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15-0505_Bond_SUR21000028_Pacific Point Dev_TR 15687 Premium: $4,966.00 SUBDIVISION FAITHFUL PERFORMANCE BOND (GOVERNMENT CODE 66499.2) Bond No. SUR21000028 Replaces Bond No. SUR20000325 KNOW ALL MEN BY THESE PRESENTS, that Pacific Point development Partners LLQ (hereafter designated as "Principal"), and Ironshore indemnity Inc. , as Surety (hereinafter called "Surety") agree to install and complete certain designated public improvements as conditioned by City Council Resolution No's. 92-6-16-4 and 03-09-16-06. WHEREAS, said Principal is required to furnish a bond pursuant to Municipal Code Section 9-5.101 and 9-5.109 et seq., for the faithful performance to guarantee certain work, more particularly described as follows: Grading (Lot 1; School Site) 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 Six Hundred Sixty Two Thousand One Hundred Forty Six Dollars and 001100 Dollars, ($662,146.00 ) 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: NJ �vklno r: C r..c -ate SURETY: Ironshore Indemnity Inc. (NOTARIZATION AND SEAL) By: hawj&,-4 - ,", MargarefA. Ginem , Attorney-in-Fact Surety Phone No. C/O WILLIS OF FLORIDA 4211 W.Boy SCOUT BLVD,#,Wj TAMPA, FL 33601 Page 2 of 3 INQUIRIES:(813)281-2995 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 1 On ai 1W before me, i D to Here se Name and 77 of he Officer personally appeared M Name(s)of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) Is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies),and that by his/her/their signature(s)on the instrument the person(s), or the entity upon behalf of which the person(s)acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph W.CORDI is true and correct. ��� Commission #2088325 Z -er Notary Public California WITNESS my hand and official seal. Orange County UET4� M 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.NationaiNotary.org - 1-800-US NOTARY(1-800-876-6827) Item#5907 Si abatODUI 1050, ar e id's:Sections 1.1$9 W 119$ `of°the:d' Code aad Sea* Oft of the �xb(�ei�tat.�ae. eaflntcgtaes-pr�fii : Tie kiI �wysica7 format oti rices sq. YLofice;is exa pple,,for pur .ose c igus#rat u icftatyptsilic of other vffsscr coinpLetinb this; certificate vetifits only the identity of the individual who-signed,the dacuinerit.to which tis .certificate-is attached,and not-the truth ness, Aoctdy,O•validity pf that,dbuiexit 8-*gf California. .Aunty bf Oil ;b�fre Vie, o 'ibsert name and'title of'Officerj,personalty appeared Who roved�O A9 oil the basis,of atisfaqtory,evid6nO to "erso l whose name(s) asl re.sul sed be4 t t7ie Wi h .4nstrumentand acknowledged -to me- that;helshe/they executed the.same:.in .hisllier/their a tl rir i, eapaczty es), grid t 14t;4y i iS/horltheir'si 'q the uistrufn i►t the etsbn(s),:or the �edtityllpoh.behalf ofwhIch-t6 06ftri(�).acted,ekec�dtedtji& nstruruent, ,eiti 'iiljder PEN;ALTXOV PRY under-Jlae laws of te.State<of California t fvriegois g paragraph is true and-correO WITNESS my hAnd and oftleiak seal, � xgpattir.�, (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 . `• 'lYR, ANETI'CARDINALE COMMIssipn#FF 138482 Qs Expires July 28,2078 i' P iyg° BMOQ,rIV„rfm P�IrAMWA 8*'M&70%9 This area for Oficial Notarial Seal DOWER DF ATTQRNEY Ironshore Indemnity Inc. III- 21000028 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-ln-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 itis 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. Stu �snal By: mane 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. _ AMY L.TAYLOR Nolery Public-Slale of Tennessee + + : ca,ldson Count' Am L Ta - a: ,� My Commission Expires 0109-16 Y Y ,';, +#:*F• 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 arT^eye seed_ i Paul S. 