15-0505_Bond_SUR21000003_Pacific Point Dev_TR 16747 Premium: $406.00
SUBDIVISION FAITHFUL PERFORMANCE BOND
(GOVERNMENT CODE 66499.2)
Bond No. SUR21000003
Replaces Bond No. SUR20000327
KNOW ALL MEN BY THESE PRESENTS, that Pacific Point Development Partners t_t.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 16747 as defined within Amendment#1 and
Reinstatement of the Subdivision Agreement for Tract 16747
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
Fifty Four Thousand One Hundred Eighty One Dollars and 00/100 Dollars, (64,181.00 ) 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
(NOTARIZATION AND SEAL)
By: � -,
Its.
SURETY:
Ironshore Indemnity Inc.
(NOTARIZATION AND SEAL)
By: 2904a�& a_
MargarefA. Ginem , Attorney-in-Fact
Surety Phone No.
C:JO WILLIS Of- I I-C)PIDA
4211 W.BOY SCUT BLVD #1D0U
TAMPA, FL 3307 Page 2 of 3
INQIJJRIES:(813)281-209)
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 ri )
l = ' �iC
On ` before me,
Date , N Jnsert am andTitl of t e 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(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.
I certify under PENALTY OF PERJURY under the laws
of the State of California that the foregoing paragraph
is true and correct.
W. CORDI
Commission#2088325 WITNESS my hand and official seal.
-+ Notary Public-California a
z Orange County
M Comm.Expires Oct 31.2018~
My Signature d&LoU
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: _ Signer's Name:
❑Corporate Officer — Title(s): ❑Corporate Officer —Title(s): _
❑ Partner — ❑ Limited ❑General ❑ Partner — ❑ Limited ❑General
❑ Individual ❑Attorney in Fact ❑Individual ❑Attorney in Fact
❑Trustee ❑Guardian or Conservator ❑Trustee ❑Guardian or Conservator
❑Other: ❑ Other:
Signer Is Representing: 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.
4
Signature
Anett Cardinale
C01T MISSfOR#FF 138482
W Expkes July 28,2018
OaWo-d T!n F
Tro �n 1AWINOODO- -
� Td1a
This area for Oficial Notarial Seal
;senate DW 105b, ttreuds�:Sections.x:189 iin 4 119-5 'off the:Civil,-Cp'tle 'lurid SeCti�on 910 of the
GO.!ewe {.+Cv,de, a ait ttr no es:po li: e:kielnwp}ysica7 format o.. e thew disclosure
notice,is-p exgnple,far puxillustratim.
A iictaiy pU6lic of other*def coiiiple$in tlt3s:
cerdfieate vetifes.only the identity,®f the
individual w'ho signed the dacu nerit.to wl i&6"-
certificate.is attached,and riot the tri tbfulnessi
accitrOLOY,'r`vauility of�,hg 4o�upient.
.State'of emiforiaia
County.of
Oi# - before rrte,,, eW
'iasert name and'title ofiDfficer}9 P ... -- who.
,ersottal]y appearesI ..
-p,mved t¢JA, nw$4 bass of` b--fs a tevidence to lse-th4,persa, )w. iot8-ion e(s}isl re sizi ct fied to,
the withitf-ftistrument and acknowledged -to --me- that'helshelthey executed the same- in his/her/their
authoiir�d apac ty(ies�j, d .that liy.hisldit rlt eiur sigbatute(s) q e ttistru[i t ]re rson(s),:-dr the
eixtity tpon,behalf of.whiph tkie perso i(s),acfed; eXecttfe'd tli nstr=ent,
I;reit fy'rider. PENA'LTt(OF' PM,. ii.rid�r 4I-le J' of 6e-Stag cif'Cali ft�iiiiii��t the fvz e�o'ht
Paragraph is true and correct
WITNESS my.hAnd and o#ficid seal: n
Si�tature q..___� Seal).
POWER OF ATTORNEY
III- 21000003
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-ln-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 hearing 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.
t x a• .
019
(d By:
Dan 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 lronshore 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
– f,Wnry VpbR4 81u19 Gf 79a,1911l0 JJ'
– Davidson County 41%icmmissionExpl-01-09-16 NotaryP
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
w
fan I
�urlalr fi 1
PauIS.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."
