15-0505_Bond_SUR21000021_Pacific Point Dev_TR 16749 Premium: $225.00
SUBDIVISION FAITHFUL PERFORMANCE BOND
(GOVERNMENT CODE 66499.2)
Bond No. SUR21000021
Replaces Bond No.SUR20000333
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:
Monument subdivision improvements within Tract 16749 as defined within Amendment#1 and
Reinstatement of the Subdivision Improvement Agreement for Tract 16749
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
Fourteen Thousand Five Hundred Dollars and 00/100 Dollars, ($14,500.00 ) 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: �. •er' -c. �`�� tt �.
SURETY:
Ironshore Indemnity Inc.
(NOTARIZATION AND SEAL)
By:
Margar A. Ginem , Attorney-in-Fact
Surety Phone No.
C/O WILLIS OF FLORIDA
4211 W BOY SCOUT BLVD,#1000
TAM PA, Fl 33607 Page 2 of 3
!NC?UIPIES: (813)281e209,9
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 n )
f
Oni before me,
Dat He Osert am&aTitle he fficer
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
is true and correct.
W. C0R01
Commission#2088325 WITNESS my hand and official seal.
Notary Public-Callfornla A
Orange County
M Comm.Ex fres Oct 31,201 a J Signature NXUA
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
Anett Cardinale
r' I A(NETT CARDINALE
Commissian#FF 138482
�aa'i Exons Jury 28,2018
f!„I BondNT"TroyFintm�e .aaasestats
This area for Official Notarial Seal
`m ate:$kl I00.0, omeftOd Sections !A 89 maid 1, - Q�;thie:�x�X.tade dud 8ealoo 8202 of thin
A3o vemin cqt.C ocje;relatingto nQtaixes:ptl#lic:- 1e 1 elo�v ysicaY format of ai�clos&e
ivoce; s_P examp!4 for puww4es austra Pp.
A iioAffy public of othdr affidea doii-.pliet'ing tfi#$.
certificate verifies only the identity of the
indivi ua-i vvho.signed•the dooment.ta whi.dh-t
Certificate is attached,and not the trdtUulness,
anciirgy;oX validity of that.(]OuToent
Stam of California.
.CQ.unty,of
insert narrze'andtitbe-of off`icerjo perso gjIy apexed who
pt oy d to A�oji thd.bas,is-o sat 5#a t�iiy.evideric tQ 6e fixe erson };ivF ose iianie s) sl re suliscrjbed tc.
%6-within •instrument and acknowledged to me• that:helshefthey executed the same- in hisfherftheit
autho ized' aciiy(1,4), (104 that-by�islfterAW;r Mpa-Wt.b(�) •Qjiifae uistrnbIVPt #fie-i rson(s},: at tiie
:c ttity uport.biAW of whiclt he pefson(§)acted,eitecuted tiJi&4nstrurneAt:
brty iiri,der FENAI;'I 'QF ti.ridor ,tae ]avvs 'of te. tat of Gall#tmia khat the faxegom
paragraph is true and'cormc
WITNESS rnj+'IAnd ai�d.officia-waL
�r (Sea)).
POWER OF ATTORNEY
III- 21000021
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:
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 duty elected ufficers,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 seat 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 certlficate
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.
IL
14%9
By-
04 a t.5tiss 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 TSteteAYLORor
Ai
_ _ Nolery Publlc- Tennessee
r Davidson County Am L T¢f
��,, �c MY Commission Ezoires D%-037fi y y
••y'' u?;:.•"�� - Notary Publlc
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 Mav 20 15
SEAL
%v r3
Paul S.Gi.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 MDEMNrTY INC
FINANCIAL STATEMENT SUMMARY
As of December 31,2014
ASSETS LIABILITIES
Bonds
$179,140,947 Losses $63,582,066
Preferred stocks a Reinsurance
0 payable on paid Losses and loss ad)ustment expenses p
Common stocks
31,840,141 Loss adjushnentexpense$ $10,384,957
Mortgage loans on real estaWArstkens 0 Commissions payable,contingent eommissionsand other similar charges $1,020,805
Mortgage loans on real estate;Other than first Rens 0 Other expenses(exduding taxes.licenses 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 bf inoome 0 Current federal and foreign Income taxes
$2,434,392
Propertles held for sa'.e 0 Not deferred tax liability
0
Cash,rash equivalents and short-term investments $15,632 9S1 Unearned premiums $29,158,576
Contract loans 0 Advance premium
Derlvattves 0 Ceded reinsurance premiums payable(net of ceding commissions) $58,222,787
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 allocated
Aggregate wrltNnsfor invested assets 0 Provisionforroinsurena
$1,545,075
Subtotals.cash and invested assets $226,614,039 Net adjushnentslnassets and tabllRlesdue toforeign exchange rates
