15-0505_Bond_SUR21000026_Pacific Point Dev_TR 16747 Premium: $6,581.00
SUBDIVISION FAITHFUL PERFORMANCE BOND
(GOVERNMENT CODE 66499.2)
Bond No. SUR21000026
Replaces Bond No. SUR20000326
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:
Street-Avenida California 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
Eiaht Hundred Seventy Seven Thousand Five Hundred Twenty Four Dollars and 00/100 Dollars, ($877,524.00 ) 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:
SURETY:
Ironshore Indemnity Inc.
K (NOTARIZATION AND SEAL)
By: 0,
Margaret/9Ginem , 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 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 r )
On f before mePhi ,
Date ( � He Na
le Insert me and TT# f th Officer
personally appeared ( V . V
Name(s)of Signer(s)
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) Ware
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
x WITNESS my hand and official seal.
+: Notary Public-California p
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(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
Setat .B 11 I0 :0, amejU S`ectiori8-1 l80 bbd. 195:ofihe:G#Yil.C011d,U4 S.Wiifi 820 of'the'
QbVemtna.Code, ie4ating-to not ries,pjbjib_"T iz :!ielow.#ysical format of the. n&W disclosii e
wtice is=a3a examplei foof iltustxatja�a;
rid-_ pt�tilic of other vffiaei coil piogym tis
cerfifi•tmte verities only t-bo idi ntity of the
indivi4uA Who,signed,the dou`oxneut tai wh Chtl�i
certificateis attached,and act the truthfulness§
�Icowy,vt vw4y of thaf:�oeunient_
State of c'ihfornia
,County df
oil .,before Tne,
-ii,sert narrxe'andtitle of'officer3a personally appmed alto'
gro;ue4 to Xif ori th .bos,is.of satisfactory-evidgxi�d to fae'thkperson(t)Whosq riam4s)is/4re Sul�crjliei to
.th& lF Atari;ijistruruent.and acknowledged to me• that°heishefthey executed the,samc: in his/her/their.
�pz—etl OpacitYCAP�)> 000 that.by�isll er/th* siPatur'e(s) .On the iastmfto t rhe pasbn(s),: or the
metttity� .behalf of which t6b ote'sbf(s),acted,.ek6ciited tb&'instrumi!ntr
I..4i-f +'Ubder 1'ENAi.'l'4'4F'I'l WURY*ider Ibe lawns oft e_Stiit 4" litfoiiva that the fairpgas g.
par,aph is true and corma
WITNESS rii:}+Mnd and official-sear;
Signature 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
'r• r ANETT CARDINALS
Commission#FF 138482
Expires July 28,2018
804d 7hru T*y F&rumnce@G4,'18sT03D
This area for Official Notarial Seal
POWER OF ATTORNEY
Ironshore Indemnity Inc. III- 21000026
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 ofIRONSHORE 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,maybe 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.
X54 ipaA�
,91'1
By:
Dane L.Suss n
Director
ACKNOWLEDGEMENT
On this 7th Day of August,2013,before me,personally came Daniel L.Sussman to me known,who being duly sworn,did depose and say that he is the
Director of Ironshore Indemnity, Inc.,the corporation described in and which executed the above instrument;that he executed said instrument on
behalf of the corporation by authority of his office under the By-laws of said corporation.
x .!L
•�+,' AMV L TAYLOR
Notary Public-State of Tennessee f t V
Davidson County
My Commission i'"
Amy L.Tay.
+�'•+;,,mow 4m"�,'.•`',• 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 191h Day of May20 15
p4.
yS9L, J
r
Paul S.Gi dam
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 INDEMNITY INC
FINANCIAL STATEMENT SUMMARY
As of December 31,2014
ASSETS
LIABILITIES
Oonds
$179,140,947 Losses
$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:#Int tens 0 Commissions payable,oontin8ent commissions and other similar charges $1,020,805
Mortgage loans on real estate;other than first Ilern 0 Other experaa(excluding taxes.licenses and fees( $5,435,126
Properties occupied by the company 0 Taxes,licenses and few.(exdudmg federal and foreign income taxa) $2,383,909
Properties held for the production of income 0 Current federal and foreign Income taxes $2,434,392
Properties held for sa'e 0 Net deferred tax liability 0
Cash,rash equivalents and short-term Investments $15,632,951 Unearned premiums $29,158,576
Contract loans 0 Advance premium
Derivatives 0 Ceded reinsurance premiums Payable(net of ceding commissions) $58,224187
Other invested assets 0 Funds held by company under relnsurarrcetreatles 0
Receivables for securities 0 Amounts withheld or retained by company for accountof others
Securities lending reinvested collateral assets 0 Remittances and Items not allocated
Aggregate write-Ins forinvestedassets 0 Provisionforrelnsurance $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
$12,458,110
Uncollected prerrsumsand agants'balancesInthe course ofcollectton $73,567,547 Derivatives
0
Deterred premiums,agents'balances and Installments booked but deferred and not 0 for or securkla
yetdue 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 reirsuredcompanies 0 Aggregate write-Ins for liabilities $4,185,928
Other amounts receivable under reinsurance contracts 0 Total liabilities excluding protected call liabilities $190,11L131
Amounts neceivab;e relating to unlrsured 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 depasR 0
Furniture andequlpmerdt Including health core delivery assets 0 POUC(NOLDERS`SSURPLUS
Net adjustment In assets and liabilities due to fordgn exchange rata 0 Aggregate wnte-Ins for special surplus funds
0
Receivables from parent,subsldiades and affiliates 0
Health are ami other amounts receivable 0 Common capital stock 5,000,000
Aggregate write-ins for other than invested assists $7,124,971 Preferred capital stock
Total assets excluding Separate Accounts,Segregated Accounts and Protected Cat, $347,414,511
Aggregate wrltt res for other than special surplus 0
Accounts
From Separate Accounts.Segregated Accounts and Protected Cell Accounts 0 Surplus Notes
TOTALS ,$.14.611 Gross paid In and contributed surplus $155,938,671
Unassigned funds surplus; ($5,335,190)
Suri us as regards policyholders $156,603,481
TOTALS .f�1 $347,414,611
°-URSCRI110and sworn inmetivsy'��*ay ofM/�y.
