15-0505_Bond_SUR21000006_Pacific Point Dev_TR 16747 Premium: $282.00
SUBDIVISION FAITHFUL PERFORMANCE BOND
(GOVERNMENT CODE 66499.2)
Bond No. SUR21000006
Replaces Bond No. SUR20000328
KNOW ALL MEN BY THESE PRESENTS, that Pacific Point Development Partners LLC
(hereafter designated as "Principal"), and tronshore 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 16747 as defined within Amendment#1 and
Reinstatement of the Subdivision Improvement 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
Thirty Seven Thousand Five Hundred Fifty Four Dollars and 00/100 Dollars, ($37,554.00 ) 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
1 (NOTARIZATION AND SEAL)
B
Y
Its: �VQ('1° S� vtrnor
SURETY:
Ironshore Indemnity Inc.
�} (NOTARIZATION AND SEAL)
By: _
MargareXA. Ginem , Attorney-in-Fact
Surety Phone No.
G/0 VVILLIS Or FLORIDA
,1211W,BOY SCOUT BLVD,#1000
'T MPA, FL 33607 Page 2 of 3
[°K)UIPIES:(813)261-2095
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
}
Onf before me, lipI ��C/
Date y �` Here Insert e a d tie oft a Officer
personally appeared l 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 samein
his/her/their authorized capacity(ies),and that by his/her/their signature(s)on the instrument the person(s),
or the entity,tion 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
rA W.CORDI is true and correct.
Commission#2088325 a WITNESS my hand and official seal.
Z . Notary Public-Czllfornia
Z Orange County n
jj
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: _ 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
I
1
I
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
Wi u¢�� ANETT CA TALE
Commfsslon#FF 188482
r' EXPIres July 28,2418
"'0" Bonded Thru Troy Fein Inourerwe 8 aI5.7018
This area for Oficial Notarial Seal
.-Setat&13W 1100, wtehO-.Seotl' ii1:199 bba- 119$'-Oflhe:dfylt Code-=4 geou'Ni 910 of too
JQ`uVp x=ut
e.-
JQ`uVpMY=qt Code, f4afi4to noto.fies.0$11;Tbe,belpv-jbysicaf format 0. dis.qjbsiird
Aqtjcejs-a4 example,-for purposes'af iliusfratiom.
h6tw'.Public or other offi6ef 60b*
Certiftate verifies only the identity of the
ind'iV'i'8ua_h0oAi9ned the dot-ut titw hi&t
,.nr . w _WA
.certificate.is attached,and not-the trLithUnessi
.'d, Of -
404wyl Ok Yali. Ity -4041im
California
C.iUilty.of
-before me,
.ibsert name and:title of icer),,personally,app red W'ha
satisfactory is/are sul}§cribeato_
fbe, wifti I&Tment and a6mowledged to -xne,'that,helshe/the
y executed the.same :in hisfher/their
44110'0xed'w4diA1164), "0 Ut.by)IiAOrA*'Mgj#ture(&) ,qtt tfie'!V§trufaot the Pgrson(s),.or the
;4tity,f1pix.behalf ofwhiGh'the pefsbfi(k).acted;.executed tffi&justru nt.
ce,itif' Urider PENkILTY OV PFRJU' .0 tire,stat the f6f'eg6rig.
RY`Onder,lbe Jaws
parNMh-is true ana correct
-
WITNE S&it Y hAnJ and.official:sell;
(Sea)),
POWER OF ArrORNEY
Ironshore Indemnity Inc. III- 21000006
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 IRONSHOREINDEMNITY 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
certlficate 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.
s
S F.AL
ta1Q F
bA1tfC's r_
ey:
D(,,,a k.Suss n
Director
ACKNOWLEDGEMENT
On this 7a`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.