Tittle plants leis$.„Charged off 0 Draftsoutsbnding
Investment Income due and accrued 5990,960 Payable to parent subsWariesand affiliates $12,458,110
Uncollected prom ums and agents'balances In the course of collection $73,567,547 Derivatives
0
Deterred 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 recoverabte 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 $4,185,926
Other amounts receivable under reinsurance contracts 0 Total liabilities exdudng protected a6 liabilities $190,811,131
Amounts recsMb a relating to uninsured plans 0 Protected celf 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 deposit
Furniture and equipment,including health are delivery assets 0 POUCYNOLDCFWSSURPLUS
Net ad)ushnent In assets and liabilities due to forcgn 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 aotal stock 5000000
Aggregate wrttrMs for other than Invested assets $7124,971 preferred capital stack
Total assets excluding Separate Accounts,Segregated Accounts and Protected Cat $347,414,611
Aggregate write-'rrs for other than special surplus 0
Accounts
From Separate Accounts.Segregated Accounts and Protected Cell Accounts D Surplus Notes
TOTALS $347,414 lilt Gross paid In and contributed surplus $156,938,671
r- -
Unassigned funds(surplus) ($5,335,190)
Surp us as regards policyholders $156,603,491
TOTALS $347,414,611
SUUMBEDand awom to me this'y'fday of MN j!:Gi j ej
..''J lrty commissc n ergeres �•1 U
NoaryPubllc
CERTIFICATE r Printed Name
RLYSSA TURKOVITZ
Public,State of New York
I certify that the above financial statements to the bests;/my Notary No,01 TU6044514
knowledge area true and accurate reflection of the nnanrlol ALy rS.ATURXOV T2
condition of the Company as of December 31,2014, r QuallfiGid In WestcITeS er Col rq
Addklonally,I certify that the above financial statements are COMM"M I'yOr”JUlY 10,2018
in agreement with the Statutory Finandal Statements filed with ttm Taxa$ 3J04blir;Ststa of New York
Department of Insurance as of the same date, - r
No.O1TU6044514
WRliam,1Gleeson Qualified In Westchester County
CFO.VP A-Leesurcr Commission Expires July 10,2014
SUBDIVISION LABOR AND MATERIAL BOND
(GOVERNMENT CODE 66499.2)
Bond No.SUR21000021
Replaces Bond No.SUR20000333
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:
Monument subdivision improvements within Tract 16749 as defined within Amehdment#1 and
Reinstatement of the Subdivision Improvement Agreement for Tract 16749
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
Fourteen Thousand Five Hundred Dollars and 00/100 Dollars ($14.500.00 ) 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 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)
Y•
Its: v�ooc 'ti z ' V�rh r
SURETY:
Ironshore Indemnity Inc.
- (NOTARIZATION AND SEAL)
By:
Margare Ginem , Attorney-in-Fact
Surety Phone No.
C/O WILLIS of FLORIDA
4211 W,BOYSCOUT BLVD,#1000 Page 2 of 3
TAMPA, FL 33607
rr1OUIRIES:(613)261-209x
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
Countv of � ) -&� � AI
On before me, , - fl d-a VIA OW
Date i tr Ins Na a and Title f 1he Officer
personally appeared l
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 helshe/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 Z WITNESS my hand and official seal.
-w Notary Public-California
Orange County y
My Comm.Expire 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
❑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 mv official seal on
the date in this certificate first above written.
Signature
Anett Cardinale
p
T C7
ANET1NALE
"__ Commission#FF 138482
g Expires July 28,2018
4 •,°••` Bonded Thru Troy Fain Imunmce 800-395-Toto
This area for Oficial Notarial Seal
`Seftts.33M 110b, Wends:Sections 1:189 0l 1195. of.';hto. Gi 1.Inde tlu�d ecti i of-of'tf�6
GOWPIMAt,Code;relatin9�to ikomjires,p�3blic,.'Thi:t belpwi ys caI format of'tt e riev disclosure
T,aticgisanexample; for-pwupg4gofillustratron:
A h6taiy,p4blic of other dfffi�ef caitipiptiad th#s
cettif bate verifies only the identity of the
indivii.uai vyha signed the dQ!�umea.tq which s
Certificate.is attached,and not-the trdthfidness,
.acc���y oX validity cif"#h���o�u�lent<
Sate.bf California.
C.bunty.of
Dia ..before tne, ete
insert name andlitie ofoff[cerj,personally app cd Who
pxolxe i tO gg on the basis o�sattisffSet&y.evidfs'nce to be tlie;p�zsriri(�)'v�hos�a�ame(s}�sf�}r6.pu*'b- to.
