15-0505_Bond_SUR21000017_Pacific Point Dev_TR 15609 Premium: $2,546.00
SUBDIVISION FAITHFUL PERFORMANCE BOND
(GOVERNMENT CODE 66499.2)
Bond No.SUR21000017
Replaces Bond No. SUR20000322
KNOW ALL MEN BY THESE PRESENTS, that Pacific Point Development Partners LLC „
(hereafter designated as "Principal"), and fronshore 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:
Landspace subdivision improvements within Tract 15609 as defined within Amendment#1 and
Reinstatement of the Subdivision improvement Areement 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
Three Hundred Thirty Nine Thousand Four Hundred Twentv Five Dollars and 00/100 Dollars, ($339,425.00 ) 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)
Its: 4'7�: ter,,}ter
SURETY:
Ironshore Indemnity Inc.
(NOTARIZATION AND SEAL)
izl4w ;�_al Aa�-za-
By:
Margaret(/ Ginem , Attorney-in-Fact
Surety Phone No,
CIO WILLIS OF FLORIDA
4211 NI Boy SCOUT BLVD,#100B
TAMPA, FL 33607 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 UJ
On before me,
D to - Here In Na a and Title of a fficer
personally appeared ��, j .-
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.
aCommission*2088325 WITNESS my hand and official seal.
Notary Public-California a
Orange County +
M Comm.Expires Oct 31,2018 J Signature
— l
Signature of Notary Public
I
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)
j Signer's Name: Signer's Name:
❑Corporate Officer — Title(s): ❑Corporate Officer—Title(s):
❑Partner — ❑ Limited ❑General ❑ Partner — G Limited I-]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
Septate.$io 10$0, whefias.;Sections1-189 and 19 S Qf tbie:Gity l cp& anti Satir�ti 9-2- 0- of the
G !e xnneut.Godes,tela*g to nOtaxie5spin IR ,'T -Il eIOW,0ysical format offil e riew,ciisclositre
xzoticgjs-anexanaple,, for purp.p4m.of illuslxat ;
nom public of dthdr offider dohipteti.ngthis-
ceriiticate vetifxes Drily the identity Of the
individual Kwho:signed the doo nerit tta wtiioh.tJ1-
certificate.is attached,and not°the truthfulness,
�craCy,v validity ai)`drat,�laet�Xrient.
State'of Califora ia_
.C.bunty.of ^�
�iissert name an title ofofficer�,personally appeared - �vhti
pfbo VeW tp M9 aii the.laasis.ofAtisfaCtnry evidenbo, Wbose name{s)34/,U+e strl scrtl-ed'to
16,wifihiri -instrument:and acknowledged -to me� that hehhelthc y executed then same:-in hislherltheir,
11
utbbri2e .rapacrty(es), �tid tltgt.by.)risl'lidr/ihe 'sip�rat'afe(s) #n the'itistruin iit e drson(s),;Vit' the
-Qtatity upon behalf of which'thic per�oi qS)acfed, eitecuted$e.iinstmuent
1,r<eitify iy�ider}'ENAL.TI! QF 1 [tXURY i rider the, Jaws St to a California}hit the
paragraph i's true and correct-
WTINESS my Band and official-seal.
S%gnataire.` T_ (Sea))
ACKNOWLEDGEMENT BY SURETY
I
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
Signature
Anett Cardinale
„s'Y"•i ANETT CARDINALE
• Commission#FF 138482
%-�;�
;�7 Expires July 28,2018
' Rwalod�yulrsryianlnawanco9p?335.7018
This area for Official Notarial Seal
POWER OF Al TORNEY
Ironshore Indemnity Inc. III- 21000017
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 itis 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.
�rndr"
a`�pPogrFy'•,
P1
4{ REAL
, t9ra I
By:
Dane 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.
SFS (1
- � - AMY L TAYLOR
Nolery Publk.Stale of Tennessee
z F aDavidson county
�ygR My Commission Expires 01-09-16 Amy L.T4
, 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 20 15
M ns,
vara
Paul S.G! clano L_
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."
