
PrOri uon for reinsurance
$1,545,07$
Subtota I s. cash a nd I nvested assets
$226,614,039
Net adjustments In assets and@abllltlesdue toforeign exWngerates
ALYSSA TURKOVITZ
Title planta less $_, Charged off
0
Drafts outstanding
Ndwy Public, State of New Voff(
Investment income due and accrued
$990,960
Payable to parent, subsidiaries and affiliates
$12,458,110
Uncollected preirfurins and agents' balances In the course of collection
$73,567,547
Derivatives
0
Deferred premiums, agents' balances and Installments booked but deferred and not
0
Payable for securities
0
yet due
Accrued retrospective prerniums
0
Payable for securities lending
0
Amounts recovmIxe from reinsurers
$33,586,257
liability for amounts held under uninsured plans
0
Funds held by or deposited with reinsured companies
0
Aggregate write -Ins for liabilities
$4,185,928
Other amounts receivable under reinsurance contracts
0
Total liabilities excluding protected call liabilities
$19(1,811,131
Amounts receivabe relating to uninsured plans
0
Protected cell liabilities
Current federal and foreign income tax recoverable and interest thereon
0
Net dcfe„ed tax sssct
$5,530,837
Total liabilities
$190,812,131
William 4 Gleason Qualified In Westchester County
U1 YP_.$. may- [- Commission Expires July 10, 2014
0
Guaranty funds receivable or on deposit
Furniture and equipment, Including health care deRveryassets
0
POUCYFFOLDEFWSSURPLUS
Net adjustment In assets and liabilities due to foreign exchange rates
0
Aggregate write -Ins for special surplus funds
0
Receivables from parent, subsidiaries and affiliates
0
Health care and other amounts receivable
0
Common cal*tal stock
5,000,000
Aggregate write-ins for other than invested assets
$7,124,971
Preferred capital stock
Total assets excluding Separate Accounts,Segregated Accounts and Protected Cat
$347,414,611
Aggregate write;ns for other then special surplus
0
Accounts
From Separate Accounts, Segregated Accounts and Protected CeilAccounts
0
Surplus Notes
TOTALS
347 d14 611
Gross paid In and contributed surplus
$1S6,938,671
Unassigned funds surplus)
($5,335,190)
Surptus as regards pollcyholders
$156,603,481
TOTALS
$347,414,611
SUBSCRIBED and sworn to methisyday ofMf%
4)%5
Mycommissienexpirer 7-/O—/T
y -
Notary Public
ALYSSA TURKOVITZ
CERTIFICATE
Printed Name
Ndwy Public, State of New Voff(
I certify that the above financial statements to the bestof my
No. 01 TU6044514
knowledge are a true and accurate reflection of the financial
ALYSSATURK0M
��1
Ql1Bilfied In ilk@StCtte&tef C./]Uflty
condition of the Company as of December 31, 2014,
...f
/
COtnrnie39�on Expires July 10r 2018
Additionally, l certify that the above financial statements are
In agreement with the Statutory Financial Statements filed with the Texas
Nota�,"Ic. State al Newyork
Department of Insurance as of the some date,
r -
No.01TU6044514
William 4 Gleason Qualified In Westchester County
U1 YP_.$. may- [- Commission Expires July 10, 2014
RELEASE
Date:
Signature:
City Clerk BDIVISION LABOR AND MATERIAL BOND
City of San Juan C st�'ano,
(GOVERNMENT CODE 66499.2)
Bond No. SUR21000007
Replaces Bond No. SUR20000342
KNOW ALL MEN BY THESE PRESENTS, that Pacific Point Develo ment 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:
Street subdivision improvements within Tract 16752 as defined within Amendment #1 and
Reinstatement of the Subdivision Improvement Agreement for Tract 16752
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
Nine Hundred Eighty Six Thousand Nine Hundred Thirty Two Dollars and 00/100 Dollars ($986,932.00 ) 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
By:. S,
Its:a�-1�,0� ztJ
SURETY:
Ironshore Indemnity Inc.
(NOTARIZATION AND SEAL)
(NOTARIZATION AND SEAL)
By:
Marga tA. Ginem , Attorney -in -Fact
WO WLLIS OF FLORIDA
Sure Phone No. Boy SCOUTBLVf],#f�
Surety TAMPA, FL 33607
iNQUIRIES: (813)281-2()95
Page 2 of 3
APPROVED AS TO FORM:
r
By: r
NOTE: Please attach Acknowledgement and Power of Attorney
Page 3 of 3
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189
1 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 )
Coun of
On L before me,
Date re 1 sert am e and 77tl 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 # 2088328 z
Notary Public - California x
z Orange County a
NlComm. Expires Oct 31, 2018
Place Notary Seal Above
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.
d�Signature _
Signature of Notary Public
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: Document Date:
Number of Pages: Signer(s) Other Than Named Above: -
Capacity(ies) 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
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
• or Expires July 28, 2018
Bonded Thru Troy Fein Insurance 800.385.7018
This area for Oficial Notarial Seal
0 'he: UvR, bode Semte 131111'050, ameftd�, gecti ns. 1-:189 bod. 119$ oft .i C u4 Seaton V 0� -of the
4.)W- Phys i cal formatofth6w
c,ndisclosure
-notice -is .4,ex3anp le, rpr.pw.Qqp of lftistratim.
A tiotaty, p)ulific or other officer t j
ceriifica4 vetifies. only. the identity of the
indi iduaj vrhos'igned the doo 'b;
toeft,to which -t U.
,certifloat-, is atLi6hedo and not the trtithfulnessi
Acctiraoy, or validity of th4r,404umem.
.State pj4paliforni.a,_
.C.6unty, of
ibswt name andlitle of officer5, personally Oppeorod
proy-g4:rO.til q oo - the basis of Wisfaqwy evidenbit to "Lid thm. -pr&.rsdfi( Wb
Whps�q harn4i) JW4�t_ 6
e. at4
,66. witfiililhs Ument, and acknowledged to me; that helsheithey executed the :same .in histherAeir,
4Rthwiged_,m'pacf',6Wm.W_jt( 'Onjhs IOW&KOIt t poson(s), of : jh&
shat. by. hiS�A'64r/
�eAtity-fipb4behalf oflOir*ftpa ofi(�),Acfed, ekequwdtjj&.-i , astru nt
I b�. if VYWr PEN;AL'Li(-O P Vk-Y -0 CAI!f la
FIRIJ ftrlbe j of St 6�f ornl that h4t thA
paragraph is true and correO-
WUNESS inyhAnd and dfficii4l- SCA,
EY
III- 21000007
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.
�SPW4 q
EAL r� P
Sy: -
Oan a 1. Suss 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.
46o
Amy L 'rayl
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 MayZD 15
I `'91f
X /IX
Paul s. Give no
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."
— —
•e
AMY L TAYLOR
Nolary Publl,_ Stale of Tennessee
Davidson County
My Commission Expires 01-09-16
46o
Amy L 'rayl
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 MayZD 15
I `'91f
X /IX
Paul s. Give no
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."