`.tbe vV mn �hieaument.and: acknowledged -to me, that;heJshelthey executed the same in..l i=slherJtheir,
autlto ?#f.opacity{tesj, d .khat.byislfer/t3�e '$i( ,fiatut:Q } tjzf..filie ittstrufitt alaersbn(S),.ter the
-entity bpbh,.behalf ofwhiph the person('s}.acted, executed tl 6.zrtsmuabnt
I;Geiky'iider ]'EIVAX,T Q>Y. PR1lJItY�irider to laws Af te.Stat of'�alwornia}b�t'tlze fagohi
paragraph i's true and corrcO
Wr NESS mybAnd aiid officio se sh; C)'
Sigoafnre
t
POWER OF ATTORNEY
Ironshore Indemnity Inc. III- 21000021
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.
191q
_
By,
Dan a L.Sus n
Director
ACKNOWLEDGEMENT
On this 7th Day of August,2013,before me,personally came Daniel L.Sussman to me known,who being duly sworn,did depose and say that he is the
Director of Ironshore Indemnity, Inc.,the corporation described in and which executed the above instrument;that he executed said instrument on
behalf of the corporation by authority of his office under the By-laws of said corporation.
wY lry, 1{'p/
l!V'
AMY L TAYLOR
_ Notary PuNlc-Slate of Tennessee
t DavOwn County
4 . • ,� My Commission Expires 01-01-18 Amy L.To
�.,4_ ..,,• .rC,� Notary PubMr
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 MaY20 15
"SCn1.+.
p,m
Pauls.Gi 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 MDEMNITY INC
FINANCIAL STATEMENT SUMMARY
As of December 31;2014
ASSETS
LIABIIITIES
Bonds
$179,140,947 LD6fa
$63,582,066
Preferred stocks p Reinsurance payable on paid losses and loss adjustment expenses p
Common stocks 31,840,141 Loss adjustment expenses
$10,384,957
Mortgage loans on real estate:Arst lens 0 Commissions payable,contingent commissions and other similar charges $1,020,805
Mortgage loans on real estate,,Other than first Bens 0 Other expense(uadud ni;Saxe licenses and fees) $5,435,126
Properties occupied by the company 0 Taxes,genes 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 Net deferred tax liability 0
Cash.cash equivalents and short-termInvestments $15,632,951 Unearnedpremlums $29,158,576
Contract loans 0 Advance premium
Derivatives 0 Ceded reinsurance premiums payable(net of ceding commissions) $58,222,187
Other invested assets 0 Funds held by company under reinsurance treaties 0
Receivables forsecurides 0 Amounts wlththeldorretained bycompany for socountofothers
Securities lending reinvested collateral assets A Remittances and items not allocated
Aggregate write-Ins forinvested assets 0 Provision for reinsurance $1,545,075
Subtotals.cash and Invested assets $226,614,039 Net adjustment in assets and Labilltles due to foreign exchange rates
Title plants less$--,Charged off 0 Drafts oubtandbhg
Investment Income due and accrued $9K960 payable to parent,subsidiaries and af0liates
$lzpsg,uo
Uncollected pre ,urns and agents'balances In the course of collection $73,567,547 Derivative
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 recovers We from reinsurers $33.586,257 Liability for amounts held under uninsured plans p
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 call liabilities $190,811,131
Amounts receivab;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 Total liabilities
$190,811,131
Guaranty funds receivable or on deposit D
Furniture and equipment,including healthcare delivery assets 0 POUCY1*XDERYSSURPLUS
Net adjustment In assets and liabilities due toforegnexchange rates 0 Aggregatewmte-Ins for special surplus funds
0
Receivables from parent,subsidiaries and affiliates 0
Health care and alheiamount%recelvabte 0 Common capital stock 5,000000
Aggregatew0te-Ins for other than Invested assets $7,124,971 Preferred capital stock
Total assets excluding Separate Accounts,Segregated Accounts and Protected Cel, $347,414,611
Aggregate write;ns for other than special surplus p
Accounts
From Separate Account,Segregated Account and Protected Cell Account 0 Surplus Notes
TOTALS _ $347,414611 Gross paid In and contributed surplus
r $156,938,671
Unsaslgned funds tjurplusl, ($5,335,190)
Surp in as regards policyholders
$156,603,481
TOTALS
$347,414,611
SUBSCR1REo and sworn to me thts'IL'day of
Mycomrnlis,-n expires.: 7-/a--/S
���.s, _/ •'*�_ _ NopryPublic
cERT1FICATE r f Pri,ted Name ALYSSA TURKOVITZ
Public,Slate of New York
I certifythat the abovefinancial statement to the best of my Notchy No.O����'4
knowledge are a true and accurate reflection of the Ana clall ALYSSA TU RKOVar
condition of the Company as of December 31,2014. ' , ! Ouslifted In Westchester County
Additionally,l certify that the above financial statements are ti. .? Ifi,44t1 xr-',.-i- Commission Expires 10,2018
In agreement with the Statutory Financlal Statement filed with the Taxis Nolac 1,ubllc,Stile of New Yogis
Department of insurance as of the same date, e
No.OITUGM514
will am J 6leason Qualified In Westchester County
!"ffl.VPATrMVIEL Commission Expires July 10,2014