IRONSJJORE INDEMNITY INC
FINANCIAL STATEMENT SUMMARY
As of December 31,2014
ASSETS LIABILITIES
Bonds
$179,140,_947 lenses $63,582,066
Preferred stocks 0 Reinsurance payable on paid lasses and loss adjustment expenses 0
Common stocks 31,840141 Loss adjustment expenses $10,384,957
Mortgage loans on real estate.first hens 0 Commissions payable,contingent commissions and other similar charges $1,020,805
Mortgage loans on real estate,Other than first liens 0 Other expenses(excluding taxes.licenses and fees( $5,435,126
Properties occupied by the company 0 Taxes,licenses and fele(excluding federal and foreign income taxes) $2,3831909
Properties held for the production of income 0 Current federal and foreign Income taxes
$2,434,392
Properties held for sa'e 0 Net deferred tax liability 0
Cash.cash equivalents and short-term investments $15,632,951 Uneamed premlums $29,158,576
Contract bans D Advance premium
Derivatives D Ceded reinsurance premiums payable(net of ceding commissions) $58,222,187
Other invested assets D Funds held by company under reinsurance trestles 0
Receivables for securities 0 Amounts withheld or retained by company for account of others
Securities lending reinvested collateral assets D Remittances and Items not allocated
Aggregate wrlte-Insforinvestedassets 0 Provision for reinsurance $1,545,075
Subtckais.cash mod invesredacsets $226,614,039 Net adjustments in assets and$abi0tiesdue toforeign exchange fates
Tide plants less$-Charged off 0 Drafts outstanding
Investment income due and accrued $990,960 Payable to parent,subsidiaries and affiliates $12,458,110
Uncollected prern@umsand agents'balances Inthe count ofcollection $73,567,547 Derivatives 0
Deferred premlums,agents'balances and installments booked but deferred and not D
Payable for securities Oyetdue
yet due
Accrued retrospective premiums D Payable for securities lending 0
Amounts recoverabre from reinsurers $33,586,257 Liability for amounts held under uninsured plans 0
Funds held by or deposited with reinsured companies D Aggregate write-Ins for liabilities $4,185,928
Other amounts receivable under reinsurance contracts D Total liabilities excluding protected cell liabilities $190,611,131
Amounts recelvahe 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 Mobilities $190,911,131
0
Guaranty funds receivable or on depose
Furniture and equipment Including health tare delivery aswts D POUCYHOtDEWSSORPLUS
Net adjustment In assets and liabilities due to foregn exchange rates D Aggregate wnte-Ins for special surplus funds 0
Receivables from parent;,subsidiaries and affiliates 0
Health care and other amounts receivable D Common calatal stock g 000 000
Aggregate write-Ins for other than Invested assets $7124,971 Preferred capital stock
Total assets excluding Separate Accounts,Segregated Accounts and Protected Cot $347,414,611Aggregate wrlte;mfor other than special surplus p
Accounts
From Separate Accounts,Segregated Accounts and Protected Cell Accounts 0 Surplus Notes
TOTALS $347,414,511 Gross paid In and contributed surplus $156,938,671
Unassigned funds{surpius; ($5,335,190)
Surp`us as regards policyholders $156,603,481
TOTALS $347,414,611
SUBSCRIBED and sworn tome thl,46y�/of M/ 4
f��� Mycommfss�cnexpirer ']-/VT
K
s^ _.a Notary public
At_YSSA TURKOVITZ
CERTIFICATE Piihted Name
Natery Public,State of New York
1 certify that the above financial statements to the bestof my
knowledge are atrueandaccurate reflection ofthe financial ALYSSATUAKOYNO.U1TU60445t4
IT2
condition of the Company as of December 31,2014, Oual tif3Cl IrlWa stcheMer County
AddWonall,I certify that the above financial statements are I� Caffuni$�&pims July 10,2458
Y fY tin:.,.. �(��-`
in agreement with the Statutory Financial Statements filed with the Texas NotF4%bIK State of New York
Department of Insurance as of the same date, _
No.01TU6044514
William Gleason Qualified In Westchester County
MLYP&TrWILML Commission Expires July 10,2014
SUBDIVISION LABOR AND MATERIAL BOND
(GOVERNMENT CODE 66499.2)
Bond No. SUR21000017
Replaces Bond No. SUR20000322
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:
Lands ace 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
Three Hundred ThiqX(line Thousand Four Hundred Twenty Five Dollars and 001100 Dollars ($339,425.00 ) 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.
(NOTARIZATION AND SEAL)
By: zya
Margare A. +einem , Attorney-in-Fact
Surety Phone No.
CIC}WILLIS OF FLORIDA
4291 W.BOY ScOUT BLVD,#low Page 2 of 3
TAMPA. FL 33667
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 )
Cour of )
On before me, S �/
Date Here I rt N and Title f th 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.
i Commission#2088325 WITNESS my hand and official seal.
�+ Notary Public-California
z Orange County
My Comm.Expires Oct 31,2018 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(les) Claimed by Signer(s)
Signer's Name: Signer's Name:
❑Corporate Officer — Title(s): a_ ❑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
`Sate_Sill 116 a honc�'s Sections ;l Y$9 avid 119$of ttie:d-ft tocfe.mad geo lob 910-of'the
orb-`e C#.Cock,feiaiing-To nata�-ie plibbe:' :liel }�,ysicaY format of alae new di :clbs-are
w0oe isp examplm,Torp .ases.o 'iwu�ice
notes plklic of other afl deX coil plating this:
cerfiMate verifies only the identity of the
ndi_rdual rho:'signed the docuieri#.ta wCh.