IRONSNORE INDEMNITY INC
FINANCIAL STATEMENT SUMMARY
As of December 31, 2014
ASSETS
Bonds
Preferred stocks
Common stocks
Mortgage loans on real estate: First kens
Mortgage loans on real estate; Other than first liens
Properties occupied by the company
Properties held for the production of Income
Properties held for sate
Cash. cash awtvalents and short-term Investments
Contract loans
Derivatives
Other invested assets
Receivables for securities
Securities lending reinvested collateral assets
Aggregate wrlte-Insforinvested assets
Subtotals. cash and Invested assets
Title plants less S._ Charged off
Investment Income due and accrued
uncollected premums and agents' balances In the course of collection
Deferred premlums, agents' balances and Installments booked but deferred and not
yet due
Accrued retrospective premiums
Amounts recovera lite from reinsurers
Funds held by or deposited with reinsured companies
Other amounts receivable under reinsurance contracts
Amounts receivalxe relating to uninsured plans
Current federal and foreign income tax recoverable and interest thereon
Net defcrreJ U3. asset
Guaranty funds receivable or on deposit
Furniture and equipment, Including health care slavery assets
Net adjustment In assets and liabilities due to foreign exchange rates
Receivables from parent„ subsidiaries and affiliates
ilea It are and oth er a rn a unci receivablt
Aggregate write -Ins for other than Invested assets
Total assets excluding Separate Accounts, Segregated Accounts and Protected Cek
Accounts
From Separate Accounts, Segregated Accounts and Protected Cell Accounts
UABIUTIES
$179,140,947 lasses
0
Reinsurance payable on paid losses and loss adjustment expenses
31,840,141
Loss adjustment expenses
0
Commissions payable, contingent commissions and other similar charges
0
Other expenses (eictudingtaxes.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 withheld or retained by company for account of others
0
Remittances and items not allocated
0
Provision for reinsurance
5226,614;039
Net adjustments In assets and Liabilities due toforeign exchange rates
0
Draftsoutstandln9
$990,560
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 write -Ins for liabilities
0
Total liabilities excluding protected cell liabllldes
0
Protected cell liabi0sles
0
$5,530,837
Told Babrlities
0
0
POUC'YHOLDEAS S SURPLUS
0
Aggregate vmte-lnsfor special surphisfunds
0
0
Common capital stock
$7,124,971
orE4eifed capital seock
$347,414,611
Aggregate write -is for other than special surplus
0 Surplus Notes
TOTALS $347,414,611 Gross paid In and contributed surplus
CERTIFICATE
I certify that the above financial statements to the bat of my
knowledge area true and accurate reflection of the financial
condition of the Company as of December 31, 2014,
Adiflbu"lly, I crrtity Ihat the -hove flnnnclal statrmentz are
In agreementwlth the Statutory Financial Statements filed with the Trxa:
Department of Insurance as of the some date.
WNllam 1 Gleason
Cf4, leP.lh rrmlN2ifa_
Unassigned funds jsurplus)
Surpaus as regards policyholders
TOTALS
$63,582,066
0
$10,384,957
$1,020,805
$5,435,126
$2,363,909
$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
$190,911,131
0
5,000,000
0
$156,938,671
($5,335,190)
$156,603,481
$347,414,611
SUBSCRIBED and swomtome thksLcd ofH'%yr !ijS
My comngssktn expires: _7 -/0—/t -
Notary
fv—/t-
Notary Public
Printed Name At.YSSA TURKOVIIZ
Notary Public, State of New York
No. 01 TU6044514
ALYSSATUIIKG1fiR Qualified In Westchester County
ComrNa%ion Expires July 10. 2018
ffiMp"Ir. Stau of Naw York
No.01TU6044514
Qualified In Westchester County
Conmmisslon Expires July 10, 2014
RE—LEE` ED V Premium: $533.00
Date;
Signature:
City Clerk
City of San Juan Capistrano, C�•
SUBDIVISION FAITHFUL PERFORMANCE BOND
(GOVERNMENT CODE 66499.2)
Bond No. SUR21000009
Replaces Bond No. SUR20000343
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:
Storm Drain subdivision improvements within Tract 16752 as defined within Amendment #1 and
Reinstatement of the Subdivision Improvement Agreement for Tract 16752
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
Seventy One Thousand One Hundred Eighteen Dollars and 00/100 Dollars, (71,118.00 ) 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 , 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: k*X'A , �► S:
SURETY:
Ironshore Indemnity Inc.
By:
Margaret Ahinem , Attorney -in -Fact
C/O WILLIS OF FLORIDA
Surety Phone No. 4211 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:
NOTE: Please attach Acknowledgement and Power of Attorney
Page 3 of 3
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189
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 of rj n ) r
On before me, 1 1.U1 Gt f 1�ul Y u�ll
Dae r. i . . c-\ Hears Inset Name and Title 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 z
� �� Notary Public - California
x Orange County n
my Comm. Expires Oct 31, 201 B t
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
-'A' ^G'• ANETT CARDINALE
:.
Commission # FF 138482
• - Expires July 28, 2018
•�TifBonded Thru Troy Fein Insurance 800-385.7079
This area for Official Notarial Seal
-Of"'fhe: OWL CO& U4 settio-li $2010 th,
-Sc4ati� Bill 1'0$.0. bfteb(fs- :Sections 1:189 acid `j 19$
Qoycvft4cAi. CQ46i ttja4gqp noiafjes. p-AbIfelbb :bplp�v- Aygical format- Of tie rim disclosure
n
-Rp0cgj--=e,xa!npIL-,-rqr' ltur apses -of illustratim-
AL)iotgty,
liblic of oth6r affide coiiipli tiny this;.
ceftificaLivetifies only, the id6,n.tity'o'f the
indii.viduai W'ho- Signed the dogptnewp whl&lft
.c ert i floate, is. attached, and not the truthfulness�
apour 0 y - Ot validity of th at, 4 ou Mem
'8t* of Califorbia -
C.Oun"'ty of
Oft6'rb
-insert-insertname and -title of,-oificerj,'Personally appeared Whq
proyed to ir(ori tho'basis of -to,
latisfactoty evidmbo to bp the, ptno(O Whcst� kiarne(s) i4 Ue Wb.s;
alae- with i r -1 in§trument. and ackwwledged -to -m& that- heishelthey excouted iho.samt iii his/heritbeir,
*qAw'.Z,ed'rapa,eiiy(ips), 499 OiAt by l isftjffieir 'Mpau qn t1ie. ij Oic
y - On&r iENALTY' OF PW" ORY 'u rider jh e la w''§ -of t1te. SW& Qr CAI ifbrnlll - tha, the fdflegoidg
Paragraph' i" true and' correct,
WUNESS, irj� hAnd a6d.-officid Seat,
POWER OF ATTORNEY
III- 21000009
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.
07
ip�e 1
By.
Dan L. Suss 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.
.
