15-0505_Bond_SUR21000019_Pacific Point Dev_TR 16752 Premium: $289.00
SUBDIVISION FAITHFUL PERFORMANCE BOND
(GOVERNMENT CODE 66499.2)
Bond No. SUR21000019
Replaces Bond No. SUR20000346
KNOW ALL MEN BY THESE PRESENTS, that Pacific Paint oevelo went Partners i_I_C
(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:
Monument subdivision improvements within Tract 16752 as defined within Amendment#1 and
Reinstatement of the Subdivision Improvemetn Agreement for Tract 16752
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
Thiq Eight Thousand Five Hundred Dollars and 00/100 Dollars, ($38,500.00 ) lawful money
of the United States, for the payment of which sum well and truly to be made, we bind
ourselves, our heirs, successors, executors and administrators, jointly and severally,
firmly by these presents.
NOW, THEREFORE, the condition of this obligation is such that, if Principal shall
promptly and faithfully perform said improvement obligations within the fully executed
and recorded subdivision improvement agreement, then the obligation shall be null and
void; otherwise it shall remain in full force and effect.
Page 1 of 3
BE IT FURTHER RESOLVED:
1. As a part of the obligation secured hereby, and in addition to the face
amount specified, there shall be included costs and reasonable expenses and fees,
including reasonable attorney's fees, incurred by City in successfully enforcing such
obligation, all to be taxed as costs and included in any judgment rendered.
2. Said Principal, for value received, hereby stipulates and agrees that no
change, extension of time, alteration, or modification of the contract documents or of the
work to be performed thereunder, shall in any way affect its obligations or this bond, and
it does hereby waive notice of any such change, extension of time, alteration, or
modification of the contract documents or of work to be performed thereunder.
IN WITNESS WHEREOF, this instrument has been duly executed by the
Principal herein named on the 19th day of May 2015 , the name and
corporate seal of each corporate party being hereto affixed and these presents duly
signed by its undersigned representatives pursuant to authority of its governing body.
PRINCIPAL:
Pacific Point Development Partners, LLC
(NOTARIZATION AND SEAL)
By: -
Its: �wYvN uc
SURETY:
Ironshore Indemnity Inc.
(NOTARIZATION AND SEAL)
By: ,
Margar A. Ginem , Attorney-in-Fact
Surety Phone No. BOY SCOUT BM)#1000
INQUIRIES:(813)281ZAMPAFL .2095
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 )
Count of
)
On before me,
Oate Here ert Na and Title o the lc r
personally appeared P
Name(s)of Signer(s)
r
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 helshelthey 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 z
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(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
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 �j
Anett Cardinale
zriT:"n''•• ANETT CARDINALE
Air",
Commission#FF 138482
Expires July 28,2018
1 , Bonded TAru Troy Fein lneurence 800-385.7019
This area for Official Notarial Seal
i
ge te. fTl 16 0.
�a .... . . 5P-de 3eo8242 of 6nedScnfiice
:Gkwerhbleot,Gvc e,tela ing-to not) es.ppbjtt;_filter eT Dov physica7 format of Abe riew disclosure
notice is-anexarnplex fvr pur .oses ofillust ;
A notary'.public of o&r 6fl dei CoDhipiotin this:
certifioateverifies.onlythe id+entity'of the
ind vidpal who.signed,the da�utnerit.tta vrhieft 'N
certificate.is attached,and not the trathfulnessi
a#urOy,o;v..alidity of that.doeuvient.
State'of California
.C.bunty of
.before 7ne,
ihsert name anti title of-officer), -emonnally aped Who..
PfOYMPd TO W WOO. of'�a Sfktary evidORO to be'ft p'e=on(g)'Whose nanie(s)isiare sept scrihedto,
1lae-Within'.•Irisbrument.and acknowledged -to me- that hAhelthey executed the.same'.in .hiAerltheir
4u1l7vzi.7.e#i capaCTty jo$), Ogd that,liy�is/l;e A iek's ghA4;re(s) 00.the'itr"stnihtohf#fie 4rson(s),:or the
ttitity bpo�.behalf of-which the persan(t): ed,-eJkocuted tfie instrurUent.
