15-0505_Bond_SUR21000010_Pacific Point Dev_TR 15609 Premium: $225.00
SUBDIVISION FAITHFUL PERFORMANCE BOND
(GOVERNMENT CODE 66499.2)
Bond No. SUR21000010
Replaces Bond No. SUR20000319
KNOW ALL MEN BY THESE PRESENTS, that Pacific Point Development Partners LLC
(hereafter designated as "Principal"), and Ironshore indemnity Inc. ,
as Surety (hereinafter called "Surety") agree to install and complete certain designated
public improvements as conditioned by City Council Resolution No's. 92-6-16-4 and
03-09-16-06.
WHEREAS, said Principal is required to furnish a bond pursuant to Municipal
Code Section 9-5.101 and 9-5.109 et seq., for the faithful performance to guarantee
certain work, more particularly described as follows:
Sanita Sewer subdivision improvements within Tract 15609 as defined within Amendment#1 and
Reinstatement of the Subdivision Im rovement Agreement for Tract 15609
NOW, THEREFORE, we, the Principal and Surety are held firmly bound unto the
City of San Juan Capistrano, (hereafter called "Obligee") in the penal sum of
Twenty Four Thousand Two Hundred Ninety Three Dollars and 001100 Dollars, ($24.293.00 ) lawful money
of the United States, for the payment of which sum well and truly to be made, we bind
ourselves, our heirs, successors, executors and administrators, jointly and severally,
firmly by these presents.
NOW, THEREFORE, the condition of this obligation is such that, if Principal shall
promptly and faithfully perform said improvement obligations within the fully executed
and recorded subdivision improvement agreement, then the obligation shall be null and
void; otherwise it shall remain in full force and effect.
Page 1 of 3
BE IT FURTHER RESOLVED:
1. As a part of the obligation secured hereby, and in addition to the face
amount specified, there shall be included costs and reasonable expenses and fees,
including reasonable attorney's fees, incurred by City in successfully enforcing such
obligation, all to be taxed as costs and included in any judgment rendered.
2. Said Principal, for value received, hereby stipulates and agrees that no
change, extension of time, alteration, or modification of the contract documents or of the
work to be performed thereunder, shall in any way affect its obligations or this bond, and
it does hereby waive notice of any such change, extension of time, alteration, or
modification of the contract documents or of work to be performed thereunder.
IN WITNESS WHEREOF, this instrument has been duly executed by the
Principal herein named on the 19th day of May , 2015 , the name and
corporate seal of each corporate party being hereto affixed and these presents duly
signed by its undersigned representatives pursuant to authority of its governing body.
PRINCIPAL:
Pacific Point Development Partners, LLC
(NOTARIZATION AND SEAL)
By:
�6n�
Its:
SURETY:
Ironshore Indemnity Inc.
(NOTARIZATION AND SEAL)
By: ?9
Margaret A.dinem , Attorney-in-Fact
Surety Phone No.
C/O WILLIS OF'FLORIDA
4211 W.BOY SCOUT BLVD 41000
TAMPA, FL 336oi 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 of `{ �n r-CDC
�anTlt
On I I before me, ,v -W C 1 Co ���
Date N fns rt Nameo the Officer
personally appeared b YVA
�n
Nam'e(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 m hand and official seal
*� Notary Public-California y
Orange County ..
M Comm.Ex Iras 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.NationaiNotary.org • 1-800-US NOTARY(1-800-876-6827) Item#5907
e te.Bill I10$.0, arimejids :Sections: i 0 and :119$ of fine:OY-i .to&and Section 8202 of tht
ry et eztl.Cor e; fe�ating o n e .- �Ia .T�Yde,iet v ?ysicaY format of dip ri- -disclosure
nonce;iS.a4 minp t; fQ r Purp9m 9#
A moty! tinC his:
certifi'aate verifies only the identity-of the
individual*ho.signed,the do ►ntent.tO w4ioh.�ol
.certificate.is attached,and noi-the truthfulness;,
aeFuraey�o vatzdkty Of thaf:doour ent.
State of fratifornia.
.C¢unty of
ihsert name andtitle afro ftcer},personally appeared
rouect tQ tit .oii the basis,of' w (Y.