A10Y L-TAYLUR
Notary Public- State of Tennessee
'Davidson county
My Com mission Expires 01-09-16
J,Vv,a
Amy L Tay
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 May 20 15
eFwL
� � r
Paul S. Gk danq
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 INDEMNITY INC
FINANCIAL STATEMENT SUMMARY
As of December 31, 2014
ASSETS
Bonds
Preferred stocks
Common Stocks
Mortgage loans on real estate: Post tens
Mortgage loans on real estate; Other than first liens
Properties occupied by the company
Properties held for the production of Income
Properties held for sale
Cash, cash equivalents and short-term investments
Contract loans
Derivatives
Other invested assets
RccelweWuc for smuritica
Securities lending reinvested collateral assets
Aggregate write -Ins forinvested assets
Subtotals. cash and invested assets
Title planta less $.., Charged off
Investment Income due and accrued
Uncollected prerrtums and agents' balances in the cause of collection
Deferred premiums, agents' balances and Installments booked but deferred and not
yetdue
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
G ti hi aakp Amds mceivnnle s on depa it
Furniture and equipment Including health are delivery assets
Net adjustment In assets and liabilities due to foreign exchange rates
Receivables from parent, subsidiaries and affiliates
Health care and other amounts receivable
AggrCgale mrte-lns for other than invrs tcd ass eu
Total assets excluding Separate Accounts, Segregated Accounts and Protected Cels
Accounts
From Separate Accounts. Segregated Accounts and Protected Cell Accounts
LIABILITIES
$179,140,947 1"*
0
Reinsurance payable on paid losses and loss adjustment expenses
31,840,141
loss adjustment expenses
0
Commissions payable, contingent commissions and other similar charges
0
Other expenses (excruding 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 premiumo payable (net of ceding commissions(
0
Funds held by company under reinsurance treaties
D
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 to foreign 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 writc-Insfor liabilities
0
Total liabilities excluding protected cell liabilities
0
Protected cell liabilities
0
$5,530,837
Total liabilities
0
0
POLICY114OLDETl5'S SLAPLUS
0
Aggregate wnte-Ins for special surplus funds
0
0
Common aotal stock
$7124,971
preferred appal stock
$347,414,611
Aggregate write-ins for other than special surplus
0 Surplus Notes
TOTALS $347,414,611 Gross paid In and contributed surplus
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 ■s of December 31, 2014,
Additionally, I certify that the above financial statements are
in agreement with the Statutory Financial Statements filed with the Texas
Department of insurance as of the same date.
WNllam J Gleason
$f4..YR-&TrmvLt I_
Unassigned funds (Surplus)
SuWte; 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
a
$156,938,671
($5,33S,190)
$156,603,481
$347,414,611
SUBSCRIBED and sworn tome yof%c%fjyf1%rj
My commtssaon expires: -7-10—lir
n
Nory Public
Notaryted Name ALYSSA TURKOVIIZ
Notary Public, State of New York
No. 01 TU6044514
ALYSSATIJftItOYf1I Qualified in Westchester County
Lommlesion Expires duly 10, 2010
Nc J bill, Stan aT Naw Yark
- r
No.01TU6044514
Qualified In Westchester County
Commission Expires July 10, 2014
RELEASED} '
Date;
Signature.
City Clerk
City of San Juan Capistrano, UBDIVISION LABOR AND MATERIAL BOND
(GOVERNMENT CODE 66499.2)
Bond No. SUR21000009
Replaces Bond No. SUR20000343
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:
Storm Drain subdivision improvements within Tract 16752 as defined within Amendment #1 and
Reinstatement of the Subdivision Improvement Agreement for Tract 16752
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
Seventy One Thousand One Hundred Eighteen Dollars and 00/100 Dollars $71,118.00 ) 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
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:
Its: ��%H.v�, S► tu.►�-ar
SURETY:
Ironshore Indemnity Inc.
By: k4�� 4 AK�
Margar A. Ginem , Attorney -in -Fact
CIQ WILLIS OF FLORIDA
1211 w. BOY 50001' BLVD, #100
Surety Phone No. 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 § 1189
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 of )
On tllld before me,
Date[ Hphib,)ere 1 rt Name an Title of he Officer
personally appeared'dx-&(em
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
i"a Notary Public - California z
Orange County '
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 . W(&&' __
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 written.
Signature
Anett Cardinale
1��1 p�•r�
i•.�;
ANETT CARDINALE
=.;
Commission # FF 138482
A
Expires July 28, 2018
•'.,R�,
Bonded Thru Troy Fein Insurance 800.395.7019
This area for Official Notarial Seal
este $ill 1050, mteIiOs$e0i.ri§J!9q b*1 9-20-oflfw
0 0 5
felating-t0,n9taft-es piibjfe: noe belpwPhy'sicil format of . ffie-hmf iisclosure
tvfceAs--4nexEppIq-f
prpurposq oMUSOatium.
f
ribby public of other 6ffidef coiripleting this;.
cerfificate verifies only the id6nfity of the
individualwha, si 'pedt the dot
. I . pWritAqwhib
,certificate. is attached; and not the truth illness;
umirazy, or vaWity ofthat doeumem
-%i* of cm, ifornia
.Q�iunty. of
.Oft ine,
,ihsert narrxc and'fitle ofofficerj,'per-mAlly appeared
'ba '6�: the Verson(ty Whoso hame(i) isl4r6. Wribed: ta
to y4j. or) the is. of s—absfaMry evidenbb to su
Jis�d -iAktrumeint and acknowledged -to me-Ibat: helshe/they executed Lhe.samv- .in- Fis/her/their,
16 ' Withi tru f- , (S) the
4vI-b-qtjZ.ed j�apaciiy'(to),, O;d .that- by. 4q Oi� '10§fhOlat the-porsbil .bt
tfttj ty. qott. behalf of-,AihIph the, P&sofio),acfed, ekecuted $e--;Instruiue'nt.
I C ro , -41*r PENkC ' "6F'#)3]d'IJRY e J" Qt &�Stato, �Malltbrbl '-thOA6
der th laws ia fdrf-goirig',
-Paragra,O'h- i' true and',correct
WUNESS-irty.hand..'a*a'd-bffilcid SCA
8 -igafux (Sea)).
POWER OF
III- 21000009
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.
aeAt
}f 1!
By:
Dane L. suss 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.
gwv� L461L
Arny L. Ta
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
11rx
rlr�
>N
Paul S. Gi darty
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."
AMY L TAYLOR
_ -
=Davidson
y �$
Notary Public- Slate of Tennessee
County
My Commission Fxpires0l-0316
gwv� L461L
Arny L. Ta
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
11rx
rlr�
>N
Paul S. Gi darty
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."
IRONSNORE INDEMNITY INC
FINANCIAL STATEMENT SUMMARY
As of December 31 2014
ASSETS
Bonds
Preferred stocks
Common stocks
Mortgage loans on real estate: Ffnt bens
Mortgage loans on real estate; Other then first liens
Properties occupied by the company
Properties held for the production of Income
Properties held for sale
Cash. cash equivalents and short-term Investments
Contract bans
Derivatives
Other invested assets
Receivables for securities
Securities lending reinvested collateral assets
Aggregate wrlte-Ins forinvesind assets
Subtotals, cash and Invested assets
Title plants less $.., Charged off
Investment Income due and accrued
Uncollected prerrsums and agents' balances in the course of collection
Deferred premiums, agents' 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 recenalge 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
Net adjustment In assets and liabilities due to fore gn exchange rates
Receivables from parent„ subsidiaries and affiliates
Health ore and other amounts receivable
Aggregate wrKrins for other than Invested assets
Total assets excluding Separate Accounts, Segregated Accounts and Protected Cet
Accounts
From Separate Accounts. Segregated Accounts and Protected Cell Accounts
0 Surplus Notes
TOTALS z _ $347,41A,631 Gross paid In and contnbuted surplus
CERTIFICATE
I car" that the above financial statements to the bestof my
knowledge are a true and accurate reflection of the financlai
condition of the Company as of December 31, 2014,
Additionally, l certify that the above financial statements are
In agreement with the Statutory Financial Statements filed with the Texas
Department of Insurance as of the some date.
