15-0505_Bond_SUR21000018_Pacific Point Dev_TR 16747 Premium: $814.00
SUBDIVISION FAITHFUL PERFORMANCE BOND
(GOVERNMENT CODE 66499.2)
Bond No. SUR21000018
Replaces Bond No.SUR20000332
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:
Grading (Lots 1,2 & H) 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
One Hundred Eight Thousand Five Hundred Thirty Three Dollars and 00/100 Dollars, ($108,533.00 ) 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 int Development Partners, LLC
(NOTARIZATION AND SEAL)
By: ��
Its: ��1a�r kyr
SURETY:
Ironshore Indemnity Inc.
(NOTARIZATION AND SEAL)
By:
Margar . Ginem , Attorney-in-Fact
Surety Phone No.
CIO WILLIS or f=LORIDA
42111 W.Boy SCOt1T BLVD,glWo
TAMPA, FL 33607 Page 2 of 3
APPROVED AS TO FORM:
By:
NOTE: Please attach Acknowledgement and Power of Attorney
Page 3 of 3
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§ 1189
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the
document to which this certificate is attached,and not the truthfulness,accuracy,or validity of that document.
State of California )
County of )
O before me, l
a to He se and Title a fflcer ,
personal) appeared Y t S
Y PP
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
is true and correct.
5�aW. CORDI
Commission#2088325 WITNESS my hand and official seal.
Notary Public-California z
Orange County '
Mv Comm.Expires Oct 31,2018 Signatures
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: ��
i
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
ANET7 CARDINALE
E -
This
Commission#FF 138482
qExpires July 28,2018
', Aiti-Vv' 9ond®d ThN Troy Fdn Inrurence M385.7olo
area for Official Notarial Seal
Sedate Bi11 1050 �tids-:Secti6fig -:189 amid: 195:4"6e:CIVI�.�c°cle cud S. .i $�Q2 of fh$
ram .Cade;. eYatin #ty nodes_p , lie:.IU lieI0V Physical formatoff` o:,rievV cli :elos-are
x�rvi�c�. s;axz example, £or pt�r�ases o�i�[�ustxatirn�:
Y1000.public of A&61.tb coitip]O ng this,
cerfifzcate verifies only the identity ofthe
individual who.signed the db�uinerit-tti wh&-_d- .
certifioato.is attached,and not the trtithfulness,
acc�ir�Cy,o'r validity t3f#hat.tiocu�itcx��.
.81'att ofWiforimia
County.of
before me, .. 66
,i5sert name ani�-title oft�fficer5,')personally 4ppmed Who.
ry evidr nce tct E�e'tli ersori fi i�++hose banie(s) slaxe su crjbr6atp:
gfioWed;ESS l��pt}-t�fe t?a51S of'satisfacto p ( )
t&e wMri 4ristrument,and acknowledged to rne° than hr)shelthey executed the same hi .h Aer/their
aptY�taltizcfi ,�a acitjt ies�, okad qh Ivy.]iis/Iier/dieft`SI *Te( 0.6P '14s&uthoDt 66 fsbn(S),.-o the
;ofxtiky,rti.pon behalf ofwhich'tlieperso>i acted,ekecutedthe instrtuu®xtt
1..�qxti#`j!'urider PENAL'I ' (QI � It1E]Ifi�( tinder Ili law s pf te.Stafd Qf' alifornla tho the f0itgoirig,
paragraph is true and corre t
WINESS itiy Band and official seaL
Signattfre Sea]
POWER OF ATTORNEY
Ironshore Indemnity Inc. III- 21000018
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 Attorneydn-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.