.certificate.is attauched�
and not the trtffhfWness�
ap0r?cy,or valid ty of that.d.ogti nt
State;pf Califomia
.Cciiinty.of
{3n bcfare ine,
`ifisert name and title of off cer5,personally upp=ed who
proy-W to inori the'bas s of aatis&d otry.evidekice to betlirr:person(i),,vWliosei ramie s W -e.io,,r 6eittp
W �r
the within. 4aktrnment and acknowledged to me� than helshelthey executed the same°.in .Yjsllierltheit
author aed .capacity(fes�}, act that;Eiy itsjlien+txier'Sigriatu e( } 'qtf #I�e-uistrt►fn t tie son(s) oSc keit
entity, tion behalf ofwhlolt ttie persori('s}acted,.eirecufed t} "snstruinent,
I:.i<erk j+'utider PEN�LTV OF' P) RJVAY under lb a laws pt 6e.Stato or Califbmia t 14t th6 foregozr%
'paragraph-is true and.correct
WITNESS my Band and-.official'seat. r
S grsature, _-- (sea]),
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.
z
Signature (� I
Anett Cardinale
ANETT CA
Comm ss on#INALE FF 138482
_ ., ,. Expires July 28,2018
e` B M,4 Ttao Troy Fele Ineurenoe 800-385.7018
This area for Official Notarial Seal
POWER OF ATTORNEY
III- 21000017
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:
Resofved, 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 an 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.
,;F,`�9,r°4Sa
r
•i ti9/9
,•, qty._ _
By:
Dane 1.Sus n
Director
ACKNOWLEDGEMENT
On this 7th Bay of August,2013,before me,personally carne Daniel L.Sussman tome 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.
nhfl'L TAYLOR 44,
Notary Publlo-Stale of Tennessee
•� Davidson County A L4Tay �
Commission Ex"901-w1a
!ary PUNIC
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 MayZD 15
4agr a+r;�.3
LEAJ,
S91q
Paul 5.G6 danq 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."
IRONSHORE;NDEMNITY INC
FINANCIAL STATEMENT SUMMARY
As of December 31,2014
ASSETS LIABILITIES
Bonds
$179,140,947 massa $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:llnttent 0 Commissions payable,contingent commissions and other similar charges $1,020,805
Mortgage loans on real estate,,DOW than first liens 0 Other expenses(excluding taxes.licenses and leas) $5,435,126
Properties occupied by the company 0 Taxes,licenses and fees(excluding federal and foreign income taxes) $2,383,909
Properties held for the production of lnoome 0 Current federal and foreign lnoome taxes $2,434,392
Properties held for sale 0 Net 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 Premiums Payable(net of ceding commissions) $58,224187
Other invested assets 0 Funds held by company under reinsurance treaties
0
Receivables for securities 0 Amounts withheld or retained by company for amount ofathers
Securities lending reinvested coilaWvassets 0 Remittances and Items not allocated
Aggregate write-Insforinvested assets 0 Provision for reinsurance $1,545,075
Subtotals.cash and Invested assets $226,614,039 Net adjustments In assets and liabilities due to foreign exchange rates
Trtle plants less$..Charged off 0 Draftsoutstanding
Investment Income due and accrued $990,960 Payable toparen%subsidiariesand af hats $12,458,110
Uncollected prent.ums and agents'balances In the course of collection $73,567,54.7 Derivatives 0
Deferred premiums,egen&balances and installments booked but deferred and not 0
Payable for securities 0
yet due
Accrued retrospective prerniums 0 Payable for securities lending 0
Amounts recoverable from reinsurers $33,586,257 Liability foramounts held under uninsured plans 0
Funds held by or deposited with reinsured companies 0 Aggregate write-Irss for liabilities
$4,185,928
Other amounts receivable under reinsurance contracts 0 Total liabilities excluding protected cell fiablllties $190,811,131
Amounts remlvahe 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
$190,811,131
0
Guaranty funds receivable or on depomt
Furniture and equipment,Including health are delivery assets 0 POUCYHOLDERS'S SURPLUS
Net adjustment In assets and liabilities due to fore gn exchange rates 0 Aggregate vette-Ins for special surplus funds 0
Receivables from parent,subsidiaries and affiliates 0
Health are and other amounts receivable 0 Common cap'tal stock g 000 000
Aggregate write-ins for other than invested assets $7124,971 Preferred capital stock
Total assets excluding Separate Accounts,Segregated Accounts and Protected Cot $3.47,414,611 Aggregate wrHpe;sir forother 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 contributed surplus $156,938,671
Unassigned funds jsurplus,' ($5,335,190)
Surp?res as regards policyholders $156,603,481
TOTALS $347,414,611
3UBSCRIBEDand sworn tomethfstrday OfHq
My comrritsc n expires:
Notary public
ALYSSA TURKOVFTZ
CERTIFICATE Printed Name Notary Public,State of New York
I cer"that the above financial statements to the best of my NO.01 TU6044514
knowledge are a true and accurate reflection of the financial ALY$SA TURKOVIT_Z
condition of the Company as of December 31,2014, Ovellf ed In Westch?esler CountyAdditionally,I certify that the above financial statements are y(' of{ •�J'p CoffmVasion Exores July I0, 2018
in agreement with the Statutory Financial Statements filed with the Texas NDtap� Lslfc stair o4hit*Y0Yk `of
Department of Insurance as of the same date, r
No.01TU5044514
William)Gleason Cluaflfied In Westchester County
9:0 VP&TMV-Vfer CorKmisslon Expires July 10,2014