Unassigned funds surplus)
Surplus 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
$4,185h928
$190,811,131
$190,811,131
0
5,000,000
0
$156,938,671
($5,33S,190)
$156,603,481
$347,414,611
SUBSCRIBEDand sworn tometh€s`! avofHg4
LIABILITIES
$179,140,947
Losses
0
Reinsurance payable on paid losses and loss adjustment expenses
31,840,141
Inas adjustment expenses
0
Commissions payable, contingent commissions and other similar charges
0
Other expenses (excluding taxes. licenses and fen)
0
Taxes, licenses and fees (excluding federal and foreign Income taxes)
0
Current federal and foreign income taxes
0
Net deferred tax liability
$15,632951
Unearned premiums
0
Advance premium
0
Ceded reinsurance premiums payable (net of ceding commissions)
0
Funds held by company under reinsurance treaties
0
Amounts withheld or retained by company for account of others
0
Remittances and Items notelloated
0
Provision for reinsurance
$226,614,039
Net adjustments In assets and tablllttes due to foreign exchange rates
0
Dreftsoutstendbhg
$990,960
Payable to parent, subsidiaries and affiliates
$73,567,547
Derivatives
0
Payable for securities
0
Payable for securities lending
$33.58k257
Uablilty for amounts held under uninsured plans
0
Aggregatewrlte-Ins for liabilities
0
Total liabilities excluding protected cell liabllldes
0
Aroieci ed cell h4bilaies
0
$5,530,837
Totelilablilties
0
0
POLICYHOLDERSS SURPLUS
0
Aggregate write-ins for spedalsurphrsfunds
0
0
Common capital stock
$7,329971
preferred capital stock
$347,414,611
Aggregate writearts for other than special surplus
0 Surplus Notes
TOTALS z _ $347,41A,631 Gross paid In and contnbuted surplus
CERTIFICATE
I car" that the above financial statements to the bestof my
knowledge are a true and accurate reflection of the financlai
condition of the Company as of December 31, 2014,
Additionally, l certify that the above financial statements are
In agreement with the Statutory Financial Statements filed with the Texas
Department of Insurance as of the some date.
Unassigned funds surplus)
Surplus 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
$4,185h928
$190,811,131
$190,811,131
0
5,000,000
0
$156,938,671
($5,33S,190)
$156,603,481
$347,414,611
SUBSCRIBEDand sworn tometh€s`! avofHg4
Mytommismanexpires- %-/p-/T
NotaryPublic
ALYSSA TURKOVITZ
Printed Name
Walry Public, State of New York
No. 01TU6044514
ALYSSATUA1f0VM _- _�»-�.Y --
7
Qual(nE>d in Westchester County
Commission
Expires .July 10, 2918
tip f� $Secs! nl New Yorte -
No,01TU6044514
wullem) Gleeson Qualified In Westchester County
s19- YPP St:aisisl. Coramhshm Expires July 10, 2014
RELEA�S D
Date:
Signature:
City Clerk
City of San Juan apistrano,
Premium: $641.00
SUBDIVISION FAITHFUL PERFORMANCE BOND
(GOVERNMENT CODE 66499.2)
Bond No. SUR21000014
Replaces Bond No. SUR20000344
KNOW ALL MEN BY THESE PRESENTS, that Pacific Point Development Partners, LLC
(hereafter designated as "Principal"), and Ironshore Indemni!Y 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:
Sanitary Sewer subdivision improvements within Tract 16752 as defined within Amendment #1 and
Reinstatement of the Subdivision Improvement Agreement for Tract 16752
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
Eighty Five Thousand Four Hundred Eighty Five Dollars and oo/1oo Dollars, (85,485.00 ) 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 , 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
k�By: �S
Its:
SURETY:
Ironshore Indemnity Inc.
By:
Margare4k Ginem , Attorney -in -Fact
OF FLORIDA
Surety Phone No. 211 W BIOYISCOUTBLVD, 10 0
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
¢'n.: •n.A..0j..s\.:i]J.�i:....v.Yx-�j..i�.atC:]�.s12+=+i: s_�t. n2!�±.i _r..vi�:.:^h Y: '[�i.:mi..�1C..'t\.: i�. :\2'?.�.i\. ..cli�l\��\��'aiFi�•. J..[ s��'-1: t}i.:\N3\�•.'.i�.ttii��e
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 of NAC-) rr r
On before me, I ma C ,
D to n i I, -, Here.inseri Nan4e and Title of tde fficer
personally appeared
Name(s) of
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.
EW. CORGI
Commisston � 2088325
iNotary Public - California
Z 0 Orange County
My Comm. Expires Oct 31, 241Pw 8 J
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: Document Date:
Number of Pages: __ Signer(s) Other Than Named Above:
Capacity(ies) 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: _ T_
❑ Corporate Officer — Title(s):
❑ Partner — ❑ Limited ❑ General
❑ Individual ❑ Attorney in Fact
❑ Trustee ❑ Guardian or Conservator
❑ Other:
Signer Is Representing:
r41
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-
.,
J
Signature
Anett Cardinale
:Fyr ANETT CARDINALE
Jig �. Commission # FF 138482
Expires July 28, 2018
Bonded Thru Troy Fain Insurance 800-385.70%
This area for Oficial Notarial Seal
': 0 R _904th,
'�S�teAOM. 1050, ar=(k$eotiOri�- 11 V �md !195. of S'ecji�vt 9,
Q pie ,Code;, tre sting to p.�es. tb1fe: The.: format
bsiir6
-noticeI&-anex�plefor put
of ilju*atjun,
A liqti.ry p
:.ia Iic of other affidr* 6DiO0lgtinbztbj$-
cerfiflimte verifies only the idbntity6f the
individualwho. signed the doeptnerkto wbithtW
.certificate, is atfadhed, and not the tnithfulnessi
'ACCOrOy, q validity of lhg 404wimt.
State of qdlifonli.a.
C.�Unty, of
_..Jmfbrd me,
.insert name and� titic d-officer),'personally oppewed
poye
WTOW-ori-00
tbe. - vvidiiii -fntrument: and acknowledged to mw'that! behhe/they executed the same. in his/her/their,
4U*(*Pd ca'PaeliAes), a0d ftby. Wkrfifiejr Ava*ew vn.; 4fe' -4strutRot the v'6"bllw'or the
-edtity, tv . keted 0lWinstament
behalf of,-%Wbirh'th& Oeftfi(�)Ac fed, e
P GT 14. OF' �M. Vky '�n ' r ' lb* e Jof tbd. �tw 6f, dA
ENk de- a -w§ th.4t the fdrogojn4,
) true Paraga iS -ue and'correct,
WnNES&iny'lAnd and..6ffi6aA sear:
Sfg- n Sau r. (Seal)
ATTORNEY
III- 21000014
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.
-
e
t+tt+t J
By.
Dane I.. Suss 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.