I:Ge=k#j+'i rider PENAI.�`�'�'"pp.�FRIIJI��f indor tie lady§ 'of die. tete ql C alifr�rhi�that tl�e fog goiz
paragraph is true and'.Gorrec
Wl TNES itay.l dndand,official Sear:
iaftire. (Seal):
POWER OF ATTORNEY
Ironshore Indemnity Inc. III- 21000019
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 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'L F p
Ixl' REAL
1919
By:
Da a 1.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.
a `rA
AMYL TAYLOR
= Nolery Public-State or Tennessee
Davldson county
My Commisston Expires 01-09-16 hmy L.Ta-
q.;�X`' Ne14ry 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 191h Day of May20
10TI15
19 i9
4,��ar rr
----
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 MDEMNITY INC
FINANCIAL STATEMENT SUMMARY
As of December 31,2014
ASSETS LIABILITIES
Bonds
$179,140,947 lasses $63,582,066
Preferred stocks - Reinsurance a
Common stocks 0 payable on paid losses and Inas adjustment expenses 0
31,840,141 Loss adjustment expenses $10,384,957
Mortgage loans on real estate.First kens 0 Commissions payable,cantin8ent commissions and other similar charges $1,020,805
Mortgage loans onreal estate:Other than first liens 0 Other expenses(exctudingtaxes,llamesand fees) $5,435,126
Properties occupied by the company 0 Taxes,licirnses and fees(exdudaeg federal and foreign income taxes] $21383,909
Properties held for the production of income 0 Current federal and foreign Income taxes
$1,434,392
?rapertAs held for We 0 Net deferred tax liability
0
Cash,cash equivalents and short-term Investinents $15,632,951 Unearned premiums $29,158,576
Contract Ions D Advance premium
Derivatives 0 Ceded reinsurance premiums payable(net of ceding commissions) $58,222,137
Other invested assets 0 Funds held by company under reinsurance treaties
0
Recet"blasfur securitles 0 Amounts withheldofretalncdbytompanyforaecountofothen
Securities lending reinvested collateral assets 0 Remittances and items not allocated
Aggregate write-Ins forinvested assets 0 Provision forralnsurance $1,545,075
Subtotals.cash and Invested assets $226,614,03.9 Net adjustments In assets and tabllltles due to foreign exchange rates
Title plants less$..;Charged off 0 Drafts outstanding
Investment Income due and accrued $990(960 Payable to parent,subsidiaries and affiliates $12,458,11D
Uncollected preourns and agents'balances in the cause of collection $73,567,547 Derivative
0
Deferred premiums,aged 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 recoverabee from reinsurers $33,586,257 UsblRty foramounts held under uninsured plans 0
Funds held by or deposited with reinsured companies 0 Aggregate write`;m tar llabll#In $4,185,928
Other amounts receivable under reinsurance contracts 0 Total Ilabllltles excluding protected call fiabilides $190,811,131
Amounts receivabce relating to uninsured plans 0 Protected call liabllitles
Current federal and foreign income tax recoverable and interest thereon 0
Net dererrid rax arset $5,530,837 Total liabilities
$190,812,131
Guaranty funds receivable or on deposit 0
Furniture and equipment,Including health care delivery assets 0 POLICY{iOLDERYSSURPLUS
Net adjustment In assets and liabilities due to foregn exchange rates 0 Aggregate vote-Ins for special surphrs funds 0
Receivables from parent,subsldiarles and affiliates 0
Health care and other amounts receivable 0 Common aotal stock 5,0D0,000
Aggregate wrttrins for other than invested assets $7124,971 Preferred capital stock
Total assets excluding Separate Accounts,Segregated Accounts and Protected Cet $347,414,611
Aggregate wripe-rs for other than special surplus
Accounts p
From Separate Accounts.Segregated Accounts and Protected Cell Accounts 0 Surplus Notes
TOTALS $347 4i4 g;; Gross paid In and contributed surplus
$156,938,671
Unassigned funds(surplus? ($5,335,190)
Surp us as regards policyholders $156,603,481
TOTALS $347,414,611
SUBSCRIBED and sworn tome this'day of Xy v,-""/s
My rpmndssan expires, 7-/4)-/V
Notary Public
CERTIFICATE mt - Pr,, ALYSSA TURKOVIIZ
tedNames
1 certify that the above financial statements to the bestaf my Notary Public,State of New YorkNO,01TU6044514
knowledge are a true and accurate reflection oftheRnanclel ALYSSATURKOtrffL tiJ®fIf♦ect . ITU604 51 Couftl]f
condition of the Company as of December 31,2$14. `
Addle]onally,Icertifythat the above Mancialstatements are t '( �,,•;fs �r+r/� &#rW July U1, 048
in agreementwlth the Statutory Financial Statements filed with the Ttxar Nohq 'pubilr„StateOfNew York _
Department of insurance as of the same date s'
No.OITU6044514
WRllam J Gleason qualified In We"ester County
CFO.Vp&Treasurer Conrmissfon Expires July 10,2014
SUBDIVISION LABOR AND MATERIAL BOND
(GOVERNMENT CODE 66499.2)
Bond No. SUR21000019
Replaces Bond No. SUR20000346
KNOW ALL MEN BY THESE PRESENTS, that Pacific Point Develol2ment Partners LLC
(hereafter designated as "Principal"), and Ironshore Indemnity Inc. ,
as Surety (hereinafter called "Surety') agree to install and complete certain designated
public improvements as conditioned by City Council Resolution No's. 92-6-16-4 and
03-09-16-06.
