15-0505_Bond_SUR21000005_Pacific Point Dev_TR 15609 Premium: $3,387.00
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. LLG
(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 Point Development Partners, LLC
(NOTARIZATION AND SEAL)
Its: ,��,'�.4�: ', ,r•U+�y�
SURETY:
Ironshore Indemnity Inc.
(NOTARIZATION AND SEAL)
e�? -z cl-
By:
Margaret . 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
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 f
On before me,
Dat He Inseil e and Title f the Officer
personally appeared lifo -
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.
r' Commission#2088325
_ ' Notary Public-Czll}ornia WITNESS my hand and official seal.
Z `' Orange County
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(lies) Claimed by Signer(s)
Signer's Name: Signer's Name:
❑ Corporate Officer — Title(s):_ El 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
$ejftate 13M 050, eiids:gectiotis x 189 bhi3 .1 M 'Of"Ofe dyiModc and Sedii U 9 Ol-of'the
Goxeut, oe;.i� laing to notices.ptt# i die belCv physical format of tie ri+ r disclosure
notice,�s,�n exat�aple,�for pw�ca�s,a�` Xus�ai�rn:
A rioti� ffec public of other naohjpllstiiti th#s
certifibate vetifies.only the identity of the
individual w'ho,signed the do;�utnchtra whichs
certificateis attached,and not'the trutWnessi
z �
IpOrAdy;0 Validity of that'doqurtterrt,.
State i�f(:alifornia
C.bunty.of
4ii _ ;before ine,
iiassert name and'title oftfficer),persowdly 4ppwed Who..
prov.f4 to ftkotl'fh'o'basis-of Otisfacgpty evidence to bM`* ,fiersori(6 Wl os iianie(s)xsJ4r sul scrj&ea to,
the Vvithiri..i`iistrument and acknowledged to -me- that h0she/they exeouted the same .in His/her/their
utl 4V.
P,-.. Opacity(io), anal that by his/lien/tFietr-slghatttt'e(q) ' .:fine. istruin�nf a rson(s),:"off t#te
_entity._eAtity. Opon behalf of which the pefsofi(t).acted, ekecuted.thi`i kstrurnent,
I; eit%fy'iilider ]°ENA:LTl?. P�:12;1�URX under:lie )avi%s 'of be. t;t pf CAfomia fat the forgoing
paragraph is true and carred
WrMESS i*,hftnd aii .Oicial seal'.
afore — (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 affix d my official seal on
the date in this certificate first above written.
Signature
Anett Cardinale
q ANETT CARDINALE
*= Commission#FF 138482
?;• EXPIres July 28,2018
r <
` Bonded Thru Troy Fein Insurance 800.3857019
This area for Official Notarial Seal
POWER OF ATTOFNEY
Ironshore Indemnity Inc. III- 21000005
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 Attorneys)-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:
Resofved,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 $7,500,000 dollars,which the Company might execute through its duly elected officers,and affix the seal of the
Company thereto. Any said execution of such documents by an Attorney-In-Fact shall be as binding upon the Company as if they had been duly
executed and acknowledged by the regularly elected officers of the Company,Any Attorney-In-Fact,so appointed,may be removed for good cause and
the authority so granted may be revoked as specified in the Power of Attorney.
Resolved,that the signature of the Director and the seal of the Company may be affixed by facsimile on any power of attorney granted,and the
signature of the Secretary, and the seal of the Company may be affixed by facsimile to any certificate of any such power and any such power or
certificate bearing such facsimile signature and seal shall be valid and binding on the Company.Any such power so executed and sealed and certificate
so executed and sealed shall,with respect to any bond of undertaking to which it is attached,continue to be valid and binding on the Company,
IN WITNESS THEREOF,IRONSHORE INDEMNITY INC. has caused this instrument to be signed by its Director,and its Corporate Seal to be affixed this
7th day of August,2013
IRONSHORE INDEMNITY INC.