�! BEAL
7919 �
y F
By:
panaL.Suss
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.Aw
n
MY L TAYLOR
_ _ Notary Pubilc-Slate of Tennessee
Davidson County
My Commission Epi—01-09-16 Amy L.Ta
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 MayZp 15
9LAL
' 791v
Paul s.Gi dart
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 SNDEMNITY INC
FINANCIAL STATEMENT SUMMARY
As of December 31,2014
ASSETS LIABILITIES
Bonds
$179,140.947 Losse $63,582,066
Preferred stocks
p Relnsurante payable on gold losses and Inas adjustment expenses
0
Common stocks
31,840,141 Loss adjustment expenses $10,384,957
Mortgage loans on real estate.Pmt kens 0 Commissions payable,contingent commissions and other similar charges $1,020,805
Mortgage loans on real estate,,Other than Ont liens 0 Other expenses(excluding taxes.licenses and fees) $5,435,126
Properties occupied by the company 0 Taxes,licenses and fees(excluding federal and foreign Income taxes) $2,383j909
Properties held for the production of Income 0 Current federal and foreign Income taxes
$2,434,392
Properties held for We 0 Net deferred tax liability 0
Cash.cash equivalents and short-term investments $15,632,.951 Unearned premiums
$29,156,576
Contract loans 0 Advance premium
Derivatives 0 Ceded reinsurance premiums payable(net of coding commissions) $58,222187
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 collateral assets 0 Remittances and items not t!loated
Aggregate write-Ins forinvested assets 0 Provision for reinsurance $1,545,075
Subtotals.cash and Invested assets $226,614,039 Net adjustments In assets and tabliltles due to foreign exchange rates
Title plants less$..,Charged off 0 Drafts outstanding
Investment income due and accrued $990„560 Payable to parent,subsidiaries and affiliates $12,458,110
Uncollected prem;ums and agents'balances in the course of collection $73,567,547 Derivatives
a
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 relnsured companies 0 Aggregate write-Ins for liabilities
$4,185,928
Other amounts receivable under reinsurance contracts 0 Total Bablllties excluding protected cel liabilities $190,811,131
Amounts recehrab:e relating to uninsured plaits 0 Protected cell liabilities
Current federal and foreign Income tax recoverable and interest thereon 0
Net deferred tax asset $5,530,837 TotalBabilitles
$190,831,131
Guaranty funds receivable or on deposit 0
Furniture and equipment,including health are delivery asset 0 POUCMMDERY55URPLUS
Net adjustment In assets and liabilities due to fdme gn exchange rates 0 Aggregate wnte-lns for special surplus funds 0
Receivables from parent,subsidiaries and affiliates 0
ttealth care and other amounts recclvable 0 Common capital stock S,lx)0,000
Aggregate write-ins for other than Invested assets $7,124,971 Preferred appal stack
Total assets excluding Separate Accounts,Segregated Accounts and Protected Cet $347,414,511
Aggregate untie;its for other than apolar surplus p
Accounts
from Separate Accounts.Segregated Accounts and Protected Cell Amounts 0 Surplus Notes
TOTALS $3,17,414,611 Gross paid In and contributed surplus
_ $156,938,671
Unassigned funds fsurplus,' ($5,335,190)
Surp us as regards policyholders $156,603,481
TOTALS $347,414,611
SUBSCRIBED and swomtome tHs?_rdayof/�J�Y
Mycomatisknexpires -7-/4)—/S-
CERTIFICATE Printed Name ALYSSA TURKOVITZ
I certify that the above financial statements to the bestaf my Notary Public,State of New York
NO.t)1TUsoaa514
knowledge are a true and accurate reflection of the financial ALYSSA TURKOVUZ
condition of the Company as M December 31,2014, r Qualified In Westchester County
Additionally,I certify that the above financial statements am 4, :.'` ��. �� ��..-, :• Commissim Expires July 1.A 2018
h1 agreement with the Statutory Flnandal Statements filed with thr Texas Notate bll4 Stat*of FfawYork
Department of insurance as of the same date, €
No.O1TU6044514
willlam J oesson Ctuafifled In Westchester County
V-Q v T.RBlivaL Commission Explres July 10,2014
SUBDIVISION LABOR AND MATERIAL BOND
(GOVERNMENT CODE 66499.2)
Bond No.SUR21000018
Replaces Bond No. SUR20000332
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:
Gradin (Lots 1,2 & H) 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
One Hundred Eight Thousand Five Hundred Thirty Three Dollars and 00/100 Dollars ($108.533.00 ) 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: r'% r
SURETY:
Ironshore Indemnity Inc.
(NOTARIZATION AND SEAL)
By:
Margaret . Ginem , Attorney-in-Fact
Surety Phone No.
0/O WILLIS OF FLORIDA
4211 K BOY SCOUT BLVD,#1000
'VAMPA, FL 33607 Page 2 of 3
fNQUIRIESS:(813)281-2005
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 CaDa
)
Coun ofOn before me, x 'h1 ni A,ere Insert N e and Title of th Q 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)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-California x ,
Z Orange County '
My Comm.Expires 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(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
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
ANETT CARDINALE
.
COMM is$ion#FF 138482
Expires P' xis MY 18,2018
yFen Ineww"9W385.71Y19
This area for Official Notarial Seal
Sea te.kill. IQ$:0, ameii4:Sections 1.184 ani :11 5 of°tfia:Gzv l coir ci eGtlou $ Q of'the
C oYe t e ode;,te�ating#a nq`tMes,pdbli,6.•Tlie,belgw.-Physical format of tiwdi" lsurer ,co
xwexa ple,,,fRr parratses off°allustra#lt��;
A Yiotaty.public of other cruder 6aiijplctinb this
cexfificate verifies.only the identity ref the
individual who'signed the do _
Motto whidh. l
certificate is attac}med�and not the lxirthfulnesss
-1ecyracy,OT valzclity Of that:docuDicv_
Matte ofCalifo_rimia
County.of
Oh_ befcice ine, , TF�e>e
"insert frame andItitle ofofficerjj,personally appeared - Who
'prOVO to °tit 00,1;k4lasis of'satisfacwyevidencd to lie the:persori(s)Whose iianae(s}Is/x6 sutzswbeatQ;
t'be.vrithiii it§s umea.and acknowledged -to me- that: heJshefthey executed the same:irm-.kislher/their,
artthetri ed -apacsty(ies , end .Haat by liisihor/6,eir'szg lat e�s� -on:Yh lostrafn fie V,6rsaa(s),,i 1lie
.c-�Atity-�Oh-behalfofvrhich'the pefsorj('s)acted,.ekdcute'd tlic:ittstruineut
1;cc ify'iiiider PENAIr.T `QF Pl1R 1l iRY VTider Ibe laws of thie fwd of Cal'oriiia}lr. the fvirl±go%t
paws raph is true and'.correct
WITNESS my Band and offrc ak scaih:
Slgx}ature (Seal),
POWIcFi DF ATfDIiIV Y
nI- 21000018
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
22°d 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.