s Mycommiss nem{ares 7 AL1 e
Notary Public
CERTIFICATE + Mited Name ALYSSA TURKOVfTZ
I certify that the above financial statements to the bestof my Notary Public,Stine Of New York
knowledge are a true and accurate reflection of the Rnandal ALYSMTUXKOVrFZ _ No.01TU6044514
condition of tlreCompany as of December 31,2014, ,f' ` I— tl41$l�ed h WeStS' MSter C43UMY
Additionally,I certify that the above financial statements are �'�,�.> .- r.OTflf1'i}8$it�fy i4,cplf�9 � 10.X018
in agreement with the Statutory Financial Statements filed with the Tomas Notary F uh114 Stale of New York
Department of Insurance as of the same date, r x
No.01TU6WS14
WNLiam J Gleason Qualified In Wastchestar County
MVP all TrUW.CL Commission E
xpdra]uly 10,2014
SUBDIVISION LABOR AND MATERIAL BOND
(GOVERNMENT CODE 66499.2)
Bond No. SUR21000026
Replaces Bond No. SUR20000326
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:
Street-Avenida California 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
Elpht Hundred Seventy Seven Thousand Five Hundred Twenty Foc ur Dollars and oolloo Dollars ($877,524.00 ) 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: s "%r' �a hoc
SURETY:
Ironshore Indemnity Inc.
(NOTARIZATION AND SEAL)
By: .
Aue�
Margare . Ginem , Attorney-in-Fact
Surety Phone No.
C/O WILLIS OF FLORIDA
4211 W.BOY SCOUT BLVD,#1000 Page 2 of 3
TAMPA, FL 33607 g
INQUIRIES:(813)281-2095
APPROVED AS TO FORM:
By:
NOTE: Please attach Acknowledgement and Power of Attorney
Page 3 of 3
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§1189
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the
document to which this certificate is attached,and not the truthfulness,accuracy,or validity of that document.
State of California )
County )
On before me,
£]ate He Insert Name and Title of Officer
personally appeared Phi 1 V
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. CORDI
Commission 0 2088325 WITNESS my hand and official seal.
z -` Notary Public-California x
x ' Orange County
My Cornet.Ex lyes Oct 31,2018+ Signature K&d/'
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:
YP 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
Seiiat -B11 105.0, ameis:Sectiarrs: 1189 ani X95:q ttie Gi�tinecie�tio' 82 of tlYd
Cr4 �rta4o*.Cvde; fel tingtb otoV`e .pu li _' e, l `w ys cal format-of hdw disclosure
noticeis_a.n example-, for puyases of igustratiarL.
A 04ty ptiWc of other 6ff6r 6*pleting thf_s�
d:er}f&ate verifies only the identity'ofthe
individual,viha signed.the dbNtnwit-to whiefift
certificate,is atia6hed,and not the truth'fulnessx
acc;raty,bt v4l 4y til"bat-do(umew.
Sfad of California.
.C.6=ty.of
on before rhe, e
ib-Sert name and,title ofOf mer),Person"y ap.P=64 who'.
Prn:ued tp M�on the basis,of satisfactbty evidots— tot 'persori(�7 Whose iiame(s)zs/ire su>; crjbe t
'the-w.i ilf-instrurment:and aoknow edged to me that=helshe/they executed the same-.in.His/her/their,
authpized' apacity(ids), 40 that by Iis]lierd.eirr`slpatz ve(s) On.the uistrum�nt the tersbil(s),-C&tiie
'entity G.Pbk�ehalf of hich tfie pefsbb(s)acted,ekecjAe'd.the instr=bnt
I:4ifify v idler PENAT,T Y QF.P.jR0.RY'finder alae Jaws of t e to of,Califs mia fiat the furtegozzf
pararaph is true an&correc
VTNES9-*band ai d.,6ffiicaak sesF:
Si.grtatuce. Seal
r
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.
v
Signature
Anett Cardinale
ANETT CARDINALE
Commission#FF 138482
€ Expires July 28,2018
Bonded Thru Troy Fein Ineurenoe B043B5.7019
This area for Oficial Notarial Seal
POWER OF Aid OR�EEY
Ironshore Indemnity Inc. III- 21000026
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.