WHEREAS, said Principal is required to furnish a bond pursuant to Municipal
Code Section 9-5.101 and 9-5.109 et seq., for the faithful performance to guarantee
certain work, more particularly described as follows:
Monument subdivision improvements within Tract 16752 as defined within Amendment#1 and
Reinstatement of the Subdivision Im rovemetn Agreement for Tract 16752
NOW, THEREFORE, we the Principal and Surety are held firmly bound unto the
City of San Juan Capistrano, (hereafter called "Obligee") in the penal sum of
Thirty Eight Thousand Five Hundred Collars and 001100 Dollars ($ 8,5oo.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: (=�
IQ
SURETY:
Ironshore Indemnity Inc.
(NOTARIZATION AND SEAL)
By: � kje ~�
Margar A. Ginem , Attorney-In-Fact
0/0 WILLIS OF FLORIDA
Surety Phone No. 14211 W.BOY SCOUT BLVD,#1000
TAMPA, FL 33607
NQUIRIES:(613)281-2096
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 �• � � )
Coun of—_
r �/ ) , /,
OnIyU ! 1 before me 26lbl V
Date If Insert Na andqtIfqt )j—
Here ficer
personally appeared
Name(s)of Signer(sj
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.
W.CO�RD
Commission325 WITNESS my hand and official seal.
Notary Public-California z x Orange County KLHI
My Comm.Expires Oct 31,2018 Signature
Signature of Notary Public
Place Notary Seal Above
OPTIONAL
Though this section is optional, completing this information can deter alteration of the document or
fraudulent reattachment of this form to an unintended document.
Description of Attached Document
Title or Type of Document: Document Date:
Number of Pages: Signer(s) Other Than Named Above:
Capacity(les) Claimed by Signer(s)
Signer's Name: Signer's Name:
❑Corporate Officer — Title(s): _ ❑Corporate Officer — Title(s):
❑ Partner — ❑ Limited ❑General ❑ Partner — ❑ Limited ❑General
❑ Individual ❑Attorney in Fact ❑ Individual ❑Attorney in Fact
❑Trustee ❑Guardian or Conservator ❑Trustee ❑Guardian or Conservator
❑Other: ❑ Other:
Signer Is Representing: Signer Is Representing:
02014 National Notary Association -www.NationalNotary.org - 1-800-US NOTARY(1-800-876-6827) Item#5907
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
E+sr' ANETT CARDINALE
.a ;.: Commission#FF 138482
lea; Expires July 28,2018
Bonded Thru Troy Fein Insurance 800-385-70W
This area for Oficial Notarial Seal
$ebato.$ill 10% araeAa-s:9ectiotis.1-:189 amici 11.95:of"*e:ei�li.-.Cocie 'ana Sec.imE ON of the
Ob-yer=c*.Co4et.t`elatln9-to noi.afi s.pu sl e.'TY e-040- ys cal format of die-hew-,disclosure
xxoUc,q.. s-a4 exa�nplL-,.for prToses ef'igustratio
A h600Y-plibIic a. other affyee�r caii letizt t[�f_s:
certif:;a a verifies only the identity ofthe
indiv'iduaI rho.sigixeds the do"Tnprit to wtit&
.eertifioate.is atta6ed,and not the truthfulness
*COPLOY,oil VaMgy of t�af doqumenT-
.Statte of California
Ctiiinty.of
Uii before rne, � i fiats
insert name and title ofrrfftcer5,personally appeared; l�11q.
proved ter h7 ot► the basis of°satisfactory evidence to fie tfi pt�rSori( _ tioe iiar�ie(s)islaceu) cr�bed't
:fie wiahir -instrument and acknowledged -to me" that hehhelth�y exeouted the.same:.in .fiis/fier/their
at�ttkii act
ti .ter est n shierthefx/
ty . .fix A y hj S O awe(s) 'qri.the cnstru(not tie tbrson(s),:ar the
',*Atjt.y. t04 behalfofwhir 'thb lier'son(t),acted,ekdctftedth6instrurnent
I;
01 rifjp'under PENAL`I'�'(3lY` P1 1LT Y' Ti&r.1he laws of t e.S#ate of Uifornvi fis t the fair gozi p
paragraph i"s true and',correO
WnNESS iiiy.Mnd aiid official;steak.
Si,�afure �Sea1).
POWER OF,4TTC?RNEY
Ironshore Indemnity Inc. III- 21000019
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 an 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.
