15-0505_Bond_SUR21000023_Pacific Point Dev_TR 15687 Premium: $225.00
SUBDIVISION FAITHFUL PERFORMANCE BOND
(GOVERNMENT CODE 66499.2)
Bond No. SUR21000023
Replaces Bond No. SUR20000324
KNOW ALL MEN BY THESE PRESENTS, that Pacific Point Develoment Partners LLC
(hereafter designated as "Principal"), and Ironshore Indemnity Inc. ,
as Surety (hereinafter called "Surety") agree to install and complete certain designated
public improvements as conditioned by City Council Resolution No's. 92-6-16-4 and
03-09-16-06.
WHEREAS, said Principal is required to furnish a bond pursuant to Municipal
Code Section 9-5.101 and 9-5.109 et seq., for the faithful performance to guarantee
certain work, more particularly described as follows:
Landscape subdivision improvements within Tract 15687 as defined within Amendment#1 and
Reinstatement of the Subdivision improvement Agreement for Tract 15687
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
Fifteen Thousand Seven Hundred Fifty Five Dollars and 00/100 Dollars, ($15,755.00 ) 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)
gy.
Its:
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
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 Califomi )
County of ^ ryy )
On fl- N before me, Ga� II(C
Date re nsert Name and Title of O icer
personally appeared
Name(s)of Signer(s)
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are
subscribed to the within instrument and acknowledged to me that he/she/they executed the same in
his/herAheir 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#E 2088325 z WITNESS my hand and official seal.
Notary Public-California
Z Orange County -
My Comm.Expires Oct 31.2018 Signature
ignature 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(lies) Claimed by Signer(s)
Signer's Name: _ Signer's Name:
❑Corporate Officer — Title(s): _ ❑Corporate Officer — Title(s):
❑ Partner — ❑ Limited ❑General ❑ Partner — ❑ Limited ❑General
❑ Individual ❑Attorney in Fact ❑ Individual ❑Attorney in Fact
❑Trustee ❑Guardian or Conservator ❑Trustee ❑Guardian or Conservator
❑Other:_ ❑ Other:
Signer Is Representing: Signer Is Representing:
02014 National Notary Association •www.NationalNotary.org - 1-800-US NOTARY(1-800-876-6827) Item#5907
`Sicoatel 13W 1.1050, amends $ectiong JA 89 bcna. 1195:of'%e d - d S I'oti '.O� of the
. .. .. ' I Q e an ee 1. 8,2
G&Veminefit Code, relating: notaries.piibjib.'The below physical format of the riew disclosure
notice,
js-anexarn le-forpur
,
P 'poi4es.of illusaration
A notary' public or other 6ffidef coh*lati.na this
certificate verifies only the identity-6f the
individual 6
individual who signed the d,putnprit,to whiehfhi�
certificate,is attached,and not the truthfulness,
Acetwooty,or validity of thatdocument,
State of California.
,County of
Oh ;before me,. there
insert name and title of officerj,personally appeared who
proved t6 ffie on the basis of satisfactory evidan6o to &Ae,jierson(�)whose barn
e(s)is/aresuliscribedto
the wiihin iristrurnent and acknowledged -to me- that he/she/they executed the same- in his/her/their
authorize ca acit i and .. . On 04 in urne' the persons}, o
.0 behalf
.XiOA a d that,by)iis/hor/their iighatpre(s) str nt rson( ) r the
entity- upo behalf ofwMch-t6e pe(soh(s).acted,executed the-instrument.
I.certif 'under PENALTY`):' P
ERJORY under..the JAWs of th6 StatC5 of"California that the foregoing
paragraph is true and correct
WITNESS my hand and officia'A seal.
SiLmature (Seal),
ACKNOWLEDGEMENT BY SURETY
STATE OF FLORIDA
COUNTY OF HILLSBOROUGH I SS.
On this 19th day of May, 2015 before me, personally came
Margaret A. Ginem, who is personally known to me (or proved
to me on the basis of satisfactory evidence) to be the person
who executed the within Instrument as Attorney-In-Fact on
behalf of Ironshore Indemnity Inc., and acknowledged to me
that he/she executed the within instrument on behalf of said
surety company and was duly authorized to do.
