15-0505_Bond_SUR21000012_Pacific Point Dev_TR 15609 Premium: $455.00
SUBDIVISION FAITHFUL PERFORMANCE BOND
(GOVERNMENT CODE 66499.2)
Bond No.SUR21000012
Replaces Bond No. SUR20000320
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:
Water subdivision improvements within Tract 15609 as defined within Amendment#1 and
Reinstatement of the Subdivision Improvement A reement 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
Sixty Thousand Six Hundred Sixty Five Dollars and 00/100 _Dollars, ($60,665.00 ) 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:
I. 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 Noint Development Partners, LLC
(NOTARIZATION AND SEAL)
Its:
SURETY:
Ironshore Indemnity Inc.
(NOTARIZATION AND SEAL)
By: zv
1.: .
Marga t A. Ginem , Attorney-in-Fact
Surety Phone No.
C/O WILLIS OF FLORIDA
4211 W BOY SCOUT BLVD,41000
TAMPA, FL 33667 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 )
On/I I before me, • �� "prn!dj77tie
lf
Date . , Here serf Namthe Officer
personally appeared 1 ( +
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.OOROI is true and correct.
Commission#2088325 WITNESS m hand and official seal.
e
Notary Public-California y
Orange County
iM Comm.Expires Oct 31,2018
SignatureA
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
S'mate;$ 4 1'0$0. Seal,ris 1-:189 �� 1195:�Qf tlie:��i1 Code-end se�ti�r� $20t of-th6
a erp;Gn it.Co e; telafing-lo riai�.fies—t� i;.'T a liew ysical format ofOip-.neW.disclosure
notice,Xs.an mWPIC<.for vg"ses.gHIUSbzagpnU
i1 t ry pG]iiic of other ofld,�r coi ipl-t n�# #S:
certificate vetifies.only the identity'of the
indiwiauai whosigned the d6�Ntaeritjp w.luch.tli�s.
certifrcaft,is attached,and not the truthfulness;,
�o�;��y��'v�lz'c#aty oi`iha�docur�enrt�
Sta d ofCa]iforimia
C.Q.unty of
Ori
'insert name"andtitle of omccr,laersunally appeared y p
peof-4 ,ttrq oo'tho'basis-of satisfactory evidence tohe-,* pe sari{s}` 3 os riarrie(s}is/are su bedtiz
%6' *Ahiii-instrument -and acknowledged to me, that helshe/they executed th$ same.in .his/]rer/their
ut r[xl eti pacitj+ es), hcid thAt by �io[drfih `4Paf00(r[ ) 'i tt#.fie uistniftnt i}ie [ rsbn(s),.a5r the
;PfItity,bpoh.behalf of",Whia'66 Oeasoil(t).acfed,eitecurted tb6instrui nent,
I:.i✓-oti 'under PENH ,'l< "C3t? l' RI R iinde Th laves oP die.Staff of,Cal vrriia .iit the'fer eg®iig
paragraph is true anii correct
WUNESS io band and offlciak seal, `s
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.
-----------r
Signature a�� -
Anett Cardinale
ANETT CARDINALE
*: COMMission#FF 138482 r
A'enl
Expires July 28,2018
Bonded Thru Troy Pain Insurance 800.395.7019
This area for Official Notarial Seal
POWER OF ATTORNEY
III- 21000012
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 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:
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-4n-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.
r
�
SEAL
1919
By;
Dane 1.Suss n
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.
AMYL TAYLOR
- Notary Publla Slate of Tennessee
Davidson Cnty
C My Comoumission Ewires 01-19-16 Amy L,Toy
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 setforth are now in force.
