15-0505_Bond_SUR21000013_Pacific Point Dev_TR 16747 Premium: $3,463.00
SUBDIVISION FAITHFUL PERFORMANCE BOND
(GOVERNMENT CODE 66499.2)
Bond No. SUR21000013
Replaces Bond No. SUR20000331
KNOW ALL MEN BY THESE PRESENTS, that Pacific Paint oevelo mens Partners LLC
(hereafter designated as "Principal"), and Ironshcre 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:
Landscape 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
Four Hundred Sixty One Thousand Seven Hundred Sixty Three Dollars and 00/100 Dollars, ($461,763.00 ) 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 Dint Development Partners, LLC
(NOTARIZATION AND SEAL)
By:
Its: � e�o�. S� rtiu' ory
SURETY:
Ironshore Indemnity Inc.
(NOTARIZATION AND SEAL)
By: leA441Z6 ,
Margare . Ginem , Attorney-in-Fact
Surety Phone No-
C/10 VJILLIS OF F=LOKIDA
4211 W.BOY SCOUT BLVD,#1000
TAMPA, FL 33607 Page 2 of 3
WC?UIRIFS:(813)281-2096
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,
Da a Here Ween° ame nd T#le of O Icer
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)an 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
5. W. CORDI is true and correct.
Commission#2088325
a _ z WITNESS my hand and official seal.
Z � Notary Public-Czlifornla z
Z Orange County
M Comm.Ex fres Oct 31,2018 J Signature
Signature of Notary Public
Place Notary Seal Above
OPTIONAL
Though this section is optional, completing this information can deter alteration of the document or
fraudulent reattachment of this form to an unintended document.
Description of Attached Document
Title or Type of Document: Document Date:
Number of Pages: Signer(s) Other Than Named Above: _
Capacity(lies) Claimed by Signer(s)
Signer's Name: —. Signer's Name:_.
❑Corporate Officer — Title(s): ❑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 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
AN TT CARDINALE
= Commission#FF 138482
r: Expires July 28,2018
,' ��ry'• Bonded Thru Troy Fein Insurance BZ3B5.7018
This area for Official Notarial Seal
Sedate Rill I00, A=.h(fs Sectiozis.1:189 ani :1195.-of;thte:C.4 Code.�d �edii 8 Q2 of the
4aQYl— *-Code, yela4m tao't es:p>illxer'T elielp'vir' ys ca7 formatof"the h di olosure
nof�ce.�srsn.exat-npl�, �arptx�a:�s v�`iIlusixatit�Q;
A iio y plibl.ic otother of�celr doiriploingthis-
cerfificate verifies only the identity-vf the
individual vyha.signed the do vrnerit.l 44liiclx:tl�ls
.certifloate,is atiaohed,and not the trdthfWness�
Agem cy,q valid4y of thg doh ent.
.State ofC,aliforfmia
Q.unty.bf
Ihsert name and title of officer),personally appweo who.
prove Sri o the'basis,of�satisfaetory evideriee to h4,J licxsari(s)vJliose riartie(s} sl�re suk�seribeclt�
%e vvxtM6, instrument:and acknowledged •to me that helshe/they executed the.same' in hislherAheir
attthofizesi capac'it}+(ics), rsd 1,by] isllierfthe z slg6atur(ts) 'qn: the bu tm,61 t - e-Vprson(s),:eii"r the.
-efitity, tipp4 behalf ofwhich'#lie persofio acted, cicecsfted tb&instrument,
T. �tti 'i rider PENp►1G' " Cal' � EJRY under Ibe lavi-s of 6.5t�it�p�'�allfnrnia f at the foiiegoz�
paragraph is true and corrcr
n_
WITNESS my.h�nd,-W,6fhcid-sealw
Sign aizi're _ (Sea]),
POWER OF ATTORNEY
Ironshore Indemnity Inc. III- 21000013
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
2_ 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 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.
p?S
SEAL
1919 !!