SEAL
1919 !i
• 4�yyY�£. F.,
By:
!]art a Lr$us " 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
s Nolery Public-State of Tennessee �
i• ^ = Davidson County
Commission Expires 01-09-1S
Amy L.7-A
Notary Pu611C
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
SEAL
Y9F! !
Paul S.GI dan o
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 IHC
FINANCIAL STATEMENT SUMMARY
As of December 31,2014
ASSETS LIABILITIES
Bonds
$179,140.947 Losses $63,582,066
Preferred stocks pReinsurance payable on paid bases and loss adjustment expenses p
Common stocks 31,840,141 Loss adjustment expenses $10,384,957
Mortgage loans on real estate:First kens 0 Commissions payable,oontIngent commissions and other similar charges $1,020,805
Mortgage loans on reel 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(exdudmg federal and foreign Income taxes) $2,383,909
Properties heli for the production of intone 0 Current federal and foreign Income taxes
$2,434,392
Properties held for We 0 Net deferred tax liability 0
Cash.rash equivalents and short-term investments $15,632,951 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 withheld or retained by company for account ofothers
Securities lending reinvested collateral assets 0 Remittances and items not Notated
Aggregate wrlte-Insforinvestedassets 0 Provision for reinsurance $1,545,075
Subtotals.cash and Invested assets $226,614,039 Net adjustments In assets and Labillties due to foreign exchange rates
Title plants less$--,Charged off 0 Draftsoutstanding
Investment Income due and accrued $990,960 Payable to parent,subsidiaries and afhllahs
$12,458,110
Uncollected prad ums 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 prernlums 0 Payable for securities lending 0
Amounts recoveralto 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 exdudng protected ce0 fiabifides $190811,131
Amounts recelvabce relating to uninsured plans 0 Protected cell liabilities
Current federal and foreign income tax recoverable and Interest thereon 0
Net deferred tax asset $5,530,837 Totallabilities
$190,81):131
0
Guaranty funds receivableor on deposit
Furniture and equipment,Including health care delivery assets 0 POUCYNOLDEFWS SURPLUS
Net adjustment In assets and liabilities due to foreign exchange rates 0 Aggregate wnte-Ins for special surplus funds 0
Receivables from parent,subsidiaries and affiliates 0
Health are and other a mounts receivable 0 Common capital stock 5 000 000
Aggregate witte-Insfor other than Invested assets $7,124,971 Preferred capital stock
Total assets excluding Separate Accounts,Segregated Accounts and Protected Cat $347,414,611
Aggregate wri[e rsfwotherthanspecialsurplus p
Accounts
From Separate Accounts_Segregated Accounts and Protected Cell Accounts 0 Surplus Notes
TOTALS 5347 416 631 Gross paid in and contributed surplus $156,936,671
Unassigned funds(surplus;. ($5,335,190)
Surp us as regards policyholders $156,603,481
TOTALS $347,414,611
SUBSCA18EO and sworn to me thislLrdaY of H-*', ,e-vs
My cementizen empires:
fNotary public
CERTIFICATE ^^^ �. Printed Name ALYSSA TURKOVITZWptery public,State Of New York
I certify that the above financial statements to the bestof my
knowledge are a true and accurate reflection of the financial ALYSSA TURKOVrrz No,Ut TU6044.514
condition of the Company as of December 31,2014, '" w Qualified In Westchester GCllli7tk"
C..ort'Lml gJLtn
Additionally,I certify that the above financial statements arc Expires JtII 10,2011 B
I v
{ r— J/ 'moi.' '.
In agreement with the Statutory Flnandal Statements filed with tine Texas Nota. bile State of New York
Department of Insurance as of the same date
NO.O1TU6044514
wgiiam 1 Gleason Qualified In Westchester County
M.VP&Treasurer Coramisslon Expires July 10,2014
SUBDIVISION LABOR AND MATERIAL 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 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: � 1
Its: v .Qc, o [1Ci+ C
SURETY:
Ironshore Indemnity Inc.