P.
o-�Skdtbry evidenit to 4�`thgpersmi(*whose names);is/#j#j -suhsedbed to
)khe.withici-hs ument and acknowledged -to rne, that°Wshelthey executed the same.in .his/herltheir
aRflmh edi i9pacii "es, ad .thAt bre{s) 'ijt1.:fine.`Itistruirtr✓att 66-t�rson(s),:of the
trttrt};upon behalf of wh en"t6ie persbri�s�acted,ek6cuted th6nstrument
I;r<eikfy'itrider PENAI,'l 'Ol'P] E7X irid$r:flat-Jaws'ofie.Stag vt"�aliforiala Chit t1ze £argot
paragraphs is true andcorrea
WITNESS ii y.hand aiid official-seat i
S.griaftite: (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 affi ed my official seal on
the date in this certificate first above writte
Signature
Anett Cardinale
:, i• 4 AN;£TT CARDINALE
• Commissbil#FF 138482
>: o•, Expkes dui
.• A��i , 8., 18
Bondad 7W T roY Fain Vnawezawa m.
BgD.3ti5-1019
This area for Official Notarial Seal
POWER OF ATrOR My
Ironshore Indemnity Inc. III- 21000010
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-f=act 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 an 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.
�.
Fa SEAL
`t 1819 _
�r
By:
Dan a 1,5111 n
Director
ACKNOWLEDGEMENT
On this 7th Day of August,2013,before me,personally carne 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.
me AMY L TAYLOR
Notary Public-State of Tennessee
-' Davidson County
MVC
—MissiOnExpires 01-09-16 dmyTay1
Notary Public
—
CERTIFICATE
I, the undersigned,Secretary of IRONSHORE INDEMNITY INC., a Minnesota Company, DO HEREBY CERTIFY that the original Power of Attorney of
which the foregoing is a true and correct copy,is in full force and effect and has not been revoked and the resolutions as set forth are now in force.
Signed and Sealed at this 19th Day of MaY ZD 15
SEAL
61'919'
Paul S.GI dano a
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 MDEMNITY INC
FINANCIAL STATEMENT SUMMARY
As of December 31,2014
ASSETS LI"IUT1ES
Bonds
$179,140,947 tosses $63,582,066
Preferred stocks 0 Reinsurance payable on paid losses and loss adjustment expenses 0
Common stocks 31,840,141 Loss adjustment expenses $10,384,957
Mortgage loans on real estate:Arst tens 0 Commissions payable,contingent commission and other similarcharges $1,020,805
Mortgage loans on real estate;Odw than first Ilea 0 Other expenses(excluding taxes.licenses and fees) $5,435,126
Properties occupied by the oompanv 0 Taxes,licenses and fees(excluding 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 Not deferred tax liability
0
Cash.cash egalvalentsand short-term Investments $15,632,951 Unearnedpremlums
$29,158,576
Contract loans 0 Advance premium
DedvatWes 0 Ceded reinsurance prerniurns payable(net of ceding commissions) $58,222,187
Other invested assets 0 Funds held by company under reinsurance treaties
0
Receivables for securities 0 Amounts withheld or retained by company for account of others
Securities lending reinvested collateW assets 0 Remlttonces and items not allocated
Aggregate write-Ins forinvested assets 0 Provision for reinsurance $1,545,075
Subtotals.cash and Invested assets $226,614,039 Not adjustments In assets and tabllkles due to foreign exchange rates
Tile plants less$.-Charged off 0 Drafts outstanding
Investment Income due and accrued $990.960 Payable to parent,subsidiaries and affiliates $12,458,110
Uncollected prem ums and agents'balances len the course of collection $73,567,547 Derivatives q
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 recoverable from reinsurers $33,586,257 Uabilltyfor amounts held under uninsured plans
0
Funds held by or deposited with reinsured companies 0 Aggregate corporins for Ilabllitles
$4,1851928
Other amounts receivable under reinsurance contracts 0 Total liabilities excluding protected eel liabilities $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 Totallabolitles
$190,811,131
0
Guaranty funds receivable or on deposit
Furniture and equipment,Including health ore detivesy,assets 0 POUCYHOLDETWS SURPLUS
Net adjustment In assets and liabilities due to foregn exchange rates 0 Aggregate wnte•Ins for special surplus funds 0
Receivables from parent,subsidiaries and affiliates 0
Health care arid other amounts receivable 0 Common aotal stock 5,000,000
Aggregate write-Ins for other than Invested assets $7,124,971 Preferred capital stock
Total assets excluding Separate Accounts,Segregated Accounts and Protected Cat $347,414,611
Aggregate wrltt;ra for other than special surplus 0
Accounts
From Separate Accounts.Segregated Accounts and Protected Cell Accounts 0 Surplus Notes
TOTALS $347,414,611 Gross paid In and contnbuted surplus $156,938,671
Unassigned funds surplus; ($5,335,190)
Surp us as regards policyholders $156,603,481
TOTALS $347,414,611
iU85CJU8ED and ssvpm to ma ftils4�rday d j�}1,/ 'U f rJ
�s f,7 PAY commll sc n expires:
f .•>F, �•� Notary Public
CEITTI FICATE AUSSA TURKOVrTZ+� Printed Name �174Qf)I�11b(IC,.S18t6 t�NeV1l York
1 certify that the above financial statements to the best-of my NO.U1.State f N
knowledgeareatrue and accurate reflection ofthefinarxiai ALYSSATURKOVrVZ QUB�IE�BLi�11TU6lt 451 GC1Uf7l�!"