In witness whereof, I have signed and affixed my official seal on
the date in this certificate first above written.
Signature
Anett Cardinale
tip'" ANI=TT CARpINgL
0AT
� M1SSbq#Fl
F I J9'fi74
5
a== EXPIres July 28,2118
9cnded 7hru troy Fafn fnIurxs 500.365701$
This area for Oficial Notarial Seal
POWER OF ATTORNEY
III- 21000023
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 indemnityi
orother 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 tate 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.
.�P".QRyOA�t iS
s; SEAL
1919
By:
Uan a L.Suss n
Director
ACKNOWLEDGEMENT
On this 71h 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 authorlty of his office under the By-laws of said corporation.
•,"'i ••i� AMY L TAYLOR
_ - Notary Public-Sl.,a a ennessse
•' Davidson County
,� My Commission Expires 01-09-16 AR1y L.'ray
��' u»'` Netary Pubtle
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
• o�
SEAL °I
19i!< 1
r
PauIS.G dans ~
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."
IRONSNOAE MDEMNITY INC
FINANCIAL STATEMENT SUMMARY
As of December 31,2014
ASSETS LIABILITIES
Bonds
$179,140,947 Lw.es $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.First tens 0 Commissions payable,contingent commissions and other similar charges $1,020,805
Mortgage loans on real estate;Other then first liens 0 Other expenses(exquding taxes.licenses and fees) $5,435,126
Properties occupied by the company 0 Taxes,Ncenses and few(excluding federal and foreign income taxes( $2,381,909
Properties held for the production of income 0 Current federal and foreign Income taxes $2,434,392
Properties held for We 0 Net deferred tax liability
0
Cash.cash equWalents and short-term Investments $15,632,951 Unearned premiums $29,158,576
Contract loam 0 Advance premium
DerivatWas 0 Ceded reinsurance premiums payable(net of ceding commisslonsj $58,222,187
Other Invested assets 0 Funds held by company under reinsurance treaties 0
Receivables for securities 0 Amounts withheld or retained by company for account of others
Securities lending reinvested collateral.assets 0 Remittances and Items not allocated
Aggregate wrlte4ns forinvested assets 0 Provision for reinsurance $1,545,075
Subtotals.cash and Invested assets $226,614,039 Net adjustments In assets and tabllltles due to foreign exchange rates
Title plants less$.,Charged off 0 Drafts outstanding
Investment Income due and accrued $9K960 Payable toparent subsidiaries and affiliates $12,458,110
Uncollected prom urns and agents'balances inthe course ofcollection $73,567,547 Derivative
0
Deferred premiums,agents'balances and Instalments booked but deferred and not 0
yet due Payable for securities 0
Accrued retrospective premiums 0 Payable for securities lending 0
Amounts recovenb5efrom reinsurers $33,586,257 Liability for amounts held under uninsured plans 0
Funds held by or deposited with reinsured companles 0 Aggregate write-ins for liabilities
$4,185,928
Other amounts receivable under reinsurance contracts 0 Total liabilities excluding protected cell liabilities $190,811,131
Amounts recelvaWe relating to uninsured plans 0 Protected cel liabilities
Current federal and foreign Income lox 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 POLICYNOLDEAS`S SURPLUS
Net adjustment In assets and liabilities due to foregn exchange rates 0 Aggregate write-Ins for special surplus funds 0
Receivables from parent subsidiaries arid affiliates 0
Health are and other amounts receivable 0 Common capital stock 5,000,000
Aggregate wrtte-ins for other than Invested assets $7,124,971 preferred capital stock
611414,
Total assets excluding Separate Accounts,Segregated Accounts and Protected Cat $347, Aggregate write;m for other than spcelei surplus p
Accounts
From Separate Accounts Segregated Accounts and Protected Cell Accounts 0 Sarplus Notes
TOTALS $347,414,511 Gross paid in and contributed surplus $156,936,671
Urmtlgned funds(surplus; ($5,335,190)
Surp oar as regards policyholders $156,603,481
TOTALS $347,414,611
SUBSCRIBEDand swom to race thls 'day of
My comrresscn explrer_ -7-/U—/R'
Notary Public
cERTiRCATE
that Pri, ALYSSA TURKOVrrZ
ted Name
1 certify that the above financial statements to the bestof my Notary Public,State of New YorkNQ.01 Tusoa4514
knowledge are a true and accurate reflection of the flnarrclal ALYSSATUIiKOVRZ
condition in Westchester County
of the Company as of December 31,2014, '�ATf1fRi8-RKJfl�� IF
Additionally,I certify that the above financial statements are { •Z fir+ ja •y es July 10,2018
In agreement with the Statutory Financial Statements filed with the Trxas 'Nota:��QlG State of Newyork
Department of Insurance as of the same date, e
No.OITU6044514
William Gleeson Clualiled In Westchester County
$fes_yP_ PSE_tL Commission Expires July 10,2014
SUBDIVISION LABOR AND MATERIAL BOND
(GOVERNMENT CODE 66499.2)
Bond No. SUR21000023
Replaces Bond No. SUR20000324
KNOW ALL MEN BY THESE PRESENTS, that Pacific Paint Development Partners LLC
(hereafter designated as "Principal"), and Ironshore Indemnity Inc. ,
as Surety (hereinafter called "Surety") agree to install and complete certain designated
public improvements as conditioned by City Council Resolution No's. 92-6-16-4 and
03-09-16-06.