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." IRONSHORE INDEMNITY INC FINANCIAL STATEMENT SUMMARY As of December 31,2014 ASSETS LIABILITIES Bonds $179,140,_947 mases $63,582,066 Preferred stocks p Relmurantt payable on paid bases and loss adjustment expenses Common stocks 0 31,840 141 Loss adjustment expenses $10,384,957 Mortgaileloans onreal estatcnrsttens 0 Cpmmisslonspayable,contingent aommissiassand othersimilarcharges $1,020" Mortgage loans on real estate;Other than first liens 0 Other expenses(excluding taxes.Ilcenses and fees) $5,435,126 Properties occupied by the company 0 Taxes,licenses and fees(excluding federal and foreign Income taxes) $2,383,909 Properties held for the production of Inoome 0 Current federal and foreign inoome taxes $2,434,392 Propertles held for We 0 Net deferred tax liability 0 Cash.cash equivalents and short-term Investments $15,632,951 Unearned premiums $29,158,576 Contract bars 0 Advance premium Derivatives D Coded reinsurance premiumsPayable(net o/ceding commisslons) $58,222,197 Other invested assets D 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 Aggregatewrlte-Ins for invested assets 0 Provision for reinsurance $1,545,075 Subtotals.cash and Invested assets $226,614,039 Net adjustments Inassets and tabllttles due to foreign exchange rates Tide plants less$...Charged off 0 Drafts outstanding Investment Income due and accrued $990,960 Payable to parent,subsidiaries and aNlllates $12,458110 Uncollected prem ums and agents'balances In the course of collection $73,567,547 Derivative D Deferred premiums,agents'balances and Installments booked but deferred arra!not 0 for or securities yetdue 0 Accrued retrospective premiums 0 Payable for securities lending 0 Amounts recovembfehomreinsurers $33,586,257 Liability for amounts held under uninsured plans 0 Funds held by or deposited with reinsured companies 0 Aggregate write-les for Ilabllttles $4,185,928 Other amounts receivable under reinsurance contracts 0 Total liabilities excluding protected cell Nabllldes $190,811,131 Amounts receWb:erelating touninsured plans 0 Protected cell liabilities Current federal and foreign income tax recoverable and interest thereon 0 Net deferred tax asset $5,530,837 Total Nab9lhles $190,811,131 Guaranty funds receivableor on deposit 0 Furniture and equipmeK Including health core delivery assets 0 POUCYHOLDEWS SURPLUS Net adjustment In assets and liabilities due to foregn exchange rates 0 Aggregate wnte-Ins for speclal surplus funds 0 Receivables from parent,subsidiaries and affiliates 0 Health care and other a mounts receivable 0 Common orytal stock 5 0D0 000 Aggregate wrttedns for other than Invested assets $7,124,971 Preferred capital stock Total assets excluding Separate Accounts,Segregated Accounts and Protected Cel $347,414,511 Aggregate vretenrss for other than special surplus p Accounts From Separate Accounts.Segregated Accounts and Protected Cell Accounts 0 Surplus Notes TOTALS $347,414,611Gross paid In and contributed surplus $156,938,671 Unassigned funds(surplus; ($5,336,190) Surp us as regards Policyholders $156,603,481 TOTALS $347,414,611 SUBSCRIBED and swam to me ttls'y`day of H f j! 1,0 f S �� .'s. � ,� My commiss.�:n expires: �•!