condition of the Company as of December 31,2014, a 1'
Addklonelly,I certify that the above financial statements are
COMMISSion EKPiMS July 10,2018
in agreement with the Statute Financial Statements filed with titer Tr. L f
g Statutory xas Hotasr);.i�irb11G State Df New York
Department of insurance as of the same date,
No.OITU6044514
W81IamJ Gleason Qualified In Westchester County
CPO.VP Z,Treas her Conhmissksn Expires July 10,2014
SUBDIVISION LABOR AND MATERIAL BOND
(GOVERNMENT CODE 66499.2)
Bond No. SUR21000010
Replaces Bond No. SUR20000319
KNOW ALL MEN BY THESE PRESENTS, that Pacific Point Development Partners, LLC
(hereafter designated as "Principal"), and Ironshore Indemnity Inc. y
as Surety (hereinafter called "Surety") agree to install and complete certain designated
public improvements as conditioned by City Council Resolution No's. 92-6-16-4 and
03-09-16-06.
WHEREAS, said Principal is required to furnish a bond pursuant to Municipal
Code Section 9-5.101 and 9-5.109 et seq., for the faithful performance to guarantee
certain work, more particularly described as follows:
Sanitary Sewer subdivision improvements within Tract 15609 as defined within Amendment#1 and
Reinstatement of the Subdivision Improvement Agreement for Tract 15609
NOW, THEREFORE, we the Principal and Surety are held firmly bound unto the
City of San Juan Capistrano, (hereafter called "Obligee") in the penal sum of
Twenty Four Thousand Two Hundred Ninety Three Dollars and0011.00 Dollars ($24,293,00 lawful
money of the United States, for the payment of which sum well and truly to be made, we
bind ourselves, our heirs, successors, executors and administrators, jointly and
severally, firmly by these presents.
NOW, THEREFORE, the condition of this obligation is such that if the above
bound Principal, his or its heirs, executors, administrators, successors or assigns, shal
in all things stand to and abide by and well and truly keep and perform the covenants,
conditions and provisions per City Council Resolution No's. 92-6-16-04 and 03-09-16-
06, on his or their part, to be kept and performed at the time and in the manner therein
specified, and in all respects according to their true intent and meaning, and shall
indemnify and save harmless the City, its offers, agents and employees as therein
stipulated, and, as necessary enter into a Subdivision Agreement, then this obligation
shall become null and void; otherwise it shall be and remain in full force and effect.
Page 1 of 3
BE IT FURTHER RESOLVED:
1. As a part of the obligation secured hereby, and in addition to the face
amount specified therefore, there shall be included costs and reasonable expenses and
fees, including reasonable attorney's fees, incurred by City in successfully enforcing
such obligation, all to be taxed as costs and included in any judgment rendered.
2. Said Principal hereby stipulates and agrees that no change, extension of
time, alteration, or modification of the terms of the agreement or of the work to be
performed thereunder, shall in any way affect its obligations or this bond, and it does
hereby waive notice of any such change, extension of time, alteration or modification of
the terms of the agreement or of the work or to the specifications.