�� ,.-� (NOTARIZATION AND SEAL)
By: J 6
Margar, A. Ginem , Attorney-in-Fact
Surety Phone No,
C/O WILLIS OF FLORIDA
4211 W.BOY SCOUT p v0,#low 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, j
Dat Here sert ame and Title f he Officer
personally appeared i
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($)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.
Z . Notary Public-California z
Orange County
MyComm.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(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:
�"t 4 :�G C^ t c C z Ga✓3 tib.. �uK W�10 4 CiY L C {i"h4�riq�f 'kN
02014 National Notary Association -www.NationalNotary.org - 1-800-US NOTARY(1-800-876-6827) Item#5907
. .
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certificate vedfaes.onlythe identity 6f the
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.certificate.is attached,and not the lrrithfulnessk
acctir�ey;vii't�alzdty��'�?��do�uAr[c�#_
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Oki before mg,= a
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proV.ezi t¢l aii the basis.vf'satisf airy evir3erice to be;`tlie liexsori(s .Whose iianie(s) Who
aslare subscribeatp.
&6yr thiti instrument and acknowledged 4o mer that;he?she/they executed the.same:.in•_hisiherftheir
i� jcapaetiy(ies), �qo that:by)ii0orftlick'Oghaa e(s) -oil "instruater�t �e�urson�(A.'lot ti e
;rAtity ti beh,idf of whiicfi-&,persori(�),aced,eit&glei d tWinstruruent,
Z, rtify'iirider PENA :T 'OR )? URX i.ridcr. ae laws'of te. taf Qf Califotnia at tE focegozri
paragraph is true and'.correc
WITNESS racy hAnd and.,o#ficid seal,
� gna .. 4Seal�.
ACKNOWLEDGEMENT BY SURETY
STATE OF FLORIDA
COUNTY OF HILLSBOROUGH I SS.
On this 19th day of May, 2015 before me, personally came
Margaret A. Ginem, who is personally known to me (or proved
to me on the basis of satisfactory evidence) to be the person
who executed the within Instrument as Attorney-In-Fact on
behalf of Ironshore Indemnity Inc., and acknowledged to me
that he/she executed the within instrument on behalf of said
surety company and was duly authorized to do.
In witness whereof, I have signed and affixed my official seal on
the date in this certificate first above writte
Signature
Anett Cardinale
ANETTCARDINALE
;.r Commission#FF 138482
• Expires July 28,2018
Bonded Thru Troy Feln Ineurence 500385.7018
This area for Official Notarial Seal
POWER OF ATTORNEY
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
1 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 seat of the
Company thereto. Any said execution of such documents by an Attorney-In-Fact shall be as binding upon the Company as if they had been duly
executed and acknowledged by the regularly elected officers of the Company.Any Attorney-In-Fact,so appointed,may be removed for good cause and
the authority so granted may be revoked as specified in the Power of Attorney.
Resolved,that the signature of the Director and the seal of the Company may be affixed by facsimile on any power of attorney granted,and the
signature of the Secretary, and the seal of the Company may be affixed by facsimile to any certificate of any such power and any such power or
certificate bearing such facsimile signature and seal shall be valid and binding on the Company.Any such power so executed and sealed and certificate
so executed and sealed shall,with respect to any bond of undertaking to which it is attached,continue to be valid and binding on the Company.
IN WITNESS THEREOF, IRONSHORE INDEMNITY INC.has caused this instrument to be signed by its Director,and its Corporate Seal to be affixed this
7th day of August,2013
IRONSHORE INDEMNITY INC.
s' SEAL
H14
1 b4Raa`r
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.94
AMYL TAYLOR LL .
Notary Public-Stale of Tennessee
=. :` DavidsonCounty
dson cnty AmY L.7e
�`.C,+'........:���` kH Crmaxiscn FrWres atk9.1B
NotaryPubbc
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
e apra.�trt
REA
.. rg•
1911 e
19f4
Paul S.GI dalm `
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."