IRbNSHORE iNDEMNITY INC
FINANCIAL STATEMENT SUMMARY
As of December 31,2014
ASSETS
LIABILITIES
Bonds
$179,140,947 losses
$63,582,066
Preferred stocks 0 Reinsurance payable on paid losses and loss adjustment expenses D
Common stocks
31,840,141 toss adjustment expenses $10,384,957
Mortgage loans on real estatc First tens 0 Commissions payable,contingent eommisslorssand other slmilarcharges $1,020,80S
Mortgage Irons on real estate;Otherthan first liens 0 Other expenses(excluding taxes.Runes and fees)
$5,435,126
Properties occupied by the company 0 Taxes,licenses and fees(cWucrft federal and foreign Income taxes) $2,383,909
Properties held for the production of inoome 0 Current federal and foreign income taxes $2,434,392
Properties held for We 0 Net deferred tax liability 0
Cash,cash equivalents end short-term investments $15,632,951 Unearned premiums
$29,158,576
Contract loan D Advance premium
Derivatives 0 Ceded reinsurance premiums payable(net of ceding cammisslons) $58,222,187
Other invested assets 0 Funds held by company under reinsurance trestles
0
Receivables for securities 0 Auntswithheld orretained bycompuryforaecounto(others
Securities lending reinvested collateral assets 0 Remittances end items not allocated
Aggregate write-Insforinvested assets 0 Provision for reinsurance $1,545,075
Subtotals.cath and Invested assets $226,614,039 Net adjustments In assets and labllltles due to foreign exchange rates
Title plants less$..,Charged off 0 Drafts oubtending
Investment Income due and accrued $99(1,960 Payable to parent,subsidiaries andaMNates
Uncollectedpremaumsandagents'balarKinthecourseatcollection $73,567,547 Derivatives $12.458,110
u
Deferred premiums,agents'balances and Installments booked but deferred and not 0
yet due Payable for securities 0
Accrued retrospective premiums 0 Payable fonecurities lending 0
Amounts recoverable from reinsurers $33,586.257 Lyabllity for amounts held under uninsured plans 0
Funds held by or deposited with reinsured companies 0 Aggregate wcite-Iris for Ilabllkks
$4,186.928
Other amounts receivable under reinsurance contracts 0 Total liabilities excluding protected cell liabilities $190,811,131
Amounts recekvWe relating to uninsured plan 0 Protected cell liabilities
current federal and foreign income tax recoverable and interest thereon 0
Net deferred tax asset $5,530,837 Total liabilities
$190,811,131
Guaranty funds receivable or on deposit 0
Furniture and equipment,Including health are delivery as" 0 POLICYHOLDERS$SURPLUS
Net adjustment In assets and liabilities due to foregn exchange rates 0 Aggregate waste-Ins for special surplus funds 0
Receivables from parent,subsldiarles and affiliates 0
Health are and other amounts receivable 0 Common notal stock 51000,000
Aggregate write-ins for other than Invested assets $7,124,971 Preferred capital stock
Total assetsexdudln Separate Accounts, $347,414,511
g pa Segregated Accounts and Protected Cel, Aggregate write+rrs for other than special surplus 0
Accounts
From Separate Accounts,Segregated Accounts and Protected Cell Accounts 0 Surplus Notes
TOTALS _#1A 7,414,611 Gross paid In and contributed surplus $156,938,671
Onasslgned funds(s urplus,
($5,335,190)
Surp"us as regards policyholders $156,603,481
TOTALS ��,,� $347,414,611
SURSCRIBED and sworn tome th,% day 04 H� }�!
/ MyEoanmliscnexpires: 7•fv-Notary public
/'yr
CERTIFICATE Printed Name ALYSSA TURKOVITZ
I certify that the above financial statements to the bestof my Notary Public,State of NeW York
knowledge are a true and accurate refection of the Financial ALYssA TURKOVITZ No.01 TU6044514
condition of the Company as of December 31,2014, - flueltf ed in Westchester County
Additionally,lcertify that the above financial statements are Y,�,�/f+y�„ ,/,{,, %'�- ,,.•,- mis8110nEcpireeJuly 10,2018
ht agreement with the Statutory Financial Statements filed with the Texai NotattPutill4 State of New York
Department of Insurance as of the same date,
No.01TU6044514
WRliam J Gleason quaffed In Westchester County
CTS.6.P 8 Trea SL Commission Expires July 10,2014
SUBDIVISION LABOR AND MATERIAL BOND
(GOVERNMENT CODE 66499.2)
Bond No. SUR21000003
Replaces Bond No. SUR20000327
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 16747 as defined within Amendment#1 and
Reinstatement of the Subdivision Agreement for Tract 16747
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
Fid Four Thousand One Hundred Eighty One Dollars and 00/100 Dollars ($54.181.00 ) 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 1 9th 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)
Y
Its: �� ��a,c� �'•��r�e�br��
SURETY:
Ironshore Indemnity Inc.