AMY L TAYLOR
Notary Public- Slate of Tennessee
- _ Davldson County
p n� MX Commission Expires 01-09-16
A., � ,�a
Amy L. Tay
Notary Pudic
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
ns.Of
Paul 5. Gi darto
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 sNDEMNIIY INC
FINANCIAL STATEMENT SUMMARY
As of December 31, 2014
ASSETS
Bonds
Preferred stocks
Common stocks
Mortgage loans on real estatm first liens
Mortgage loans on real estate; OUw than first liens
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
DerlveUves
Other invested assets
Receivables for securities
Securities lending reinvested collateral assets
Aggregate write-Insforinvested assets
Subtotals. cash and Invested assets
Title plants less S.., Charged off
Investment Income due and accrued
Uncollected premiums and agents' balances In the course of collection
Deferred premlums, agents' balances and Installments booked but deferred and not
yetdue
Accrued retrospective premiums
Amounts recoverable from relnsuren
Funds held by or deposited vdth relnsured companies
Other amounts receivable under reinsurance contracts
Amounts recehabie 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 care delivery assets
Net adjustment In assets and liabilities due to fore gn exchange rates
Receivables from parent, subsidiaries and affiliates
Health care and other amounts receivable
Aggregate write -Ins for other than Invested assets
Total assets excluding Separate Accounts, Segregated Accounts and Protected Cat
Accounts
From Separate Accounts, Segregated Accounts and Protected Cell Accounts
0 Surplus Notes
TOTALS 534'1,+634,611 Gross paid in and contributed surplus
CERTIFICATE I
I certify that the above financial statements to the bestof my
knowledge are a true and accurate reflection of the nnanclal
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 tha Texas
Department of Insurance as of the some date.
WBllam J Gleason
1: f0. Y?A Ti m,is r -
Unassigned funds surplus)
Surplus as regards policyholders
TOTALS
$63,582,066
0
$10,384,957
$1,020,805
$5,435,126
$2,383,909
$1,434,392
0
$29,158,576
$58,222,187
0
$1,545,075
$12,458,110
0
0
0
$4,18S,92B
$19Q811,131
$190,911,131
0
5,000,000
0
$156,938,671
($5,335,1901
$156,603,481
$347,414,611
SUBSCRIBED and swom to me this°�jrlar of May,
LIABILITIES
$179,140,947
Losses
0
Reinsurance payable on paid kisses and lass adjustment expenses
31,840,141
Loss adjustment expenses
0
Commissions payable, contingent commissions and otherslmilar charges
0
Other expenses{exctudingtaxes. licenses and fees►
0
Taxes, licenses and fear (excluding 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
AnsOUALS col t hrrcid o r retalmd by Company for etc o u rut of othefs
0
Remittances a nd items not allocated
0
floc non for r4insw4nce
$226,614,039
Net adjustments in assets andLab] Jill es due toforeign exchange rates
0
Draftsoutslandln¢
$990,860
Payable to parent, subsidiaries and affiliates
$73,567,547
Derivatives
0
Payable for securities
0
Payable for securities lending
$33.586,257
Uablhty for amounts held under uninsured plans
0
Aggregate wrlttlmfor liabilities
0
Total Rablilties excluding protected cell flabindes
0
Protected cell liabilities
0
$5,530,837
Totidhabilitles
0
0
POUCY14OLDEWSSURPLUS
0
Aggregate wnte-lnsfor special surplus funds
0
0
Common capital stock
$7,124r971
preferred apltal stock
$347,414,611
Aggregate wrlte-lns for other than special surplus
0 Surplus Notes
TOTALS 534'1,+634,611 Gross paid in and contributed surplus
CERTIFICATE I
I certify that the above financial statements to the bestof my
knowledge are a true and accurate reflection of the nnanclal
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 tha Texas
Department of Insurance as of the some date.
WBllam J Gleason
1: f0. Y?A Ti m,is r -
Unassigned funds surplus)
Surplus as regards policyholders
TOTALS
$63,582,066
0
$10,384,957
$1,020,805
$5,435,126
$2,383,909
$1,434,392
0
$29,158,576
$58,222,187
0
$1,545,075
$12,458,110
0
0
0
$4,18S,92B
$19Q811,131
$190,911,131
0
5,000,000
0
$156,938,671
($5,335,1901
$156,603,481
$347,414,611
SUBSCRIBED and swom to me this°�jrlar of May,
rfJ J S
Mycomrrisson expires- 7-/(j—/T
NotaryPublk
ALYSSA TURKOVITZ
wimud Name
Notary Public, State of New York
No. 01 TU6044.514
'I'YSSATU—J� -'
) '
Ouelffled In Westchester County
I_ f`.�c.-7r
Camrrdsoion Expires July 10. 2010
No bil4 State df New York
No.01TU6044514
Qualified in Westchestar County
Commission Expires July 10, 2014
REL.EAs D
Date.
Signature:
City Clerk
City of San yuan stronQ'SUBDIVISION LABOR AND MATERIAL BOND
(GOVERNMENT CODE 66499.2)
Bond No. SUR21000014
Replaces Bond No. SUR20000344
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:
Sanitwy Sewer subdivision improvements within Tract 16752 as defined within Amendment #1 and
Reinstatement of the Subdivision Improvement Agreement for Tract 16752
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
Eighty Five Thousand Four Hundred Eighty Five Dollars and 00/100 Dollars ($85,485.00 ) 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
By: _
Its:NJ
E
SURETY:
Ironshore Indemnity Inc.
By: 2L4MAk", A!EL0--,Z
Margaret . Ginem , Attorney -in -Fact
C/O WILLIS OF FLORIDA
Surety Phone No. 4211 W BOY SCOUT BLVD, #1000
TAMPA, FL 33607
�NQLIIRIES: (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
ALL-PURPOSE •D
.r!s•a ri.:\..•n:. atCr�<.a:•. x.<. Ni..i:Ns. •-� <.-� :i..•7:.v:�Y. i�' .�...v..s...sn .v�. • .ate • gtiY_' �r� 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 )
County f }
On before me,
Gate Here
personally appeared ( �7
Name(s) of Signer(s)
Officer
IG
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 L
Notary Public - California z
z Orange County D
AR Comm. Ex ices 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 a16L__
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(ies) 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
❑ Othgr:
Signer/ Is Representing:
02014 National Notary Association - www.NationaiNotary.org - 1 -800 -US NOTARY (1-800-876-6827) Item 45907
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
ANETT CARDINALE
=•:
Commission # FF 138482
Expires July 28, 2018
Bonded Thru Troy Fein Ineurence 800-385.70,9
This area for Official Notarial Seal
I W of
lj�te dill 1050, aiftefi$s gecti6rig 1189 aMd, 1195-: of--*"fhe: OY4 -Codd- Wa Seotion 8.2. iia
O*y�pw relating jonoiaries;pti lice' phygic� . format
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_Clow
-pqdq� is -on exaMple,,.-
or pur
Ahom. .Uy p
. . t tic Ot Other 6ffi66 dow&fing thig
ceriffik-ati verifies.only the id6fity'cif the
individual who signed, the
_Cefiftoate, is afta6hed, and not the tr4thfidnessi
aqctjracy, of vaMjh(. pf th4T.doqimiertT_
8tAt,g bf CAforhia
,C.6unty. of
oil -bufor.6 fne, ffia
�insert Dame andlitle of officer), personally appeared Aar
hoso
to
on, th-0 of� qfktor W
.4ti. y ovidonpb
_fli6 withiri -iasnvmetit:,and acknowledged to mw that: helshelthey executed the - same- in his/her/their.