WHEREAS, said Principal is required to furnish a bond pursuant to Municipal
Code Section 9-5.101 and 9-5.109 et seq., for the faithful performance to guarantee
certain work, more particularly described as follows:
Landscape subdivision improvements within Tract 15687 as defined within Amendment#1 and
Reinstatement of the Subdivision Improvement Agreement for Tract 15687
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
Fifteen Thousand Seven Hundred Fifty Five Dollars and 001100 Dollars ($15,755-oo ) 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, shat
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
k�-�_ (NOTARIZATION AND SEAL)
By:
Its:
SURETY:
Ironshore Indemnity Inc.
(NOTARIZATION AND SEAL)
By: >
Margaret Einem , Attorney-in-Fact
Surety Phone No.
C/O WILLIS OF FLORIDA
4211 W BOY SCOUT BLVD,#1WD
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
i
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 ofAAd)
On before me, {
Late Here lokert Aorne and Title f 4 Officer x
personally appeared f4 Q
Name(s)of Signer(s)
a
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#2
Notary Public -California zz WITNESS my hand and official seal.
' Orange County
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
=S tie.Bill 10 0, �tri.eyids Sections .1$9 and 1195'_of';the:Glvil and ge(,.rOli 810 of thO
e ge t.Code; rebating t I iies:puk�liia: a.bel tvv jsbysical format Of
alae ri V disclosure
�vtZo ; s Rnexample;-far pis ses o f i1justrafzo
A MW' public of other offder doi4l�et1,n this,
verifies only the identity of the
individual who:signed,the dt Apipeiitio whiehft
certificate is attached,and not the trdthfidnessx
cci racy,or val dxty n that.do u
at
Stats of Caitifomia
_C.bunty of
i before-me, fid
'iiisert name and title of ofrwerj,personally OppeW#O the
prnve4 10 Xq oi)'thd'basiS.of Satisfactory-evidence to be't��..person(s)'.v�lxase iiaxrie(s}�sl�e sul?�crjbed t�
;tbd.WiNr'-fmtrurnent and acknowledged lo me- that h0she/they executed the,same_ in .l islher/their
#%,0tC sed .MPaaiiy0q), "d that:ny.IiS/hO0#7.epi,AWxat-We(s)On ase Itistruf hi the Verson(s),:ar the
�ti�tiiy tipoit.behalf of whiGi�tfie persor���,acted,.ei�ecutecl tFi�iristruinent
1, eit 'iitider PENAL'T "t l? F IUirw6ttoRXdat�e foriygoizi
'paragraph is true and correct
WITNESS my hAnd and..officaak sea[;
Sigtz>F Seal
r
ACKNOWLEDGEMENT BY SURETY
STATE OF FLORIDA
COUNTY OF HILLSBOROUGH I SS.
On this 19t`' 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.