(NOTARIZATION AND SEAL)
By: ,,/
Margared Ginem , Attorney-in-Fact
Surety Phone No.
GIC WILLIS OF FLORIDA
4211 W.BOY SCOUT BLVD,#1000
TAMPA, EL 33607 Page 2 of 3
!NQUIRIES: (313)281-209"
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, • '�-fJ �1' 1
Date a He In a and Title f t Officer
personally appeared
me(s)of Signer(s)
e
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#2088325 WITNESS my hand and official seal.
Notary Public-California z
z '' Orange County '
My Comm,Expires Oct 31,2018 J 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: ws_ Document Date:
j Number of Pages: Signer(s) Other Than Named Above:
Capacity(les) Claimed by Signer(s)
Signer's Name: Signer's Name:
❑Corporate Officer — Title(s): ❑Corporate Officer —Title(s):_.
❑ Partner — ❑ Limited ❑General ❑ Partner — Limited ❑General
❑ Individual ❑Attorney in Fact ❑ Individual ❑Attorney in Fact
❑Trustee ❑Guardian or Conservator ❑Trustee ❑Guardian or Conservator
❑Other: ❑ Other:
Signer Is Representing: 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 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
E
TT CARDINALE
mission#FF 138482
res July 28,2018
d Thru Troy Faln Inaurence 900-995-7019
This area for Oficial Notarial Seal
Sepafe - ill 105.0; e�ids:Sections 1189 dnd` 195: 'Ohe:C-Ml Code end Sect' W! of'tha
rig e e at.Codejeja�n,g-to iiOig "res,'gt slie. '1"liie:bel. -Physical format of Vie,hew disclosure
ngaoe_S-;- nM exapple; for pur ase c il u*at� ;
A i'iotaty'public or other 6Mdef roiniplPtingtll 5�
certificate verifies.only,the identity cif the
individual vuho signed.thedo xnent,tra wlitc3i.t i s
certificate.is attached,and not the truthfulnessf
` coixra0y,010,alzdty of XwoUpimt.
State ofC-aliforimia
County.of
+Q bek.rd rots,:
ihseert name and title Of officerl,personally appeared. > hn
pioW to X9 ori Aq basis oi`satisfactoiy-evidtoe to fie persor4(s)'Whose iianie(s) sle}re subscrjbedt�i:.
the.w;tlhiri�•itnstrument and aeknowledged -to me, that h0shehhey executed the.same: in� hisfherltheir•
�01,9i�zet ,eopacity iesj, "d .than by.-iis/horfd ek �i�h.atur`eW 4n.theAnstruinorJt the Verson(s),;or lie
rttity oft.behalf of whaGlx'tk Persbn(s)acted,ei eeuted fli instr=ent<
r,Cerk fy'itrider PENAL'1<S 6vPJEAjO yiirider.ibe laws of fie.St�fe vf'Galxft�tniit��t tkk�fviegoiri�
'Para m-ph-is true and'.correct
WUNE394y hkndadd,bfeiaksear;
igsaattiro (Seal)
i
POWER DIF ATTORNEY -
Ironshore Indemnity Inc. III- 21000003
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-tri-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$7,500,000 dollars, which the Company might execute through its duly elected officers, and affix the seal of the
Company thereto. Any said execution of such documents by an Attorney-In-Fact shall be as binding upon the Company as if they had been duly
executed and acknowledged by the regularly elected officers of the Company.Any Attorney-ln-fact,so appolltted,may be removed for good cause and
the authority so granted may be revoked as specified'1n the Power of Attorney.
Resolved,that the signature of the Director and the seal of the Company may be affixed by facsimile on any power of attorney granted,and the
signature of the Secretary,and the seal of the Company may be affixed by facsimile to any certificate of any such power and any such power or
certificate bearing such facsimile signature and seal shall be valid and binding on the Company.Any such power so executed and seated and certificate
so executed and sealed shall,with respect to any bond of undertaking to which it is attached,continue to be valid and binding on the Company.
IN WITNESS THEREOF, IRONSHORE INDEMNITY INC. has caused this instrument to be signed by its Director,and its Corporate Seal to be affixed this
7th day of August,2013
IRONSHORE INDEMNITY INC.