Signed and Sealed at this 19th Day of May20 15
t�
3 L A
aeAl '5n,t
, 1!119
*
v7
Paul S.GE 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 INDEMNITY INC
FINANCIAL STATEMENT SUMMARY
As of December 31,2014
ASSETS
_ LIABILITIES
Bonds
$179,140,947 ossa
$63,582,066
Preferred stocks
p Reinsurance payable on paid bases and lass e40slment expenses
Common stocks 0
31,M,141 loss adjustment expenses $10,394,957
Mortgage loans on real est"Arat bens 0 Cmmmissions payable,oontingenl eomminlons and other similar charges $1,020,805
Mortgage loans on"estate:Other than first liens 0 Other expenses(excluding taxes.licenses and fees) $5,43S,126
Properties occupied by the company 0 Taxes,Rcames 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 sale 0 Net deferred tax liability 0
Cash cash equivalent%and short-term Investments $15,637,951 Unearned premiums
$29,158,576
Conti 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 trestles 0
Receivables for securities 0 Amounts withheld or retained by company for account of others
Securities(ending reinvested collateral assets 0 Remittances and items not allocated
Aggregate write-Ins forinvested assets 0 Provision for reinsurance $1,S4S,075
Subtotals.cash and Invested assets $226,614,039 Net adjustments les assets and tabllitles due to foreign exchange rates
Tole plants less$.-,Charged off 0 Drafts outstanding
Investment Income due and accrued $990,960 Payable to parent,subsidiaries and aKNates
$12,458,110
Uncollected prem urns 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
yetdue Payable for securities a
Accrued retrospective premiums 0 Payable for securities lending 0
Amounts recovers life from reinsurers $33,586,257 Oablllty for amounts held under uninsured plans p
Funds held by or deposed with reinsured companies 0 Aggregate write-Ins for liabilities
$4,185,928
Other amounts receivable under reinsurance contracts 0 Total llabllltlesexcluding protected cell liabilities $190,811,131
Amounts receivaee 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 Total Habiltles
$190,811,131
Guaranty funds receivableor on deposit 0
Furniture and equipment,Including health care delivery assets 0 POUCYHOLDEWSSURPWS
Net adjustment In assets and liabilities due to foregn 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 aptal stock 5000000
Aggregatewrtle-Ins for otherthanInvested$$sets $7,124,971 Preferred capital stock
Total assets excluding Separate Accounts,Segregated Accounts and Protected Cat $347,414,611
Aggregate write;ns for other than special surplus p
Accounts
From Separate Accounts,Segregated Accounts and Protected Cell Accounts 0 Surplus Notes
TOTALS $347414,611 Gross paid In and contributed surplus
$156,938,671
Unassigned funds(y urplusj ($5,335,190)
Surp:us as regards policyholders $156,603,481
TOTALS $347,414,611
SUBSCRIBED and sworn tome this
Y:
Mycomrnissc.nexphres. 7•/o /Ss
NotaryPubllc
G� f
CERTIFICATE r Printed Name ALYSSA TURKOVIIZ
I terrify that the above financial statements to the lustof my afy Public,State of New YOfIC
knowledge arc a true and accurate reflectlon of the financial ALYSSA TU RKOVITL No.01 TU6044,514
condition of the Company as of December 31,2014, - ; - -- .. Quallfled In Westchester County
Additionally,Icertify that the above financial statements are =�e� fr � Commission Expires July W 201a
In agreement with the Statutory Financial Statements filed with the Trus$ tlotac$Mubllc,State of New Yerk
Department of Insurance as of the same date,
No.01YU6044514
WRllam J Gleason qualified In Westchester County
9Q,Va kTraU=L- Coramissfon Expires July 10,2014
SUBDIVISION LABOR AND MATERIAL BOND
(GOVERNMENT CODE 66499.2)
Bond No. SUR21000012
Replaces Bond No. SUR20000320
KNOW ALL MEN BY THESE PRESENTS, that Pacific Point Development partners LLC
(hereafter designated as "Principal"), and Ironshore Indemnitor 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:
Water 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
Sixty Thousand Six Hundred Sixty Five Dollars and 00/100 Dollars ($60.665.00 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:
ti
i
SURETY:
Ironshore Indemnity Inc.
&&A4z6z—' 4/to j�XK�- (NOTARIZATION AND SEAL)
By:
MargaretZ 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
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 Californi )
County of_ _ ' 9 )
I r4_ �_
On 11 Z4 before me, [ ! I A(uDa te
a re J sert Name and f1t14 of the Officer
personally appeared V
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.
z Notary Public-Czlifornla z
Orange County
My Comm.Expires Oct 31,2010 s
r,►,�-.,,. ,,; 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:
ElCorporate 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: r Signer Is Representing:
02014 National Notary Association •www.NationalNotary.org • 1-800-US NOTARY(1-800-876-6827) Item#5907
eriate 1301110$0, ehas-:Sections a:189 alai, 1 XIS:gf;ttia:Civil ��rle �d ���ti�m 82Q� of't�ie
GoVerPMeAt,Co46j t'ela6pg.-Jo rtgtai e ; >rl l m "T'1r ;l eJ�W. hysjca format o ,the nevi disclosure
-notice.-is."exappJe; far poses cif i ustratzt ;.
.1�YOtary p*ic at other dfider canipl�efii
certificate verifies only the id0tity pf the
ind vidual who signed the docutnera,to,,hi&tl
.cer-ificate.is attached,and nof the trufhfulness�
apoi4r4q,o valWity of dIAT do,�urtie t
8tlte bf California.
E,6unty of
t}� :before me, . �h
'ihsert name''an&btle of offiicerl,Personally appCar$ti .. 'ha
droved td rt► oit'the basis of'satisfa�tbiry.eviden a tc, ,tCke-.person(s)v+�haset nanie(s)is/are l2�crlbe t
the within °irzstrurnent and acknowledged -to xme,'that'hdshe/they exccuted tbo same_ in .His/her/their
autUori tl capaciiy(*), and that;�y.Iislfiexftheir ligbatufe(s) -qn#lie itistrufnOf tbO j*rsb i(s),.cif the
—e ititxtipaia,behalf of'w�ich-the pefsosi("),acted,.ekdeatedthe;.ipsirmi mt,
I:.Cerkif .OFF UIZX under.:klae Jaws of t e.Stato of California ith. t tl2s forte aii
paragraph is true au&correct-
WUNESS40 hAnd and oficla.sear, r
�ignatare �Seal�
F
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 writt
yy
Signature
Anett Cardinale
^t ANETT CARDINALE
E-,,� Commission#FF 138482
Z;4 Bonded Thru TroyExpires July
o19
This area for Official Notarial Seal
I POWER OF ATTORNEY
III- 21000012
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 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:
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-1n-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 duty 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.