'Ra' '4), Ai bsftutnot Aiq penon(s), or thq
pa�fty(j a04 that: by bis/ficriffieir'sigha.lmire(4) -Ott.
tftfityum
acted, ekecdedtb&,instr bnt
-Oe�ifif - VYWr OF* P�k,JUORY*idprl be )a*§ of tbi� §WO, d ia g6
LT�( I 611ibrh' ',th.4fth6 rdre
-paragraph i's true and'zormck
WUNESS in.Y hAnd and.6fficia"I seal.,
III- 21000014
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.
SEAL
1919
By:
i7an a L, Suss 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.
�n(.y.. AMYL TAYLOR
- Ivo+Ary Pub1lC• 51o1c of irmrssee
Davidson County
My Commlulw Expires 01-09-16
Amy L Tay]
Notary FuWje
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 May 20 15
�}°Ra
` BEAL01
Paul S. Gi arro
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 INDEMNITY INC
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 gens
Properties occupied by the company
Properties held for the production of income
Properties held for sale
Cash. cash equivalents and short-term Investments
Contract loans
Derivatives
Other invested assets
Receivables for securities
Securities tending reinvested collateral assets
Aggregate write -Ins for Invested assets
Subtotals. cash and Invested asseb
Title plants less $_, Charged off
Investment Income due and accrued
Uncollected promiums and agents' balances in the course of collection
Deferred premlums, agents' balances and Installments booked but deferred and not
yetdue
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 dr l cu rd tax assn
Guaranty funds receivable or on deposit
Furniture and equipment, including health are delivery assets
Net adjustment In assets and liabilities due to foregn exchange rates
Receivables from parent, subsidiaries and affiliates
Health are and other amounts receivable
Aggregate wi lte-Ins for other than Invested assets
Total assets excluding Separate Accounts, Segregated Accounts and Protected Cet,
Accounts
From Separate Accounts. Segregated Accounts and Protected Cdl Accounts
LIABILITIES
$179,140.947 1a'
0
Reinsurance payable on paid tosses and loss adjustment expenses
31,840,141
los adjustment expenses
0
Commissions payable, contingent commissions and other similar charges
0
Other expenses (excluding loxes. licenses and fees)
0
Taxes, licenses and fees (exdud'mg federal and foreign Income taxes)
0
Current federal and foreign Income taxes
0
Net deferred tax liability
$15,632,951
Untamed premiums
0
Advance premium
0
Ceded reinsurance premiums payable (net of ceding commissions)
0
Funds held by company under reinsurance treatles
0
Amounts withheld or retained by company for account of others
0
Remittances and items not Vloated
0
Provision for reinsurance
$226,614,039
Net adjustments In assets and tabilltles due to foreign exchange nates
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 foramounts held under uninsured plans
0
Aggregate write -Ins for liabilities
0
Total liabilities excluding protected ce011abllltles
0
"rutecteo cell I'BIJlllt:es
0
$5,530,837
Total liabilities
0
0
POUCYHOLDEWS SURPLUS
0
Aggregate write -Ins for special surplus funds
0
0
Common aptal stock
$7,124,971
preferred appal stock
$347,414,611
Aggregate write -.ns for other than special surplus
0 Surplus Notes
TOTALS 534'7 414 611 Gross paid In and contributed surplus
CERTIFICATE
I certify that the above financial statements to the bestof my
knowledge area true and accurate reflection of the financial
condition of the Company as of December 91, 2014,
Additionally, l certify that the above financial statements are
in agreement with the Statutory Financial Statements filed with the Texas
Department of Insurance as of the same date,
NMllam J Gleason
V%SLP $Ftg&%V rRL
Unasslxned fundsburplus)
Surp'us 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
$4,1851928
$19o,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 to me this 'day of I l qq , 41 % S
Mycomrnlsoan expires,, 7-/V—/T
Notary Public
Printed Name Al_YSsa TURKOVIIZ
Notary Public, State of New York
ALYS5ATtJRKOViT! NO. 017116044514
Qualified in Westchester County
Gummjsaion Expires July 10, 2018
Hotae� WlwStaeeolfyewYark __
No.01TU6044514
Qualified In Westchester County
Commission Expires July 10, 2014
RELEA ED [ ,
Date:
Signature:
City Cierk
City of San Juan Capistrano,
Premium: $289.00
SUBDIVISION FAITHFUL PERFORMANCE BOND
(GOVERNMENT CODE 66499.2)
Bond No. SUR21000019
Replaces Bond No. SUR20000346
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:
Monument subdivision improvements within Tract 16752 as defined within Amendment #1 and
Reinstatement of the Subdivision Im rovemetn Agreement for Tract 16752
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
Thirty Eight Thousand Five Hundred Dollars and 00/100 Dollars, ($38,500.00 ) 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 , 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:
Its:
SURETY:
Ironshore Indemnity Inc.
By:
Mar gar A. Ginem , Attorney -in -Fact
Sure C/O WILLIS of FLORII)A
Surety Phone No. 4211 W. BOY SCOUT BLVD, 41WD
TAMPA, FL 33607
iNQUIRIES: (813)281-2095
Page 2 of 3
(NOTARIZATION AND SEAL)
(NOTARIZATION AND SEAL)
APPROVED AS TO FORM:
By:1
NOTE: Please attach Acknowledgement and Power of Attorney
Page 3 of 3
EY
III- 21000019
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
7`h day of August, 2013
IRONSHORE INDEMNITY INC.
By.
Dame L. Suss 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.
rN rr����•, '�
daje.0?tar'•
z
_ .f•.w - AMYL TAYLOR
Notary Public-Btale of Tennessee
'•. = DavWson county Amy L. Tayl
oo
'y My Commission Expires 010316 Notary Public
4y�py
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
BEpL
1B1B i
PeuIS.edano�
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 MDEMNIN INC
FINANCIAL STATEMENT SUMMARY
As of December 31, 2014
ASSETS
Bonds
Preferred stocks
Common stocks
Mortgage loans on real estates Arst kens
Mortgage loans on red estate; Other than first liens
Properties occupied by the company
Properties held for the production of Income
Properties held for sole
Cash, cash equivalents and short-term investments
Contract bails
Derivatives
Other invested assets
Reu WaWPA for Sew rhJ es
Securities lending reinvested collateral assets
Aggregate write -Ins for invested assets
Subtotals. cash and invested assets
Tale plants less $._ Charged off
Investment Income due and accrued
Uncollected premiums and agents' balances in the course of collection
Deferred premiums, agents' balances and Installments booked but deferred and not
yet due
Accrued retrospective prerniums
Amounts recoveratKe from reinsurers
Funds held by or deposited with reinsured companies
Other amounts receivable under reinsurance contracts
Amounts receivalse 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 care delivery assets
Net adjustment In assets and liabilities due to foreign exchange rates
Receivables from parent subsidiaries and affiliates
Health are and other amounts receivable
Aggregate write-ins for ether than Invested assets
Total assets excluding Separate Accounts, Segregated Accounts and Protected Cat.