•S��P9V2,AS>i
�i bFAt
t t0i9
By:
a,,, 5uss 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.
4
_ X77 AMY L TAYLOR
Notary Public-Stale of Tennessee
t7Yritlson£lfUnly
._- c� A1yf.SIIYMRIIanFina1-09-76 AmyL Tay
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 MayZD 15
t9}9 i
• "4.>.fyh� .
Paul S.Gi dana
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
11ABIlIT1E5
Bonds
$179,140,947 Losses $63,582,066
Preferred stocks 0 Reinsurance payable on paid losses and lass adjustment expenses
0
Common stacks
31,840,141 Loss adJustment expenses $10,384,957
Mortgage loans on real estate:first kens 0 Commissions payable,contingent commissions and other similar charges $1,020,805
Mortgage loans on real estate;Otba then first liens 0 Other expenses(excluding taxes,llunses and fees) $5,435,126
Properties occupied by the company 0 Taxes,licenses and fees(exdudmg federal and foreign income taxes) $2,383,909
Properties held for the production of income 0 Curterrt federal and foreign income taxes
$2,434,392
Properties held for see 0 Net deferred tax liability 0
Cash.rash equivalents and short-tens Investments S15,632,951 Unearned premiums $29,158,576
Contract loans D Advance premium
Derivatives 0 Ceded reinsurance premiums payable(net of ceding commissions) $58,222187
Other invested assets 0 Funds held by company under reinsurance treaties 0
Receivabiesfor securities 0 Amounts withheld or retained by Company for account of others
Securities lending reinvested collatert assets 0 Remittances and Items not allocated
Aggregate wrtte4ns forinvested assets 0 Provision for reinsurance $1,545,075
Subtotals.cash and Invested assets $226,614,039 Net adjustments in assets and labllllles due to foreign exchange rates
Title plants less$•-,Charged off 0 Drafts outstanding
Investment Income due and accrued $990,960 Payable to parent,subsidiaries and affiliates
$12,458110
Uncollected prenCums and agents'balances In the course of collection $73,567,547 Derivative
0
Deferreddcpremiums,agents'baknce and Installments booked but deferred and not 0 Payable for securities
0
Accrued retrospective premiums 0 Payable for securities lending 0
Amounts rersverabte from reinsurers $33,586,257 Uablllty foremounts held under uninsured plans 0
Funds held by or deposited with reimuredcompanies 0 Aggregatewrite-Insfor liabilities $4,1851928
Other amounts receivable under reinsurance contracts 0 Total liabilities excluding protected cell flablflties $190,811,131
Amounts recelvab:e relating to uninsured plans 0 Protected cell liabilities
Current federal and foreign income tax recoverable and interest thereon 0
Net deferred tax asset $5,530,837 TotalRabllitLes
$190,811,131
Guaranty funds recehvbk w an deposit
D
Furniture and equipment,Including healthcare deRveryassets 0 POUCYMDERSS$URPLUS
Net adjustment In assets and IlablBtles due to fore'gn exchange rates 0 Aggregate wnte•lns for special surplus funds
0
Receivables from parent subsldkWesand affiliates 0
Health are and other amounts receivable 0 Common ca0tal stock 5000000
Aggregate wrtte-Ins forotherthan Invested assets $7,124,971 Preferred capital stock
Total assets excluding $347,414,611
Separate Accounts,Segregated Accounts and Protected Cat
Accounts te;
Aggregate wrias for other than special surplus 0
From Separate Accounts-Segregated Accounts and Protected Cell Accounts 0 Surplus Notes
TOTALS $347,414 611 Gross paid In and conbtbuied surplus
$156,938,671
Onaixigned funds(surplus;
($5,335,190)
Surp us as regards pollcyholders
$156,603,481
TOTALS
$347,414,611
SUBSCRIBED and sworn tome thls'��lay of/y/��✓ j tj
/ -0, r My commiss:s n expires, '7-/O—/T
NotaryPublic
CERTIFICATE .` PriltedName ALYSSA TURKOVITZ
I certify that the above financial statements to the best of my Not"Public,State Of NOW York
knowledge are a true and accurate reflection of the nnerwisl ALY53A TUAKOM No.O1 TU6044514
condition of the Company as of December 31,2014, Qllafitled In We5tchester County(
Additionally,I certify that the above financial statements are { ..''r "•aP„•_ r� x.,:,a,7 r.onlifftsion E*m July 10,2018
in agreement with the Statutory FlnandaI Statements filed with thn Text krkat.�rsbllc,State of New York
Department of Insurance as of the same date;
No.01TU6044S14
WRIlem1 Gleason Qualified In Westchester County
M, .VP&TreesureL Coamisslon ExplresJuly 10,2014