By:
Dan a L.Sits 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,, AMY LTAYLOR
Notary Public-Stale of Tennessee
Davidson County
�+ My Commission Fxpires"1-0918 Amy L 76
m,,0.. +�. Notary Pl+h1k
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
.trait's
�ar�
- seni
i9r9 1
1
Paul S.Gi dano Y
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.”
IRONSIlORE INDEMNITY FffC
FINANCIAL STATEMENT SUMMARY
As of December 31;2014
ASSETS
LIABILITIES
fonds
$179,140,947 La"ei
$63,582,066
Preferred stocks p Reinsurance payable on paid losses and loss adjustrnent expenses p
Common stocks
31,M,141 loss adjustment expenses $10,384,957
Mortgage loans on real esbte:l1rst Fens 0 Commissions payable,contingent cOnRyd Bions and other similar charges $1,020,805
Mortgage Irons on reel estate,Other than first liens 0 Other expenses(excluding taxes.licenses and fees( $5,435,126
Properties occupled by the company 0 Taxa,licenses and fees(excluding 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
Properties held for lWo 0 Net deferred tax liability 0
Cash,cash equWalents and short-term Investments S15,632,951 Unearned premiums
$29,158,576
Contract bans 0 Advance premium
Derivatives 0 Ceded reinsurance premiurrrs 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 wlthheidor retained by company for accountof others
Securities lending reinvested collatera'assets 0 Rrmlttanresandltemxnot a4aated
Aggregate wr;tcbsfor lnvestcdmitts 0 Provision(or reinsurance $1,545,075
Subtobls.cash and Invested assets $226,614,039 Net adjustments In assets and tabllHles due to foreign exchange rates
Title plants less$..,Charged off 0 Drafts outstanding
Investment Income due and accrued $990960 Payable to parent,subsidiaries and affiliates $12,458,110
Uncollected prerts ums and agents'balances in the course of collection $73,567,547 Derivatives
0
Deferred premiums,agion&balances and Installments booked but deferred and not 0
yet due Payable for securities 0
Accrued retrospective prengums 0 Payable for securities lending
0
Amounts recoverable from reinsures $33.586,257 ;Jab llltyfor amounts held under uninsured plans 0
Funds held by or deposited with reinsueed companies 0 Aggregate write-Ins for liabilities
$4,185,928
Other amounts receivable under reinsurance contracts 0 Total liabilities excluding protected all liabilities $190,811,131
Amounts receivaWe 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 liabilities
$190,812,131
Guaranty funds receivable or or deposit 0
Furniture and equipment,Including health are delivery assets 0 POUCYNOLDERS'SSURPLUS
Net adjustment In assets and liabilities due to foreign exchange rates 0 Aggregate wnte-Ins for special surplus funds 0
Receivables from parent,subsidiaries and affiliates 0
Health are and other amounts receivable 0 Common capital stock S 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 Cot $347,414,611
Aggregate write in for other than special surplus 0
Accounts
from Separate Accounts,Segregated Accounts and Protected Cell Accounts 0 Surplus Notes
TOTALS _ 347 414 R;11 Gross paid In and contributed surplus $156,938,671
Unassigned funds{surplus, ($5,335,1901
Surp ur as regards policyholders $156,603,481
TOTALS y h� $347,414,611
SUBSCRIBED and swom tome tits t'day of
Mytommissan express 7-10—/f&
NotaryPutift
CERTIFICATE Printed Name ALYSSA TURKOVITZ
I certify that the abovefinancial statements to the bcstof my
Notary Public,State of New York
knowledge are a true and accurate reflection of the finarKI&I ALY55ATURKOVTFZ No.OITU6044514
condition of the Company as of December 31„2014, Qualif ed In Westchester County
Additionally,Icertifythatthe above financial statements am .� 71:x. Zri-'l C �nExpiresJuiy10,2018
in agreement with the Statutory Financial Statements filed with the Texas rtornt�4uWlc,State of NewYork.,
Department of insurance as of the same date, r
No.01TU6044514
William J Gleason Qualified In Westchester County
$"Ffl,Y—P UMnwrOr Commission Expires July 10,2014
SUBDIVISION LABOR AND MATERIAL BOND
(GOVERNMENT CODE 66499.2)
Bond No. SUR21000013
Replaces Bond No. SUR20000331
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:
Landscape 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
Four Hundred Sixty One Thousand Seven Hundred Sixty Three Dollars and 00/100 Dollars ($461,763.00 } 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 _,_1015 , 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)
Y•
SURETY:
Ironshore Indemnity Inc.