IRONS14ORE;NDEMNITY INC
FINANCIAL STATEMENT SUMMARY
As of December 31,2014
ASSETS LIMILFTIES
Bonds
$179,140,947 losses $63,582,066
Preferred stocks 0 Reinsurance payable on paid losses and loss adgus"ent expenses o
Common stocks 31,840,141 Loss Wjusbnent expenses $10,384,957
Mortgage loans on real estate;First kens 0 Commissions payable,contingent commissions and other similar charges $1,020,805
Mortgage foanson real estate;Other than first Bens 0 other expenses(excluding taxes.11canses and fees) $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 foreign income taxes
$2,434,392
Properties held for We 0 Net deferred tax liability
0
Cash cash equivalents and short-term Investments $15,632,951 Unearned premiums $29,158,576
Contract loans 0 Advance premium
Derivatives 0 Ceded reinsurance premiums payable(net of codingcommissbns) $58,222,187
Other invested assets o Funds held by company under reinsurance treaties 0
Receivables for securities 0 Amounts wlthheldorretained bycompany for amount ofothers
Securities lending reinvested collateral,assets 0Remittances and items not ailoated
Aggregate write-Ins forinvested assets 0 Provision for reinsurance
$1,545,075
Subtotals.cash and invested assets $226,614,039 Net adjustments in assets and lablittles due to foreign exchange rates
Title plants less$..,Charged off 0 Drafts outstanding
Investment Income due and accrued $990,960 Payable to parent,subsidiaries and affiliates $12,458,110
uncollected prey ums and agents'balances In the course of collection $73,567,547 Derivatives
0
Deferred premiums,ager&balances and installments booked but deferred and not 0
yet due Payable for securities 0
Accrued retrospective prerrqums 0 Payable for securities lending 0
Amounts recoverabiefromreinsurers $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 ce0 tlabifhies $190,811131
Amoums rerrNab;e relating to uninsured plans 0 Protected cell liabilities
Current federal and foreign income ax recoverable and interest thereon 0
Net deferred ax asset $5,530,837 Total Rabilitles
$190,81],131
Guaranty funds receivableoren deposit D
Furniture and equipment,including healthcare delivery assets 0 POIICYMDER S SURPLUS
Net adjustment In assets and liabilities due to foWgn exchange rates 0 Aggregate wnte-Ins for special surplus funds 0
Receivables from parent,subsidiaries and affiliates 0
Health are and other amounts receivable 0 Common notal stock 5.000,000
Aggregate wrttrins for other than Invested assets $7.124,971 Preferred capital stock
Total assets excluding Separate Accounts,Segregated Accounts and Protected Cel $347,414,511
Accounts Aggregate vwlte,ns for other than special surplus 0
From Separate Accounts.Segregated Accounts and Protected Cell Accounts 0 Surplus Notes
TOTALS Gross paid In and oontrrbuted surplus
_ $3a7,414�611 $156,938,671
Unassigned funds(surplus; ($5,335,190)
Surpr in as regards policyholders $156,603,481
TOTALS $347,414,611
SUBSCR18ED and sworn tome WAY-day of H"y1V "'('j s
Mycornnvisctoessprres; 7•/L)-� .
NouryPubfic
CERTIFICATE Printed Name ALYSSA TURKOVTTZ
I certify that the above financial statements to the bestaf my Notary Public,State of New YorkNO.04TU6044.514
knowledge area true and accurate reflection of the Rnwiclal. p1yr�TV RKOVffZ
condition of the Company as of December 31,2014, Qualified in Westchester CiOilrlty
Addlbonafly,Icertify that the above financial statements are ti. :.;�� p., ��.s. r,-.,ti' ComWb$IOIiExpires July 10,2018
In agreement with the Statutory Financial Statements filed with the Tekas NDtstbile.State of New York
Department of Insurance as of the same date.
No.01TU6044514
William Gleason Quallfied In Westchester County
SFR YP$IfaaltefJ 1 Commission Expires MY 10,2014