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15-0505_Bond_SUR21000009_Pacific Point Dev_TR 16752 Premium: $533.00 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 Luc (hereafter designated as "Principal"), and Ironshore Inclemnily 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 Sevens 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 (NOTARIZATION AND SEAL) By: Its: SURETY: Ironshore Indemnity Inc. �A (NOTARIZATION AND SEAL) By: Nfargaret . Ginem , Attorney-in-Fact ('40 WILLIS OF FLORIDA Surety Phone No 4211 W,BOY SCOUT BLVD,#1000 `1"AMi�A, FL 33607 MUIRIES:(613)281-2095 Page 2 of 3 APPROVED AS TO FORM: By: NOTE: Please attach Acknowledgement and Power of Attorney Page 3 of 3 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT 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 ) r On before me, f Oa e e In ert Name and True of 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, Commission#2088325 WITNESS my hand and official seal. ,- Notary Public-California Z Orange County �f r 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: ©2014 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 aiy t'''•., ANETT CARDINALE Commission#FF 138482 a Expires July 28,2018 Bonded Thor Troy Fein Insurance 800305•7019 t This area for Official Notarial Seal Metd'vS`ectioris 11$9 Scolip- 910'ofth xoY e t.,Code;telafing-t4 ntitahes,p blib'The-bi v'�• ,p cal:format of ll�e riow disclosiue �,t�tice,zs_anexa��le; for purposes o�il�ush�a#lnn; A i>ioOj?,ptrlilic of other df]16 r corn-feting tlt3s: certii'm4vetiftes.onlythe identity'ofthe individual who.signed the docwnerit,to whIdh t' certificate-is attached and not the trdthf'ulness� accirrady,os Val&Ay of 1W do4uffient. So bfCaifornia. G.ptinty of Qit -.- - .before me, ifisert name and title of officer,personally Appeared ho' proved Xi'};iAi oo-tho basis of'satisfhh y.evidence to fie:'tho,porsan(�)`valioso riarrte(s)is/4re subsq to fhe" vvffhiri--iris-trrunent and. acknowledged -to me that he/she/they executed the saute-in .l iAerithein autb''Ozed c-Vaeiiy(es), 4i :.I th slher/their`!;Pov C s ti.'the "itistrutuc.:lt tlle'-tfson(s),.or the e4tityopoi behalfofwhIA-1 ' person(§).acted;ekecutedth iastrwipent ceitiff+ iYiider PEVA T ('Ot? ' itXEJR*Y under the laws Qf t6 State af'CallfnnRia tho tits or oxri paragraph is true and-correct WITNESS in.yIAnd aiid..offizW—sept. Sg�atiire. (Sea]) 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. fi o i.5 Ixi SEAL Mip (a By: flan 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. ea,� AMYL TAYLOR Notary Publla Slate of Tennessee ��JJ Davidson County :,q,.'••.,, `,` My Commisslon Expires 01.09-16 JTayl 'amu Na:ery 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 asset forth are now in force. Signed and Sealed at this isin Day of May Zp 15 = SFaL ' sewle l Paul5.Gi clan ' 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." IRONSHOREMDEMNITY INC FINANCIAL STATEMENT SUMMARY As of December 31,2014 ASSETS LIABILITIES Bonds $179,140,947 Lues $63,582,066 Preferred stocks p Relnaurarlu payable on pall losses and loss asdJustment expenses 0 Common stocks 31,9140,141 loss adjustment expenses $10,384,957 Mortgage loans on real estate.First tens 0 Commissionspayable,contingentcornmissiorssandotheralmilarcharges $1,020,805 Mortgage loans on real estate,,Other then first liens 0 Other expenses(excluding taxa.licenses and fees) $5,435,126 Properties occupied by the company 0 Taxes,licenses and fees(exdudmg federal and foreign Income taxes) $2138009 Properties het for the production of income 0 Current federal and foreign Income taxes $2,434,392 Properties held for sae 0 Nat deferred tax tiablilty 0 Cash.cash equivalents and short-term Investments $15,632,951 Uneamed premiums $29,158,576 Contract loans 0 Advance premium Derivatives 0 Ceded reinsurance premiums payable(net of ceding commissions) $58,224137 Other invested assets 0 Funds het by company under relnsurancetreatles 0 Receivables for securities 0 Amounts withheld or retained by company for account of others Securities lending reinvested collater*assets 0 Remittances and items not allocated Aggregate write-Ins for!nvested assets 0 Provision for reinsurance $1,545,075 Subtotals.cash and Invested assets $216,614,039 Net adjustments In assets and tabllltles due to foreign exchange rates Title plants less$..,Charged off 0 Drafts outstanding Investment Income due and accrued $990,S60 Payable to parent,subsidiaries and aff hates $12,458,110 Uncollected prem ums and agents'balances In the course of collection $73,567,547 