• � r ,
(NOTARIZATION AND SEAL)
By: dill
Marge t A. 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:(613)231420915
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 )
On before me, &amnd
Date rh Here Insetof Officer
personally appeared r
Name(s)of Signer(s)
a
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) [stare
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.
Mi�Cornrnlssion#2088325
ZE
Notary Public-California WITNESS my hand and official seal.
Z go Orange County
MY Comm.Ex ices 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
r ❑Other: ❑ Other:
Signer Is Representing: Signer Is Representing:
I
02014 National Notary Association •www.Nationa[Notary.org - 1-800-US NOTARY(1-800-876-6827) Item#5907
ACKNOWLEDGEMENT BY SURETY
STATE OF FLORIDA
COUNTY OF HILLSBOROUGH I SS..
On this 191`' 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
ANETT CARDINALE
:•: := COdT Mission#FF 138482
Expires July 28,2018
'•J „„'" Bonded Thru Troy Fdn Ineurence Aoo-Woio
This area for Oficial Notarial Seal
` e ate: z11 I0 0, er d"s:Sections: :Y$9 acid 195:q :tlie:Cm orle.�d r esti i 8�jot of the
JQOVgMWeut,Code, telae ng:# n�j es: l5iM The bel��ov'�}ays cal format of e-tteW di�closure
mance;js, examle'.for put. oses ofil use at sn
A rioter p4iblic at other affrcex coiripleting tt ;
cerfifia ate verifies only the identity of the
indimfdu41 who:signed,tlae do u erit.to whiCfi.tb$
,certificate.is atfached,and not the trut3ifulness.,
oecur�.Cy;4i�t�al��ity ci�tha�;de�urnen�.
State nf4;a ifomia
County of
oil befr�re tne, Tfieito
'insert name and title cif-offiicgr,personally Oppeared
pfoyge4 tO Ag.oit t€-e basis,of'sat st'acto,.y.evidence t�o' ,-Ah—fiersori(s)Whosd nan}e(s)is/gb.su*rj6d to
%6.Vvithiri.•itis& mens and acknowledged lo m&'that helshelthey exeouted the.samv.in-.h,,Aer/their
:00- 44 that.Oy hisl' or/dhe* Si hatu e{ ) 'qo 11 lgt truipoo t e'ppfson(s),,of the
tr RY—matt.behalfof--whtclt`tliepefson('s),arted,.ek6ci dthe nstruinent
1:.cwtify'under ]'ENAI,T�C F �lyRfU1 X iinder.0 J` -of ie,State pf'�alafariila the,the'fci goiti%
paragaph is true and earreO-
WrrNES'rny.hnnd and offiiefal.seat. r
Sgr�ature, Seal.
k
POWER QE ATTORNEY
Ironshore Indemnity Inc. III- 21000013
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
deliverfor,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.
= SEAL
By:
Dan a L.Suss n
Director
ACKNOWLEDGEMENT
On this 7`t'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.
�l
— AhSY L TAY✓<S]R
Notary public-Stale of Tennessee
+ .w + DdVIESOn County --
y, h1/CummdselWlF�W'a+01-09-16 Amy L.Ta
Z d VYy Notary Pubk
CERTIFICATE
I, the undersigned, Secretary of IRONSHORE INDEMNITY INC., a Minnesota Company, DO HEREBY CERTIFY that the original Power of Attorney of
which the foregoing is a true and correct copy,is in full force and effect and has not been revoked and the resolutions as set forth are now in force.
Signed and Sealed at this 19th Day of May 20 15
=4
SZAL
1Bi1
Paul S.GI dwo
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."