4f:pRR*t�'i
SEAL/ 1
0ft o1119', t -
- 'J
syc
Dan a 1.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 TAYLOR
Nolary Pu611c-Slate or Tennessee
Davitlson County Amy L.Tn
y q,"..,,,..•''„��: .yCommission Expires obo31S Notary Public
#u# 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
ha.^
V•
^o
SEAL
doll
Paul 5.G .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;NDEMNITY 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 loss adjustment expenses
0
Common stocks
31,840,141 loss adjustment expenses $10,394,957
Mortgage loans on real estate.first Lens 0 Commissions payable,contingent commissions and otherslmilar charges $1,020,805
Mortgage loans on real estate;Other than first Ivens 0 Other expenses(excluding taxes.licenses and fees) $5,435,126
Properties occupied by the company 0 Taxes,kenses 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 We 0 Not deferred tax liability 0
Cash.cash equhralentsand short-term Investments $15,6329S1 Unearned premiums
$29,158,576
Contract loans 0 Advance premium
Dedvatives 0 Ceded reinsurance premiums payable(net of coding commissions) $58,222,187
Other invested assets 0 Funds held by company under relnsurancetreatles
0
Receivables for securitles 0 Amounts withheld or retained by company foraccountof others
Securities lending reinvested collateral assets 0 Remittances and iterm not allocated
Aggregate write-Insforinvestedassets 0 Provision for reinsurance
$1,545,075
Subtotals.cash and lnvested assets $226,614,039 Netadjustnents In assets and labilkles due to foreign exchange rates
Tide plants less$.-,Charged off 0 Drafty outstanding
Investment Income due and accrued $990,960 Payable to parent,subsidiaries and affiliates $12,458,110
Uncollected premums and agents'balancesin the course of collection $73,567,547 Derivatives
4
Deferred premiums,agents'balances and Installments booked but deferred and not 0
yet due Payable for securities 0
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-Ins for liabilities
$4,185,928
Other amounts receivable under reinsurance contracts 0 Total Mobilities excluding protected cell flablfltles $190,811,131
Amounts receWab:e relating to uninsured plans 0 Protected cell liabilities
Current federal and foreignincome tax recoverable and interest thereon 0
Net deferred tax asset $5,530,837 Total liabilities
$190,611,131
Guarantyfunds receivableor on deposit 0
Furniture and equipment,indudlng health are delivery asset 0 POUCYNOLDERTSSURPLUS
Net adjustment In assets and liabilities due toforegnexchange 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 capital stock 5,0D0,000
Aggregate write-Ins for other than Invested assets $7,124,971 Preferred capital stock
Total assets excluding Separate Accounts,Segregated Accounts and protected Cot $347,414,611Aggregatewrltt4rs for other than special surplus p
Accounts
From Separate Accounts,Segregated Accounts and Protected Cell Accounts 0 Surplus Notes
TOTALS $547,e 14,{,11 Gross paid In sod contributed surplus $156,938,671
Unassigned funds jsurplusj ($5,335,190)
Surplus as regards policyholders $156,603,481
TOTALS { $347,414,611
SUBSCRLRED andsvrom to me Ndsy"day of/yf}
/ My commiisFcn 4xpnres_ 7=/o)F iS
Notarypublic
CERTIFICATE s Printed Name ALYSSA TURKOVITZ
I certify that the above financial Public,State of New York
nanclal statements to thebestof my NO.01TITUfi044514
knowledge are adaccurate reflection ofthefinancial ALYSSATLIRKOVTZ { U®tjfjDidry1� tGtTl@F('itltJCit
condition of the Company as of December 31,2014, �' ., /
Additionally,I certify that the above financial statements are {,, / }' CUfTTmisslOfl Expires July 10,2{)1$
In agreement with the Statutory Financial Statements filed with the•Texan No"PLrblIS St►la of Hew York _L-
Department of Insurance as of the same date, - r
No.OITU6044514
WRIlam1 Beason QuaBRed In Westchester County
CFO.VP&IlemNrtr Commission Expires July 10,2014