IN WITNESS WHEREOF, this instrument has been duly executed by the
Principal herein named on the 19th day of May , 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.
r (NOTARIZATION AND SEAL)
By: �� � .
Margare . Ginem , Attorney-in-Fact
Surety Phone No.
C/O WILLIS OF FLORIDA
4211 W BOY SCOUT BLVD,#1000 Page 2 of 3
TAMPA, FL 33607
!NQUIRIES:(813)281-2095
APPROVED AS TO FORM:
By:
NOTE: Please attach Acknowledgement and Power of Attorney
Page 3 of 3
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§ 1189
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the
document to which this certificate is attached,and not the truthfulness,accuracy,or validity of that document.
State of California )
Coun of �/v On _ before me, \
Date Here Ins Na a and Titl of the Officer
personally appeared ' 1
ame(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.CORDIis true and correct.
PCommission#2088325
`� Notary Public-CzAfornla WITNESS my hand and official seal.
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(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
'SeMte.kill 10$0, awdh s;Sectiglis. 11$9 �a and sectilp-a 9:90 of•tfie
QoV,;MWgAt-.Code; reXa'ting tO notWes.ptilil o_ TTe,bd�w-physical format of tt e r1ev dis_closiire
notice.is-p example; £or pur rases of llustratian;
A hbtaY pliblic of other oteer&mpletingthls
certificate vetlfes onlythe identity iifthe
individual vihcr Biped-the doh twit.to vvh!6kt-
,certificatels attached,and not the truthfulness,
;O*Ady,of Vand ty t #hae:docu z tt.
State ofCalifomia
G,Q.unty of
did
_..before me, lia
itle
'iSxsertd#m,fir<tr'ox}tth�6a4 of r�5a'ttps a�oal]evidentcrod e ro��' • • er5dn � vs+'hose n�x1 s x . '. who'
slfire.sulc�thed t .
tbe.withiii-instrument and acknowledged to me that-l�elshelthey executed the same=in l islherltheir
.I t' rigid Opacity(`r s. , chat; y"h. l rltiie r 4aWTOW 'On OIp'IA$truf:Aoiit 0e Verson(s), Or tho.
er tityupoh behalf of which the pefsofi(�),acted, cxecuted#Jii Instruroent.
1,peiti y• rider PENAi I"�(`OP P)Elt3UltY'hider :the Jaws of tbie Stag of Cal fori�la thin the i`ariegoiq�
-paragraph Ys true and'correc#•
n
WITNESS i. Wmd and offie9ai seal'; +
�1glla�llt,G'_ 4Sea1).
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
,�1sYv"'f•, ANETT CARDINALE
t Commission#FF 138482
� Expires July 28,2018
�9' ,P� Bonded TMu Troy Fein Insurance 800-385.7019
This area for Official Notarial Seal
POWER al ArraRlvEv
Ironshore Indemnity Inc. III- 21000010
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 bands,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-
oR"°
j IIAL r�
Se19
�-
By: - -
Daane 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.
r.w AL"LThYLOR
z — Notary Publl.Slaleof Tennessee 'f
Davldson County
My Commisslon Ex0es M-t19.t8 AAmyL.
No"Punk
CERTIFICATE
I, the undersigned, Secretary of IRONSHORE INDEMNITY INC., a Minnesota Company, DO HEREBY CERTIFY that the original Power of Attorney of
which the foregoing is a true and correct copy,is in full force and effect and has not been revoked and the resolutions as set forth are now in force.
Signed and Sealed at this 19th Day of May20 15
J,L`o'eoi� ...
r
REAL
70t4 1
Paul 5.0 dano
Secretary
'WARNING:Any person who knowingly and with intent to defraud any insurance company or other person,files and application for insurance or statement of claim
containing any materially false information, or conceals for the purpose of misleading information concerning any fact material thereto, commits a fraudulent
insurance act,which is a crime and subjects such person to criminal and civil penalties."