IRONSADHE INDEMNITY INC
FINANCIAL STATEMENT SUMMARY
As of December 31,2014
ASSETS LIABILITIES
Bonds
$179,140,947 Losses $63,582,066
Preferred stocks 0 Reinsurance payable on paid losses and loss ad)ustment expenses 0
Gammon stocks 31,840,111 loss adjustment expenses
$10,384,957
Mortgage loans on reel estate,Tirst kens 0 Commissions payable,contingent commissions and other slm8ar charges $1,0201805
Mortgage Irons on real estate,Other then first liens 0 Other expenses(exdud niftaxes.licenses and fees) $5,435,126
Properties occupied by the company 0 Taxed licenses and fees(excluding federal and foreign income taxes) $2,381,909
Properties held for the production of income 0 Current federal and foreign Income taxes $2,434,392
Properties held for We 0 Nat deferred tax liability
0
Cash,cash equivalents and short-term Investments $15,631'„951 Unearned premiums $29,158,576
Contract loam 0 Advance premium
Derivatives 0 Ceded reinsurance premiums payable(net of ceding commissions) 558,222,187
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 collates;assets 0 Remittances and Items not allocated
Aggregate write-Ins forinvested assets 0 Provision for reinsurance
$1,545,075
Subtotalt.cash and Invested assets 5226,614;039 Net adjustments In assets and tabllltles due to foreign exchange rates
Title plants less 5..,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 in the course of collection $73,567,547 Derivatives
0
Deferred premiums,agents'balances and installments booked but deferred and not 0
yet due Payable for securities 0
Accrued retrospective premiums 0 Payable for securities lending 0
Amounts recoverable from reinsurers $33,586,257 liability for amounts held under uninsured plans 0
Funds held by or deposited with reinsured companies 0 Aggregate write-Ins for liabilities $4,185,928
Other amounts receivable under reinsurance contracts 0 Total liabilities excluding protected cell liabilities $190,811,131
Amounts receivaWe relating to uninsured plans 0 Protected call llabllrlles
Current federal and foreign Income tax recoverable and interest thereon 0
Net deferred tax asset $5,530,837 Totathabilities
$190,811,131
Guaranty funds receivable or on deposit 0
Furniture and equipment,Including health caret delivery assets 0 POUCYNOLDERS"SSURPLUS
Net adjustment In assets and liabilities due to fond.gn exchange rates 0 Aggregate wnte-Ins for special surplus funds 0
Receivables from parent,subsidiaries and affiliates 0
Health are and other amounts receivable 0 Common captal stock 5000 000
Aggregate write-ins for other than Invested assets $7,124.971 preferred capital stock
611414
$347, ,
Total assets excluding Separate Accounts,Segregated Accounts and Protected CO $347,414,611
wrlW.ns forother than special surplus 0
Accounts
From Separate Accounts,Segregated Accounts and Protected Cell Accounts 0 Surplus Notes
TOTALS _$347,414„613 Gross paid In and contributed surplus
$156,938,671
Unassigned funds tsurplusj ($5,335,150)
Surp ur as regards policyholders $156,603,481
TOTALS $347,414,611
SUBSCRIBEDand sworn to me thP%',LdV of H�14.'D 1 S
mfr My commissa n expires: '7-/0—/if'
•'s+ ` C_ss �. _ NotaryPublic
CERTIFICATE Pr lted Name ALYSSA TURKOVRZ
I certify that the above financial statements to the best of my Notary Public,State of New YorkNO.U1 T1J6044514
knowledge are a true and accurate reflection of the 11nancld ALYSSA TURKOVITI
conditlonofthe Company asofDecember 31,2014, Qualified in Westchester'Callrlty
a{ r. / Lt z^”
Additionally,I certify that the above financial statements are yg,� Clfnmleslfln Fxpirea July 10,2010
In agreement with the Statutory Financial Statements filed with the Texas Nors4*ubllc,State of New York ..
Department of insurance as of the same date.
No.OITU6044514
WNllam 1 Gleason Qualified In Westchester County
9:9,VP&Trealmm Commission Expires July 10,2014