`••.•aqr rs>r�y
'yQ. _,�i••*_ 11.1M17yWCryskPn,:nls1ys1i-mLS7EaAtlYprefCT%�e0n1n-0e9sse
Am
41,
Davidson County 1TO f
,. Noory Pu1Nk
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 t91h Day of May ZD 15
191D
tam
Pauls.Gi dam 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 31,2014
ASSETS UABIUTIES
Bonds
$179,140,947 losses $63,582,066
Preferred stocksReinsurance payable p gable on paid losses and Inns adjustment expenses p
Common Stocks 31,840,141 Loss adjustment expenses $10,384,957
Mortgage loans on real estate.first tons 0 Commissions payable,contingent cornmissloess and other similar charges $1,020,805
Mortgage loans on red estate,,Other than first liens 0 Other expenses(excluding taxes.licenses and fees) $5,435,126
Properties occupied by the company 0 Taxes,licenses and fen(excluding federal and foreign income taxes) $11383,909
Properties held for the production ofincome 0 Current federal and foreign Income taxes
$2,434,392
Properties held for sale
0 HN deferred tax Ilablttty 0
Cash.cash equivalents and short-term investments $15,632„951 Unearned premiums $29,158,S76
Contract loans 0 Advance premium
Derivatives 0 Ceded reinsurance premiums payable(net of ceding commissions) $58,222,387
Other invested assets 0 Funds held by company under reinsurance treaties
0
RecelvaWes for securities 0 Amounts wlthhNdorretalned by company for aaountofothers
Securities tending reinvested collateral assets 0 Remittances and items not allocated
Aggregate write-Ins for7nvested assets 0 Provision for reinsurance $1,545,075
Subtotals.rash and Invested assets $216,614,039 Net adjustments In assets and tabilltles due to foreign exchange rates
Title plants less$-4 Chargdd off 0 Drafts outstanding
Investment Income due and accrued $990,960 Payable to parent,subsidiaries and afBllates
$12,458,110
Uncollected prem ums and agents'balances in the course of collection $73,567,547 Derivatives
0
Deferred premlums agents'balances and Instalments booked but deferred and not 0
yet due Payable for securities 0
Accrued retrospective prersuums 0 Payable for securities lending 0
Amounts recoversbie from reinsurers $33,586,257 liability for amounts held under uninsured plans 0
Funds held by or deposited with reinsured companies 0 Aggregate writealu for liabilities $4,185,928
Other amounts recelvable under relnsurance contracts 0 Total liabilities excluding protected cell liabilities $190,811,131
Amounts receivab:e relating to unins wed plans 0 Protected cell liabilities
Current federal and foreign 1 rime tax recoverable and interest thereon 0
Net deferred tax asset $5,530,837 Total liabilities
$190,811,131
0
Guaranty funds receivable or on deposit
Furniture and equipment,including health are delivery assets 0 POUCYHOLDERS'S SURPLUS
Net adjustment In assets and liabilities due to foregn exchange rates 0 Aggregate wnte4nsfor special surplus funds 0
Recelvables from parent subsidiaries and affiliates 0
Health are and other amounts receivable 0 Common ay,tal stock S D00 000
Aggregate write-im for other than Invested assets $7,124,971 Preferred apltalstock
Total assets excluding Separate Accounts,Segregated $347,414,611 Accounts and Protected Cek Aggregate write-',ro for oilier than special surplus p
Accounts
From Separate Accounts,Segregated Accounts and Protected tell Accounts 0 Surplus Notes
TOTALS $347,414,611 Gross paid In and coritnbuted surplus
$156,938,671
.Unassigned fundsourplust ($5,335,190)
Surp us as regards policyholders $156,603,481
TOTALS $347,414,611
SUBSCRIBED and sworn to me thlsyday of M/T1Y_,Gr f'rj
f� /�ji��� lNywmrNss-:nmrpirts: '7�q.-�'S['
Notary Public
1
CERTIFICATEr Printed ALYSSA TURKOVITZ
that ted Name Notwy Public,State of New York
I certify that the slave financial statements to the best of my fJo,-01 TU6044514
knowledgeareetrueandaccurate reflection of the flnamlel ALYSSATURKOV4Z OUEtiItI8L1 InWestchesterIU6451
AddiconditbnaltheLompanyas a ovefinDeceman 31,tate / f_�-! lommiseion lrFii4„my 1Q 013
Additionally,I certifythettlteshove financial statements are / 7/1„v.