Tdhis 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 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 seated 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.
y nPr
� Aa.
SERI,
fpf5 ,
f
By:
Dane L�Sus n
Director
ACKNOWLEDGEMENT
On this 7"'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 tronshore 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.
TAt•.,
- Al-0Y L.T�TLOR f
_ — Notary Public-Stale of Tennessee
- ^" _ Davidson County
'•,,q,'- lay Cammseanm EXpaa9r at.0g-ra Amy L.Ta`
'•;1,,�•',+;',r*`` Notary Public
CERTIFICATE
I, the undersigned, Secretary of IRONSHORE INDEMNITY INC., a Minnesota Company, DO HEREBY CERTIFY that the original Power of Attorney of
which the foregoing is a true and correct copy,is in full force and effect and has not been revoked and the resolutions as set forth are now in force.
Signed and Sealed at this 19th Day of May Zp 15
,p r
sear
silts 1
1
Paul s.Gi danp __
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
UABIUTIES
Bonds
$179,140,947 tosses
$63,582,066
Preferred stocks
p Reinsurance payable on paid lasses and Inss adjustment expenses
Common stocks 0
31,940,141 Loss adjustment expenses $10,384,957
Mortgage loans on real estate:First kens 0 Commissions payable.oontingentcommlmlonsand other similar charges $1,020,805
Mortgage loans on real estate,Other than first liens 0 Other expenses(Wmding taxes.licenses and fees) $5,435,126
Properties occupied by the company 0 Taxa,licenses and foes(excluding federal and foreign Income taxes) $2,383,909
Properties held for the production Of!ncome 0 Current federal and foreign Inoome taxes $2,434,392
Properties held for sale 0 Net deferred tax liability 0
Cash.cash equivalents and short-term investments $15,632,951 Unearned premiums $29,158,576
Contract loans 0 Advance premium
Derivatives 0 Ceded reinsurance premiums payable(net of ceding commissions) $58,222,187
Other invested assets 0 Funds bald by company under reinsurance treaties
0
Receivables for securities 0 Amounts withheld or retained by company for accountefothers
securities Icnding reinvested celhtera'assets 0 Remittances and Items not allocated
Aggregate write-Ins for4nvested 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 aocrued $990,960 Payable to parent,subsidiaries and affiliates
$12,458e 110
Uncollected prerd urns and agents'balancesIn the course of collection $73,567,547 Derivatives
0
Deferred premiums,agents'balances and Installments booked but deferred and not 0
yetdue Payable for securities 0
Accrued retrospective premiums 0 Payable for securities lending 0
Amounts recoverabiefrom minsurers $33.586,257 Liablllty for amounts 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 liabilities excluding protected cell liabilities $190,811,131
Amounts receivaNe relating to uninsured plans 0 Protected cell liabilities
Current federal and foreign income tax reomrable 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 health are delivery assets 0 POUCYHOLDEWS SURPLUS
Net adjustment In assets and liabilities due to foregn exchange rates 0 Aggregate wnto-lns for special surplus funds 0
Receivables from parent,subsidiaries and affiliates 0
Health are and other a mounts receivable 0 Common a0tal stock 51000,000
Aggregate wrtte-Ins for other than Invested assets $7,124,971 Preferred appal stock
Total assets excluding Separate Accounts,Segregated Accounts and Protected Cat $347,414,611
Accounts Aggregate write-ins for other than special surplus 0
From Separate Accounts.Segregated Accounts and Protected Cell Aocounts 0 Surplus Notes
TOTALS $347 414 611 Gross paid In and coMr4buted surplus
$156,938,671
Unassigned funds(surplusl ($5,335,190)
Surp`us as regards policyholders $156,603,481
TOTALS ,.y� $347,414,611
SUBSg138ED and sworn to me this 'rday of Jy}f yt 'Gr%rj
MY 1nmrr4tY.0 n expires 7•/,V-I 11g
Notary Public
CERTIFICATE Printed Name ALYSSA TURKOVITZ
I certHy that the above financial statements to the bestof my Notary Public,State of Now Yb*
knowledge ate a true and accurate reflection of the finantlal ALYSSA TURI CNM No.017116044514
condition of the Company as of December 31,2014, r Qu$iiflod In Westchester C;our11y
Additionally,1 certify that the above financial statements are Comm Halon Expires July 10.2010
In agreement with the Statutory Financlal Statements filed with the Texas 'Nobst,lRrblle,State of New yolk
Department of Insurance as of the same date.
No•OITU6044514
WNHam J Gleason QuallBed In Westchester County
M. of Ttlurer Commission E
xplres July 10,2014