�"aFP�R1p�
� i y
SEAL
1919
1. -�
By:
Dan a L.Suss n
Director
ACKNOWLEDGEMENT
On this 7th Day of August,2013,before me,personally came Daniel L.Sussman to me known,who being duly sworn,did depose and say that he is the
Director of Ironshore Indemnity, Inc.,the corporation described in and which executed the above instrument;that he executed said instrument on
behalf of the corporation by authority of his office under the By-laws of said corporation.
Ally L TAYLOR
Notary Pub9o-Stale or Tennessee
ZZ
' Davidson CouiPY Amyl.79
Mp CommissionE pros 01-0Wt$
„ Notary Publk
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 atthis19th Day of May 20 15
.u°of bggf±
SEAL
1010
1911
Paul S.GI ano -
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 LIABILITIES
Bonds
$179,140,947 Losses
$63,582,066
Preferred stocks 0 Reinsurance payable on paid losses and loss 009ustment expenses 0
Common stocks 31,840,141 Lou adJustmentexpenses
$10,391,957
Mortgage loans on real estate.Arlt fens 0 Commissions payable,contingent commissions and other similar charges $1,020,805
Mortgage loans on real estate;Other thanfirst llem 0 Otherexperaes(exgicilnotaxes.IIrent aand fen) $5,435,126
Properties occupied by the company 0 Taxes,licenses and fees(excluding federal and foreign Income taxes) $2,383 9D9
Properties held for the production of Income 0 Current federal and forelgn Income axes
$2,434,392
Properties held for sale 0 Na deferred tax liability 0
Cash.cash ectulvalents and short-term investments $15,637 951 Unearned premiums $29,158,576
Contract loans 0 Advance premium
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 withheldorretalnedbycompany for amount ofothen
Securities lending reinvested coliatera!assets 0 Remittances and Items not allocated
Aggregate wrlte-Insforinvestedassets 0 Provision for reinsurance $1,545,075
Subtotals.cash and Invested assets $226,614,039 Net adJustrnents In assets and tabilltles due to foreign exchange rates
Title plants less$,.;Charged off 0 DraftsoutstandMy
Investment Income due and accrued $990,960 Payable to parent,subsidiaries and affiliates $12,458,110
Uncollected prenfurns 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
yet due Payable for securities 0
Accrued retrospective premiums D Payable for securities lending 0
Amounts recoverable from reinsurers $33,586,257 Llablilty 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 cell liabilities $190,811,131
Amounts receivab:e relating to uninsured plans 0 Protected cell liabllitles
Current federal and foreign income ax recoverable and interest thereon D
Net deferred ax asset $5,530,837 Toat gabliitles
$190,811,131
Guaranty funds receivable or on deposit 0
Furniture and equipment,Including health care delivery assets D POLICYHOLDEWS SURPLUS
Net adjustment In assets and liabilities due to fore gn exchange rates 0 Aggregate wnte-Ins for special surplus funds 0
Receivables from parent,subsldiarles and affiliates 0
Health are and other amounts receivable D Common capotal stock 5,0D0,000
Aggregate wrtte-lnsfor otherthanInvested assets $7,124,971 Preferred capital stock
Total assets excludin rate Accounts, $347,414,611
g Septa Segregated Accounts and Protected Cel. Aggregate wrltr m for other than species surplus 0
Accounts
From Separate Accounts,Segregated Accounts and Protected Cell Accounts 0 Surplus Notes
TOTALS $3-0T 416,611 Gross paid In and contributed surplus
$156,938,671
Unassigned funds Jsurplus; ($5,335,190)
Surp`uy as regards policyholders $156,603,481
TOTALS $347,414,611
_ Sl1R5tiRI8EDand swam to me thls •dayof
M/yl�!.
v'J .f Mycommisrnesp,ra: 7.14;—I�
��-� /• v;,f���-� - - Hoary Public
.1011
CERTIFICATE Pri�ad Name ALYSSA TURKOVIIZ
I certify that the above financial statements to the bestof my
Notary Public,State of New York
knowledge are a true and accurate reflection of the financial ALYSSATURxOvrij No.0ITU6044514
condition oftheCompany asofDecember 51,2014, f Oust.i#ledInWestchester County
Additionally,I cetify thathe above financial statements are Y� . nr� f f� .y C'UIT Mi8siOn ftpil8'Ei July 10,2018
M agreement with the Statutory Flnandal Statements filed with the Texas Notatf,1'ublic.Scale of New York
Department of Insurance as of the same date
No.01TU6044514
William Gleason Clisaflaed In Westchester County
SLi2.VP&Teti asu�rer Conrmisshsn Expires July 10,2014