in agreement with the Statutory Finandal Statements filed with the Tex&i NQtO,4APVbItr.State of New York
Department of Insurance as of the same date,
No.OlTU6044514
William Gleason Quallfled In Westchester County
CFO.VP 8:Trepsurcr Coramission Expires July 10,2014
SUBDIVISION LABOR AND MATERIAL BOND
(GOVERNMENT CODE 66499.2)
Bond No. SUR21000006
Replaces Bond No. SUR20000328
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 im rovements within Tract 16747 as defined within Amendment#1 and
Reinstatement of the Subdivision improvement 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
Thirty Seven Thousand Five Hundred Fifty Four Dollars and 00/100 Dollars ($37,554.00 ) 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, shat
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:
Its:
SURETY:
Ironshore Indemnity Inc.
(NOTARIZATION AND SEAL)
By:
Margare A. Ginem , Attorney-in-Fact
Surety Phone No.
C/®MLLIS OF FLORIDA
4211 W,BOY SCOUT BLVD,#1000 Page 2 of 3
TAMF'f-<, FL 33007
If QUIRJESS (813)281-2090
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, • Ltr" 1. �1
ateere Ins a e and Title o the Officer
personally appeared 4 t4
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($),
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 x WITNESS my hand and official seal.
z , Notary Public-California
Z ' Orange County
My Comm.Ex fres 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:
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 19'' 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
• � rAwe"
y .
Commission#IFF 1 8482
Expires July 28,2018
+r Bonded Thru Troy Fain Ineurence BOD-85.7018
This area for Official Notarial Seal
SeUte:Biu I1Ol wtehd's Sections )189 anti :�19� cidtlie:C.-Ml Coe an cdco $ of the
r ri de; eZai g#(� # ,Ps, #�lic�.'y"e,lie� rysical.form4t'p nL ciisclositre
mptics is an exepple;,for pur�. ofMusOati€m.
itY t pU ilic otother vffidelr coi#Owtiz;gth#.s•.
cet#ifica2e verifies only the identity of the
individual vnc�r signed_the dootnent.ta uvh dh-ts
certificate.is attached,and not the truthfulness,
AOU146y,o%)validity of th4T,.dtiqu*nj.
Sfatd of California
Qbtinty of
r ;before fne, .. �>,e
Ihsert dame andtitle of officer),person.*appeared Abu
fpy-W to trig Dil-tho'ba,is.of'4atisfactory-evidobbe h7 f;�#6ve:lS�ari�S�.�9 ose hame(s)asl�ro sttl�scribei�'tp.
fhe wMid inst r-meat.and acknowledged -to me-'thaV h0shelthey exeouted the samw im hislherlt'heir•
iutlst is ed rapachy(!'4), ood .that;by,� isftr/tf* szgnatge(s,) 'On the iristrurncijt itlne�i�rsat�[s},:-a the
titity upQ behalf of whiGlt tfie persnri s ,acted,ekecuted tho.instru�rnent,
I,i<eit 'i rider PENALTY'(QF P JURY tirid$r.tlae ]aw's'of thet of ulfornli that'the fotegoi
paragraph is true andcorrect
WITNESS myl AM arid offiuiak seah.. i
Signa'ure (Sea]),
POWER OF ATTORNEY
Ironshore Indemnity Inc. III- 21000006
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 he 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.
e ;r O,4�y�
f
j f
REAL
I110 —
I110
t ALSus'
Director
ACKNOWLEDGEMENT
On this 7t"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.