Derivatives D 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 recoveraW from reinsurers $33,596,257 UablIlty foramounts held under uninsured plans 0 Funds held by or deposited with reinsured companies 0 Aggregate wtite4usfor liabilities $4,1851928 Other amounts recetvable under reinsurance contracts 0 Total liabilities excluding protected cell Ilabllkies $190,811,131 Amounts receivab,e 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 Taal liabilities $190,811,131 Guarantyfunds receivablew on deposit 0 Furniture and equipment,including health are delivery assets 0 POUCYHOLDERSS SURPLUS Net adjustment In assets and liabilities due to fore gn exchange rates 0 Aggregate write-Ins for special surplus funds 0 Receivables from parent subsidiaries and affiliates 0 Health are and other amounts receivable 0 Common aotal stock S ODO ODO Aggregatewrtte-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 wrier ns for other than special surplus p Accounts From Separate Accounts,Segregated Accounts and Protected Cell Accounts 0 Surplus Notes TOTALS $347 d414,611 Gros,paid In and contr4buted surplus $155,938,671 a - Onessslgned funds jsurplus,' ($5,335,190) Surp oat as regards policyholders $156,603,481 TOTALS $347,414,611 SUBSCRIBED and swom to me tNsM day of Myrwmmlrs�cnexgres; -7-JV—/Ss` NoaryPuWlc VITZ CERTIFICATE Printed Name NoR APubISt A State O New York certify that the above financial statements to the bestof my knowledge are a true and accurate reflection of the Rnancial. ALYSSA TU RkOVrf2 No.01 TU6044514 condition of the Company as of December 31,2014, ' Ql anile>~In Westchester Count/ Additionally,I certify that the above financial statements are {Y Gommfe 1 gilts July 1fir`2018 In agreement with the Statutory Financial Statements filed with the Texas NQtat+Qf'Publlr.5tate of New York 't Department of Insurance as of the same date. No.01TV6044514 WRllam J Gleeson qualified In Westchester County {JSP Treasurer Contmission Expires July 10,2014 SUBDIVISION 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 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: tiT .ar`, dun ,c SURETY: Ironshore Indemnity Inc. (NOTARIZATION AND SEAL) By:, `/? Mar.gare A. Ginem , Attorney-in�FaCt 0,10 WILLPS ClF FLORIDA •1211 VII.BOY SCOUT BLVD,#1000 Surety Phone No. TAMPA, FL 33607 ^NQUIPIES:(813)2612095 Page 2 of 3 APPROVED AS TO FORM: By: NOTE: Please attach Acknowledgement and Power of Attorney Page 3 of 3 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT 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, V V I G Date Here I rt Name an Title of he Officer personally appeared T Name(s)of Signer(s) a 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 is true and correct. W.C"" Commission#2088325 WITNESS my hand and official seal. Z `*� Notary Public-Czllfornla n r Orange County My Cama. Expires Oct 31,2018+ 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: T_. 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: FG'.'. -_ ..�n "� ', �'•'e' '�4.' '�t'�Esa'� "�-G�i�` 3' =f�°�"�,'�,t.-mss._' -.�.'�lrr�.'�{"a�i�.�,>zz.� 02014 National Notary Association •www.NationalNotary.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 *�'"�''`•, ANE7CARDINALE Commission#FF 138482 Expires July 28,2018 Bonded Thor Troy fain Insurance 800-385.7018 This area for Oficial Notarial Seal fi -Bi11�. 1000, arrnWd's :Sectioiis 1-:189 ac id 119.5-of;tlia: ly l �orle cud geo.tf.- 82Qt-of 1ho f"x e enf.Code;.telating to noiiubf fbt ne;below,Opical format of tfte:heW disglosure ,s-an exapft for purposes ofi ustrat�on A iiofary public of other officer coiholetinb�thf.s, certificate verifies.only the identity of the individual who:sighed.the documerit,to wh .thi certificate is attached,and riot the trutlifitlness� Acci" y,oivatfity of thaf:dooupients State bf'Galifornia. Cbunty.of Oix :befcire the, fi insert name and'title of officer,personally app s wha rowed t e ori'th'e ba,is of atisfacto: evtderice to b thy. 0rsori k Whose harae s i P.� . . . .€�.rri,: � �'� �. P ��' ( ) � subscribed to, -the 1vAW,instrument:and acknowledged -to me-'thav helshelthey executed the same in .hislherltheir- aL ' iso rgapaciiy{i s ,. d .that,liy. isAeridi.e x`s gbatuye(s Oa ilie instrufuta7t 3e a rson(s),.Of die entity.y. bpo�.behalf ofwhlgh'thi.pefsosi('s)acted,ekecuted tble-instrcvctent, I:cG if Airider PENkT TY'OV PW."VkY�ih&r flee l'iWs of tie. t f ,of t✓al'briiia W.tl�e fol 969 1 paragraph i"s true and correct WITNESS my hcnd and offiicW—seal; ;; afure (Sea]), f POWER OF ATTORNEY Ironshore Indemnity Inc. III- 21000009 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 duty 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 sea(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 small 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. JSEAL 1L1s By: Daniel L.Sussnian 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. ,•` Y1T^ ',• AMY TAYLOR 1r'4mry AoDtic-&tate or Tomessae Davidson County My Commisslon Expires 01-0316 Am�Ll - '•: wa +`��� Notary Publlt 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 May 20 15 4 SeAt n . 