Accounts
From Separate Accounts, Segregated Accounts and Protected Cell Accounts
0 Surplus Notes
TOTALS 5347,414,611 Gross paid In and contributed surplus
CERTIFICATE r
1 certify that the above financial statements to the bastof my
knowtedge area true and accurate reflection of the finzn I n:
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 the Texas
Department of Insurance as of the some date,
William 1 Gleason
M. Y..P& ToSb_k�SI-
Unassigned fundsjsurplus),
Surpus 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
SA00,000
0
$155,936,671
($5,335,190)
$156,603,481
$347,414,611
SUBSCRIBED and sworn to methisy'dayofM}%y t'Gs%S
a
Mycomrms"n expires- -7-10—IT
Notary public ALYSSA TUFIKOVrR
Printed Name teary public, State of New York
ruyssnTURltavrrr. - - No.01TU6044514
Auslifled in Westchester County
Commiesian Expires July 10, 2018
N tft,Stele offvewYark
• r' r
No.OITU6O44514
Qualified In Westchester County
Commission Expires July 10, 2014
UABIUTIES
$179,140,947
losses
0
Reinsurance payable on paid losses and loss adjustment expenses
31,840,141
loss adjustment expenses
0
Commissions payable, contingent commissions and other similar charges
0
Other expenses (excluding loxes. ficenses and fees),
0
Taxes, licenses and fees (excluding 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 treaties
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 loassets and liabilities due to foreign exchange rates
0
Draftsoutstandbxs
$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 write -Ins for liabilities
0
Total Oabllltles exdudng protected cell liabilities
0
Protected cell liabilities
0
$5,530,837
Total liabilities
0
0
POUCYHOLOERS S AZRPLUS
0
Aggregatevmte-Ins for special surplus funds
0
0
Common capital stock
$7,124,971
preferred capital stock
5347,414,611
Aggregate wrlWns for other than special surplus
0 Surplus Notes
TOTALS 5347,414,611 Gross paid In and contributed surplus
CERTIFICATE r
1 certify that the above financial statements to the bastof my
knowtedge area true and accurate reflection of the finzn I n:
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 the Texas
Department of Insurance as of the some date,
William 1 Gleason
M. Y..P& ToSb_k�SI-
Unassigned fundsjsurplus),
Surpus 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
SA00,000
0
$155,936,671
($5,335,190)
$156,603,481
$347,414,611
SUBSCRIBED and sworn to methisy'dayofM}%y t'Gs%S
a
Mycomrms"n expires- -7-10—IT
Notary public ALYSSA TUFIKOVrR
Printed Name teary public, State of New York
ruyssnTURltavrrr. - - No.01TU6044514
Auslifled in Westchester County
Commiesian Expires July 10, 2018
N tft,Stele offvewYark
• r' r
No.OITU6O44514
Qualified In Westchester County
Commission Expires July 10, 2014
RELEAS D
Date:
Signature:
City Clerk lstrano,
City of San Juan Cap BDIVISION LABOR AND MATERIAL BOND
(GOVERNMENT CODE 66499.2)
Bond No. SUR21000019
Replaces Bond No. SUR20000346
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:
Monument subdivision improvements within Tract 16752 as defined within Amendment #1 and
Reinstatement of the Subdivision Imr)rovemetn Aqreement for Tract 16752
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
Thirty Eight Thousand Five Hundred Dollars and 00/100 Dollars ($38.500.00 ) 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
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: �C�-z
Its: ► I\
SURETY:
Ironshore Indemnity Inc.
By:
Margar t A. Ginem , Attorney -in -Fact
(VO WILLIS OF FLORIDA
Surety Phone No. 4211 W, BOY SCOUT BLVD,#1000
'PAMPA, FL 33607
MQUIRIES: (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 § 1189
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 )
Coun of b )
On before me,
Date , 4
HereInsertNaandTinl t fficer
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(les), 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
zaOrange
Notary Public - Californiaz County
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
K�l
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
I-1 r)thPr-
Signer Is Representing:
02014 National Notary Association • www.NationaiNotary.org • 1 -800 -US NOTARY (1-800-876-6827) Item #5907
0 0 1 5 C' t -.Code, wd ge� -the
sebate. 13M 05 hmatds. -Secti ig. 1-:189 kb .ti= 92.0� bf
0119,'Ofthe vm
'ies.-pAbl- Th6. �016 P11 �i f ''e -new. disclosure
now le, n-nat' 0 th
y c I f jq. osure
pticq exaTple,, for, pwppses.of
A hOtbry. 0 6*pIOffnbF thisi-
Ublic of offi6r offide
certificate vetifies,ordy the idimtity6f the
individual whQ_ signed, the dqotnerkto w-HAAWS
.certificate. Is atta6hed, and not the trtithfulnessi
ppc4moy' Ov V44ty Srf 6#40PI"knicat.
.Stag of Calforni.a.
.C.bunty of
in -sot name an& title dvfficerj, persogily appeased Aa
thfi. wiWiri ktt=ent. and acknowledged to me, that: helshelthe s i hWh A e
y executed the ame, n er h ir
or
son(s)':bf the
-eAtity, &b. kehalf of whickth'6 156MA(s).acted, executed ftlastrmabnt.
I _000A. UOd6r. P, E NkLTY. bF, P�Mjg-y *ia�r.t . be laws 9tw. or CAlitorilU th'a ts� forego ria
y j s Ot 6
-Pamwi0h' is true anti correct -
WITNESS *y.hAM a official seal;nd, Officii sea
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
1 Seal
POWER OF ATTORNEY
Ironshore Indemnity Inc.
III- 21000019
KNOW ALL MEN BY THESE PRESENTS, that IRONSHORE INDEMNITY INC., a Minnesota Corporation, with its principal office in New York, NY doe!
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 ov
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 seated 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, 2023
IRONSHORE INDEMNITY INC.
RVON r
8'P � 4Ss5n NEAL
1910
sy:
Dane L.
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.
����YrTAl11,''ri
SPP _
ANY L. TAYLOR
_ - Nolery Public- 51ffie oFTennessee
Davldw County
90._dc
My Commission Expires 01-06-16
r l
Amy L. Tayl
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 May _ -20 15
f
Paul 5, Gi lona r
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 INDEMNITY INC
FINANCIAL STATEMENT SUMMARY
As of December 33, 2014
ASSETS
Bonds
Preferred stocks
Common stocks
Mortgage loans on real estate: Rist karts
MortaaRe loanson real estate,, Other then first liens
Properties occupied by the company
Properties held for the production of income
Properties held for sale
Cash. cash equivalents and short-term investments
Contract loans
Derivatives
Other invested assets
Receivables for securities
Securities lending reinvested coliaterat assets
Aggregate write -Ire forinvested assets
Sublwals- cash and Invested assets
Title plants less $ , Charged off
Investment income due and accrued
Uncollected presrtums and agents' balances in the course of Collection
Deferred premiums, agents' balances and installments booked but deferred and not
yetdue
Accrued retrospective premiums
Amounts recovenike from reinsurers
Funds held by or deposited with reinsured companies
Other amounts receivable under reinsurance contracts
Amounts receivable relating to uninsured plans
Current federal end foreign Income tax recoverable and interest thereon
Net deferred tax asset
Guaranty funds receivable or on deposit
Furniture and equipment, including health care delivery assets
Net adJustment In assets and liabilities due to foresgn exchange sates
Receivables from parent, subsidiaries and affiliates
Health are and other .mourns receivable
Aggregate write-ins for otherthan invested assets
Total assets excluding Separate Accounts, Segregated Accounts and Protected Cat
Accounts
From Separate Accounts, Segregated Accounts and Protected Cell Accounts
TOTAt.S _ Gross paid In and contributed surplus
_.. $347414,511
T�
CERTIFICATE
I certify that the above financial statements to the best of my
knowledge are a true and accurate reflection of the financial
condition of the Company as of December 33, 2014,
Addtdonally, I certify that the abaft lino ncial statements are
in agreement with the Statutory Financial Statements filed with the Texas
Department of Insurance as of the same date.