Ab9Y L PAYP_Of{ t
e Notary Public-State or Tennessee
'-,• - Davidson C—ty -
,� A C"mlulon Eto"Orae-16 Amy L.Tay]
Notary Puft
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,MayZp 15
iaWyb�
SEAL P
19$0
1
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#NDEMNfTY INC
FINANCIAL STATEMENT SUMMARY
As of December 31,2014
ASSETS LIABILITIES
Bonds
$179,140,947 Lo"e $63,582,066
Preferred stocks
p Reinsurance payable on paid lasses and loss adlustrnent expenses
0
Common stocks
31,840,141 toss adjustment expenses $10,394,957
Mortgage loans on real estate.first liens 0 Commissions payable,contingent commissions and other similar charges $1,020,805
Mortgage loans on real estate;Other than first liens 0 Other expenses(exctuding taxes.names and fees) $5,435,126
Properties occupied by the company 0 Taxes licenses and fees(exdudmg 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
Prop end es held for sa'e 0
Net deferred tax liability 0
Cash.cash equivalents and short-term investments $15,632,951 Unearned premiums $29,158,576
Contract loans D Advance premium
Derivatives 0 Ceded reinsurance premiums payable(net of ceding commissions) $58,224187
Other invested assets 0 Funds held by company under reinsurance treaties
0
Receivahlesfor secuemes 0 Amounts withheld or retained by company for account of others
Securities lending reinvested collateral assets 0 Remittances and Items not allocated
Aggregate write-Ins fortnvestedassefs 0 ProvisionForrelnsurance $1,545,075
Subtobls.cash and Invested assets $216,614,039 Net adjustments In assets and tabilitie due to foreign exchange rates
Title plants less$..,Charged off 0 Drafts outstanding
Investment Income due and accrued $990,960 Payable to parent,subsidiaries and of hates $12,458,210
Uncollected prom ums and agents'balances in the course of collection $73,567,547 Derivative
0
Deferred premiums,agents'balances and Installments booked but deferred and not 0
yet due Payable for securities 0
Accrued retrospective premiums 0 Payable for securities lending 0
Amounts recoverebfefrom reinsurers $33,586,257 Uabllityfor amounts held under uninsured plans 0
Funds held by or deposited with reinsured companies 0 Aggregate wdWIns for liabilities $4,185,928
Other amounts receivable under reinsurance contracts 0 Total liabilities excluding protected ce9llabllldes $190,E11131
Amounts recelvabte 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 TOM.NablRies
$190,911,131
Guaranty Nods receivable or on deposit 0
Furniture and equipment,Including health pre delivery assets 0 POUCYHOLDERYS SURPLUS
Net adjustment In assets and liabilities due to fordgn exchange rates 0 Aggregate wnte-Ins for special surplus funds 0
Receivables from parent,subsidiaries and affiliates 0
Health are and other s mounts receivable 0 Common ap•tal stock 5 000 000
Aggregate write-ins for atherthanlnvesWasseta $7,124,971 preferred capital stock
Total assets excluding Separate Accounts,Segregated Accounts and Protected Cel, $347,414,611
Accounts Aggregate write=.ns for other than special surplus p
From Separate Accounts,Segregated Accounts and Protected Cell Accounts 0 Surplus Notes
TOTALS _ $347,414,611 Gross paid In and contributed surplus $156,938,671
Unassigned funds(surplus; ($5,335,190)
Surp ui as regards policyholders $156,603,431
TOTALS �y $347,414,611
!'U&SCRI6FD and sworn tomethlsy_'day of
!� MyromnXl%,snesputs '] /0'7Y1
s ' - Notary Public
ALYS
ICERTIFICATE
cef I hat ' Printed Name Notary Public,State of Navy York
1 certHy that the above financial statements to the bestof my NO.Q1 6044.514
knowledge are a true and accurate reflection of the financial ALY&SATURKOVnZ.
condition of the Company as of December 31,2014, / Qualified In Westchester CoiJrtt}(
if CiU, t}it3
Additionally,I certify that the above financial statements are
rmm�sa Fcoirss•Jul aJf
In agreement with the Statutory Flnandal Statements filed with the Texas Hotat 4ubil0tate of New York
Department of Insurance as of the same date,
No.01TU6044514
William Gleason Qualified In Westchester County
CFO.VP R Treasurer Commisshan Expires July 10,2014