IRONSNORE MDEMNITY INC
FINANGAL STATEMENT SUMMARY
As of December 31,2014
ASSETS
LIA81lfTIES
Bonds
$179,140,947 lasses $63,582,066
Preferred stocks
p Reinsurance payable on paid losses and bas pdJustment expenses
0
Common stocks
31,840,141 loss adjustment expenses $10,384,957
Mortgage loans on real estate,Ant kens 0 Commissions payable,contingent oomrrJulons and other similar charges S1,020 0S
Mortgage lam ns on red estate;Other then first liens 0 Other expenses(excludingtaxes.llcensas and fees) $5,435,126
Properties occupied by the company 0 Taxet,licenses and fees(excluding federal and foreign income taxes) $2,383,909
Properties held for the production of Income 0 Current federal and foreign inoome taxes $2,434,392
Properties held for Asia 0 Not deferred tax liability
0
Cash,cash equivalents and short-term investments S15,632r951 Unearned premiums $29,158,576
Contract loans 0 Advance premium
Derlvatim 0 Ceded reinsurance premiums Payable(net of ceding commissions) $58,22;187
Other invested assets 0 Funds held by company under reinsurance treaties
0
Receivables for securities 0 Amounts withheld or retained by company for account of others
Securities lending reinvested collatera9 assets 0 Remittances and Items not allocated
Aggregate write-Ins forinvestedassets D Provision for reinsurance $1,545,075
Subtotals.cash and Invested assets $226,614,039 Net adjustments In assets and tabilltles due to foreign exchange rates
Title Plant less$.,Charged off 0 Draftaoutstanding
Investment Income due and accrued $990,960 Payable to parent,subsidiaries and affiliates $17,458,110
Uncollected prem'umsand agents'balances Inthe course ofcollwion $73,567,547 Derivatives
tl
Deferred premlums,agents'balances and Installments booked but deferred and not 0
yet due Payablefor securities 0
Accrued retrospective premiums 0 Payable for securities lending 0
Amountsrecoversl;e from reinsurers $33,586,257 Liability foremounts held under uninsured plans 0
Funds held by or deposited with reinsured companies 0 Aggregatewrlte-Insfor liabilities $4,185,929
Other amounts receivable under reinsurance contracts 0 Total Debilities excluding protected cell fiabilbles $190 811,131
Amounts receivatae relatlng to uninsured plans 0 Protected cell liabl11Iles
Current federal and foreign Income tax recoverable and interest thereon 0
Net deferred tax asset $5,530,837 Totalliablities
$190,611,131
Guaranty funds receivablereceivableor on deposit D
Furniture and equipment,including health pre deBvay assets 0 POUCYHXDEIISS 5VRPLUS
Net adjustment In assets and IlablOties due to tore lin exchange rates 0 Aggregate write-ins for special surplus funds 0
Receivables from parent,subsidiaries and affiliates 0
Ikalth care and oche+amounts recelvable 0 Common caotal stock 5000 OOD
Aggregate wrtte•Ins for other than Invested assets $7124,971 Preferred capital stock
Total assets excluding Separate Accounts,Segregated Accounts and Protected Cal, $347,414,511
Accounts AggregatewriDe nsfwother than special surplus 0
From Separate Accounts,Segregated Accounts and Protected Cell Accounts 0 Surplus Notes
TOTALS $At7;S14,611 Gross paid In and oontrabutedsurplus
- .::r:�c, ._.......�- ---- •�•� $156,938,671
Unassigned fundsjsurpius; ($5,335,190)
Surp'us as regards policyholders $156,603,481
TOTALS
$347,414,611
SUBSCRIBED and sworn tame thIS d y of Hq)l
;X Myconnrrgssc n expires- 7-/0—/T
� � s-y+ - - •�__ _ Notarypubllc
CERnFICATE �— Ph-lted Name ALYSSA TURKOVITZ
I certlfy Notary Public,State of NeW York that the above financial statements to the bestaf my NO.01 TUt1044.514
knowledgeareatrue and accurate reflection ofthefinancial ALYSSA,TUR1Cf11rrrZ gtl9jlfl@Ct Westchester County
of the Company as of December 31,2G14, j , f „!
Additionally,Icertify that the above financial statements arc Ca=68ionEXPIMSJuly10
r2018
in agreement with the Statutory Financial Statements filed with the Trxa '
c v t ;Q/' . l5•flotat�•PubIlc,SlsteafWet7rYork
Department of insurance as of the some date. ,
No.01TU6044514
Wflllaml Beason Qualified In Westchester County
a0.VP&Tregsurer Conemisslon Expires July 100 2014