R � f
Signature
Anett Cardinale
ANETT CARDINALE
s•; :.= Commission#FF 138482
z Expires July 28,2018
Bonded Thru Troy Feln Insurenoe 800385.7010
This area for Oficial Notarial Seal
POWEt OF All i]RIVEy
III- 21000023
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 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.
to KAL
` 14f9
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.
L TAYLOR
Notary Publlc-Stale of Tennessee
Davidson Cpukly
My GW+lfnlilw Expaaaal+G9.46 Amy L.7ay
`�"�;'ztouoaT•'`�,` 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 191h Day of May 20 15
qP Qfiit�i
fi
4 9f:h1
Y4fA
Paul S.Gi dano _ —
Secretary
'YARNING: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 tensa $63,582,066
Preferred stocks Reinsurance
0 payable on paid losses and lass adjustment expenses p
Common stocks 31,844141 Loss adjustment expenses
$10,311,1,957
Mortgage loansonrealestate:Rrsttens 0 Commissions payable,contingent commissions and othersknilarcharges $1,020,805
Mortgage loans on real estate;Otho than first liens 0 Other experues(excluding taxes.llcelues 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 Current federal and foreign Income taxes $1,434,392
Propertles heli for We 0 Net deferred rix Itabllity 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 preniiurtp payable(net of ceding commissions) $58,222,187
Other invested assets 0 Funds held by company under reinsurance treaties 0
Receivables for securities 0 Amounts Withheld orretained bycompanyforaccountofothers
Securities lending reinvested collateral assets 0 Remittances and Items not allocated
Aggregate write-ins for]nves[ed assets 0 Psion for reinsurance $1,545,075
Subtotals.cash and Invested assets $226,614,039 Net adjustments In assets and$abilities 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 $12,458,310
Uncollected prem ums and agents'balances in the course of collection $73,567,547 Derivatives
0
Deferred premiums,agents'balances and installments booked but deferred and not a
yet due Payable for securitles 0
Accrued retrospective prensiums 0 Payable for securities lending
0
Amounts recovenbte from reinsurers $33.586j257 UabWty for amounts held under uninsured pians 0
Funds held by or deposited with reinsured companies 0 /aggregate write-Iris for liabilities $4,185,928
Other amounts receivable under reinsurance contracts 0 Total liabilities excluding protected cell liabilities $190,a 11,131
Amounts rec*WWe relating to uninsured plans 0 Protected cep Ilabllitles
current federal and foreign Income tax recoverable and interest thereon 0
Net deterred tax asset $5,530,837 Total liabailitles
$190,811,131
Guaranty funds receivable or on deposit 0
Furniture and equipment,Including health are delivery assets 0 POUCYHOLDERYSSURPLUS
Net adjustment In assets and Ilabilides due to foreign exchange rates 0 Aggregate wnte-Ins for special surplus funds 0
Receivables from parent,subsidiaries and affiliates 0
Health are and other amounts receivable 0 Common capital stock S 000 000
Aggregate write-Insfor otherthanInvested assets $7,124,971 Preferred capital stock
Total assets excluding Separate Accounts,Segregated Accounts and Protected Cat $347,414,611
Aggregate wrltHrs for other than special surplus 0
Accounts
From Separate Accounts,Segregated Accounts and Protected Cell Accounts 0 Surplus Notes
TOTALS _ 5347,414,611 Gross paid In and eontrzbuted surplus $156,930,671
Unassigned funds(surplus, ($5,335,190)
Surp us as regards policyholders $156,603,481
TOTALS $347,414,611
s
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Notary Public
CERTIFICATE Priited Name ALYSSA TURKOVITZ
I certify that the above financial statements to the best of my Notary Public,State Of NOW York
knowledge are a true and accurate reflection of the finarrtlal A,LYSM TURKOVM No.01TU6044514
condition of the Company as of December 31,2014, r j jye-�❑ualfflye�,�d� illWestch-asterGofJfttjf
■J
Additionally,I certify that the above financial statements are �} /, QTrlfT-Iri9tfat�li n Expirea Jelly 10,2018
In agreement with the Statutory Flnanclal Statements fited with the Trxa< 'Natatblly Stain of New York '
Department of Insurance as of the same date, -
No.01TU6044514
William Gleason qualified In Westchester County
WQ4 VP LTr serer_ Coramissfon Explres Jury 10,2014