-�pp99R�tji
6eA�
r•�
1919
By.
Dane L.Sus 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 aAYLOR
Notary Wk.61 le of Tennessee
+. DdVld—County
Myr
y Commisslon Expires 01-09-16 Amy L.Tay
,'�`'; 1nvt„'.a'•. - Notary Fi0c
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 MayZp 15
t.'`�P4oq*r
$FA4
1419
1
Paul s.Gf dans
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 3NDEMNRY INC
FINANCIAL STATEMENT SUMMARY
As of December 31,2014
ASSETS LIABILITIES
Bonds
$179,140,947 Losses
$63,582,066
Preferred stocks
p Reinsurance payable on paid losses and Inns adjustment expenses
Common stocks 0
31,840,141 less adjustment expenses $10,384,957
Mortgage loans on real estate:Arst kens 0 Commissions payable,contingent oommistions and other similar charges $1,020805
Mortgage loans on real estate;Other then first liens 0 other expenses WOuding taxes.licenses and fees) $5,435,126
Properties occupied by the company 0 Taxes,licenses and fees(exdudmg federal and foreign income taxes)
Properties $2,383,909
p production of income 0 Current federal and foreign Income fixes $2,434,392
Properties held for Me 0 Nat 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 prerniums 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 foraecountofothen
Securities lending reinvested colhtera assets 0 Remittances and items not allocated
Aggregate wrlteAns forinvested assets D Provision for reinsurance $1,545,075
Subtotals.cash and Invested assets $226,614,039 Net adjustments In assets and tabllltles due to foreign exchange rates
Tide plants Ins$,.;Charged off 0 Drafts outstanding
Investment Income due and accrued $990,960 Payable toparent subsidiaries and affiliates
$12,458,1.10
Uncollected premlumsand agents'balancesInthe course Ofcollection $73,567,547 Derivative:
0
Deferred premiumsr a{ente balances and installments booked but deferred and not 0 payable for securitiesyet due 0
Accrued retrospective premiums 0 Payable for securities lending 0
Amounts recoverabie from reinsurers $33,58Q257 Liability foramounts held under uninsured plans 0
Funds held by or deposited with reinsurcdcompanies 0 Aggregate write-Ins forllabllkaes $4,185,828
Other amounts receivable under reinsurance contracts 0 Total liabilities excluding protected eefiliabllides $190,811.131
Amounts receivab a relating to uninsured plans 0 Protected cell liabilities
Current federal and foreign Income tax recoverable and interest thereon 0
Net deferred tax asset $S,530,837 Totalkabilitiet
$190,811,131
Guaranty funds receivable or on deposit 0
Furniture and equipment,including health care delivery assets 0 POUCYNDLDERSS SURPLUS
Net adjustment In assets and liabilities due to foregn exchange rates D Aggregate waste-Ins for special surplus funds 0
Receivables from parent subsidiaries and affiliates 0
Nealth are and other amounts receivable 0 Common cap tal stock 5 000 000
Aggregate write-Ins for other than Invested assets $7,124,971 Preferred capital stock
Total asset.excluding Separate Accounts,Segregated Accounts and Protected Cat $347,414,611
Aggregate write;ra for other than special surplus 0
Accounts
From Separate Accountr,Segregated Accounts and Protected Cell Accounts 0 Surplus Notes
TOTALS $147,414 611 Gross paid In and contributed surplus $156,938,671
Unassigned funds(surplus! ($5,335,190)
Surp t"as regards policyholders $156,603,481
TOTALS / $347,414,611
SUBSCRIBED and sworn to methlsrysdayofHq)l ,'Py3/rj
-•� r;' My commatsc n expires ']'.to—
NotaryPublic
CERTIFICATE i ry Phited Name ALYSSA TURKOVITZ
I certify that the above financial statements to the best of my
Note"Public,State of New York
knowledge area true and accurate renectionofthe nnanclal ALYSSAITURKCIVII17 No.01TU6044514
condition of the Company as of December 31,2014, Oua pried M Westchester Courtly
Addklonally,I certify that the above flnenclal statements are :.� l,rs„` 1114w. you '# Cot ]"l Expirm July 10.2018
In agreement with the Statutory Financial Statements filed with liar,Texas Notag10,bilc,state or"ew York -�
Department of Insurance as of the same date.
No.01TU60WS14
William Gleason Qualified In Westchester County
gFD_yPJUM*surdf Commission Expires July 10,2014