101r • s Paul S.Gi dams 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 I RONSHORE MDEMN ITY INC FINANCIAL STATEMENT SUMMARY As of December 31,2014 ASSETS LIABIl1T1ES Bonds $179,140,.947 tosses $63,582,066 Preferred stacks 0 Reinsurance payable on paid losses and loss adjustment expenses Common stocks D 31,840,141 toss adjustment expenses $10,394,957 Mortgage loans on nal estate:tirst kens 0 Commissions payable,oontingent commissions and other similar charges $1,020,805 Mortgage loans on real estete;ttherthen first liens 0 Other expenses(excluding taxes.llcansesand fees) $5,435,126 Properties occupied by the company 0 Taxes,licenses and fees(excluding federal and foreign Income taxed Properties held for the production of Income 0 Current federal and foreign Income taxes $2,383,909 $1,434,392 Properties held for cele D Net deferred tax liability 0 Cash.r$hequivalents and short-term investrnents $15,632,9S1 Unearned premiums $29,158,576 Contract bans D Advance premium Derivatives D Ceded reinsurance Premlums payable(net of ceding commissions) $58,222,187 Other invested assets 0 Funds held by company under reinsurance treatleis 0 Receivables forsecuritles 0 Amounts withheld or retained by company for account of others Securities lending reinvested collateral,assets 0 Remittances and Items not allocated Aggregate Wrlte-Ins forinvested assets D Provision For reinsurance $1,545,075 Subtotals.cash and Invested assets $226,614,039 Met adjustments In assets and tabllltles doe to foreign examnge rat" Title plants less$...Charged off 0 Drafts ouhtanding Investment Income due and accrued $990,960 Payable to parent,subsidiaries and affiliates $12,459,110 Uncollected premiums and agents'balances In the course of collection $73,567,547 Derivatives Deferred premiums,agents'balances and insbgmma booked but deferred and not D a yet due Payable for securities 0 Accrued retrospective premiums 0 Payable for securities lending 0 Amounts recoverable frorn minsuress; $33,586,257 LJabilltyfor amounts held under uninsured plans 0 Funds held by or deposited with reinsured companies 0 Aggregate write-Ins for liabilities $4,185928 Other amounts receivable under reinsurancecontracts 0 Total liabilities excluding protected cell liabilities $190,811,131 Amounts receivab;erelating touninsured plans 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 Hinds receivable or on deposit D Furniture and equipment,including health care delivery assets 0 POUGYHOLDERS•S SURPLUS Net adjustment In assets and liabilities due to forego exchange rates 0 Aggregate vette-Ins for special surplus funds 0 Receivables From parent,subsldiartes and affiliates 0 Health are and other amounts receivable 0 Common cap4al stock 5 000 000 Aggregate write-Ins for otherthan invested assets $7,124,971 preferred capital stock Total assets excluding Separate Accounts,Segregated Accounts and protected Cet $347,414,611 Accounts Aggregate write-tsforotherthanspecialsurplus 0 From Separate Accounts.Segregated Accounts and Protected Cell Accounts 0 Surplus Notes TOTALS $347;a1E,611 Gross paid Irk and contributedsurplus $156,938,671 Unassigned funds(surplus; ($5,335,190) SuWus as regards pollcyboldera $156,603,481 TOTALS $347,414,611 SUBSCRIBED and sworn to methlsiYds+yofHq �y MYoomrNss.rnesp,res� i/U'I S.S, Notary Public CERTIFICATE Printed Name ALYSSA TURKOViTZ I certify that the above financial statements to the bestof my Notary Public,State Of New York knowledgeareatrue and accurate reflection ofthe fina tlsi ALySSATURKOVM NO.01TU6044$14 condition of the Company as of December 31,2014, / / Qualffied in Westdiester Gounly Additionally,I certify that the above financial statements are .r{.. ,,y I J �/ . Commission Expires,Filly 10,2018 In agreement with the Statutory Financial Statements filed with the Taxa.§ Notap¢,YubtlG State W New York til. Department of Insurance as of the sa me date No.OITU6044514 William J Gleason Qualified In Westchester County �F =Y LCtiglvlCL Cornmissfon Expires July 10,2014