William 1 Gleason
�M YP.Pr_irmy[+(
$156,938,671
Unassigned funds (surplus) ($5,33S,190)
Surplus as regards polkyholders
$156,603,981
TOTALS
$347,414,611
SUBSCRIBED and swom to me thisY-rday of r%It}/ t "e" rj
My- mmsncn exprer 7 -/O -/T
Notary Public
pe6nted Name ALYSSA TURKOWTZ
Notary Public, State of New York
�Li ss : ruaxavriz No. 01TU6044514
Oualified In Westchestef County
C[1f17frlj1387[]J'I ExOSS July 10, 2018
r+on��uisllc, Ssale of flew fork �.
No. MTU6044514
Qualified In Wes"ester County
Commission Expires July 10, 2014
LIABILITIES
$179,140,947
Losses
$63,582,066
0
Reinsurance payable on paid losses and loss ad]ustment expenses
0
31,840,141
Loss adjustment expenses
$10,384,957
0
Commissions payable, oontingentcommisslarrsand other slmilarcharges
$1,020,805
0
Other expenses (exctusingtaxes. licenses and fees)
$5,435,126
0
Taxes, licenses and fees (excluding: federal and foreign income taxes)
$2,383,909
0
Current federal and foreign Income taxes
$2,434,392
0
Net deferred tax IiabBFty
SIS,632,951
Unearned premiums
0
$29,158,576
0
Advance premium
0
Ceded reinsurance premiums payable Inet of ceding commissions)
$58,222,187
0
Funds held by company under reinsurance treaties
0
Amounts vlthheld or retained by company for account of others
0
0
Remittances and Items not allocated
0
Provision for reinsurance
$1,S45,07S
$226,614,039
Net adjustments In assets and fabl8tlesdue toforeign exchange rates
0
Drafts outstanding
$990,,960
Payable to parent, subsidiaries and offl8attrs
$12,458,110
$73,567,547
Derivatives
0
0
Payable for securities
0
0
Payable for securities lending
$33,586,257
Liability foramounts held under uninsured plans
0
0
Aggregate write -Ins for liabilities
0
$4,185,929
0
Total liabilities excluding protected cog liabilities
$190,811,131
0
Protected cell Iiablkles
0
$5,530,837
Total I abilkfes
$190,811,131
0
0
PODUCYHMDERYSWRPWS
0
Aggregate wnte•lnsfor special surplus funds
0
O
0
Common capital stock
5,000,000
$7,124,971
preferred capital stock
$347,414,611
Aggregate wriWns for other than special surplus
0
0
Surplus Notes
TOTAt.S _ Gross paid In and contributed surplus
_.. $347414,511
T�
CERTIFICATE
I certify that the above financial statements to the best of my
knowledge are a true and accurate reflection of the financial
condition of the Company as of December 33, 2014,
Addtdonally, I certify that the abaft lino ncial statements are
in agreement with the Statutory Financial Statements filed with the Texas
Department of Insurance as of the same date.
William 1 Gleason
�M YP.Pr_irmy[+(
$156,938,671
Unassigned funds (surplus) ($5,33S,190)
Surplus as regards polkyholders
$156,603,981
TOTALS
$347,414,611
SUBSCRIBED and swom to me thisY-rday of r%It}/ t "e" rj
My- mmsncn exprer 7 -/O -/T
Notary Public
pe6nted Name ALYSSA TURKOWTZ
Notary Public, State of New York
�Li ss : ruaxavriz No. 01TU6044514
Oualified In Westchestef County
C[1f17frlj1387[]J'I ExOSS July 10, 2018
r+on��uisllc, Ssale of flew fork �.
No. MTU6044514
Qualified In Wes"ester County
Commission Expires July 10, 2014
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
CIVIL CODE § 1189
A notary public or other officer completing this certificate vefes 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 )
Countx of ) n Il
On bert �V
fore me, No
hHere Pert Na and Title o the ►c r
personally appeared / l ( ( _
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 capacitypes), and that by his/her/their signature(s) on the instrument the pemon(s),
or the entity upon behalf of which the person(s) acted, executed the instrument.
W. CORDI
Commission # 2088325
z d Notary Public - California z
Orange County
A
r.0
Comm. Ex ires Oct 31, 2018
Place Notary Seal Above
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
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: _ Document Date:
Number of Pages: 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 — 1:1Limited ElGeneral
❑ Individual ❑ Attorney in Fact
❑ Trustee ❑ Guardian or Conservator
❑ Other:
Signer Is Representing:
tea - w utw_
02014 National Notary Association • www.NationaiNotary g or 1 -800 -US NOTARY (1-800-876-682�em 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
r ---
This area for Oficial Notarial Seal
,:*
`
ANETT CARDINALE
=
Commission # FF 138482
•
Expires July 28, 2018
Bonded Thru Troy Fein Insurance 900305.7019
This area for Oficial Notarial Seal
S.9
and Sewula -W..
.4wato, Bill 100. ofieff0s.$0 :Sections 1189 w 119.5 oflhe: dyl of tie
QC&MMCIA"Cok. nowes.pAbIfe, nt)elplq physical format- of t1i
.riev di jo.osure
-notice;s.A4 example, -for put. q4es-4igustrat.,Im.
A h6taty. p0b hc of other 6fflde� 66W]�#ng tbts.-.
certificate vetifies onlytbo identity -6f the
individ.vai who. -signed the d6_0Tnca,tb w-hAthis
'certificate. is. attached, and not the tr6thfulnessi
-#pbftay, ox validity of thaf000umerttl
8ta f
,W o Califoriiia
C.bun� 6'f
7ibsert name -and title lot officer}, -personally appwed
0,Dyp4 t6 X4 oo Abo ' 'bas ' is - of 4atisfactory ev iderioo to bWft pasq*) *.-�os 0 n a. M e W 1, S/ari� S'U' bArri 6 b a t4
J16. Withiri bl�eot_ and acknowledged -to me,'tbat- h0sheithey evmuted. the .same: In his/her/their
49010tized. zapueliyoes),. and thAt by DiS&kr/dxek sloatult(s) 'Qti: the '!Astruriiept �e P.6rson.(S),, bt th
t4tity. up6n. beh-41f executed ftinsuument.
1, Cert 'ilnder P»ALT"4OF' vjjkju II aWpt the. Stft%�X'Ca
lifDmtifat tis ibri�gDirip
paragraph- is true mid'co=4
WUNESS im.y- bW ah.d.6fficiil- seal';