�r�.SS ��„..._ Notarypublic CERTIFICATE PriRkd Name Notary State of New Yo* I certify that the above financial nanclal statements to the bestof my knowledge are a true and accurate rellectlon of the financial ALYSSA TU RKOV"Z No.01 TU6044514 condition of the Company as of December 91,2014, Ouallf ed In Vlfe5tchewer Cour11Y Additionally,I certify that the above financial statements are Y n frA CiC1)17J Oft&9[r"JUlY 10,,20`18 In agreement with the Statutory Financial Statements filed with tho Texas 'N 1513r,$lata of New York Department of Insurance as of the same date, No.02TU6044514 WH Ilam J Gleason Quallfled In Westchester County Q9 Yl>&TregsVr-CL Contrrlssion Expires July 30,2014 SUBDIVISION LABOR AND MATERIAL BOND (GOVERNMENT CODE 66499.2) Bond No. SUR21000028 Replaces Bond No. SUR20000325 KNOW ALL MEN BY THESE PRESENTS, that Pacific Point Development Partners, LLC (hereafter designated as "Principal"), and Ironstiore Indemnity Inc. T— as Surety (hereinafter called "Surety") agree to install and complete certain designated public improvements as conditioned by City Council Resolution No's. 92-6-16-4 and 03-09-16-06. WHEREAS, said Principal is required to furnish a bond pursuant to Municipal Code Section 9-5.101 and 9-5.109 et seq., for the faithful performance to guarantee certain work, more particularly described as follows: Grading Lot 1; School Site) 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 Six Hundred Sixty Two Thousand One Hundred Forty Six Dollars and o0/loo Dollars ($662,146.00 ) 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) Its: SURETY: Ironshore Indemnity Inc. (NOTARIZATION AND SEAL) By: Margare'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 California ) County of ) On Ij before me, He nse Name and rtle o e Officer 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 capaclty(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. -�i Notary Public-California a z 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: i ©2014 National Notary Association • www.NationalNotary.org • 1-800-US NOTARY(1-800-876-6827) Item#5907 e td till I105 muenes._Sections 11189 b4ia :1195:0f*d:OVILOY&'mid 8e04oti 8.90 -of the C .1!e ei .CoOe-; eat ng Q nQi�a�rites,ptl lit<: 'I"tTe:l el wir }ays cal format of t}ie t ei digolbsure uoteq.is-44exa�ApIL,,,fgrpwraoses -fi0tisiratmL- notary pubic a other olicel cciixaIeting#t ; cerfifieate verifies only the identity of the individua.i vvha signed the do u ffineri#. zvhi I t Cetcate Is attached,and not the trLitlAwnessi }r,ciira.ey,o'T pial gy of fhal',do�urrimt Std'of- aldornia. .6unty.of Can _ befire Tne, e 'ibsert naive snit title of afficer5, ersanal]Y aPP Bd wh,o grnVPd t0 taaj or1-tho basis,ofsatisfkaory.evidence to#ie'ih pe Qri[ ) Whoseiianie(s)' si re suti ribed tci: 'the-within irisatrument and acknowledged to me- that helshelihey executed the.samt. in his/her/their. authrietl cavity( ), "d .164t:ly,]xisliierl'th ':� iate{s) .the.'ut'strutnat theersan(s),;lira futity behalf of wlii�h tlii;persbr{s acfed,,eaeuted tTie znstruruent �; eit y'u�ider PENAL'I' `C?F T-RY'iiridor the Ia'ws of t�e.�Utef.of Ujforhia haat the fAi�geirfg paragraph is true anil'correcf WTIFNESS mi Band and.affiaia .seat, 'Si.gnatxit� .. .. 4Sea1�. 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 ANET cr° Y£bt Commiss on#IFF 138482 , •'4 Expires July 28,2018 Bonded Truu Troy Fein Inver—000.3&x7019 This area for Oficial Notarial Seal POWER OF ATTORNEY Ironshore Indemnity Inc. III- 21000028 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 3 SEAL e..7918. By: Dane 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. .*ry4.*wxg9� - 4 L.TAYLDiR ,1 _ Notery Public-6lele of Tennessee i+�• My Commission Expka OT-08-16 AMY LT" I��'`�%y,,,,' i• NotaryPubAc 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 2nd has not been revoked and the resolutions as set Forth are now in force. Signed and Sealed at this 191h Day of May20 15 f`SEAL"F' 1919 Paul S.G1 rlana - —�� 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 WC FINANCIAL STATEMENT SUMMARY At of December 31,2014 ASSETS _ LIABILITIES Bonds $179,140,947 Aa s $63,582,066 Preferred stacks 0 Reinsurance payable on paid losses and loss Common stocks adjushnmt expenses 0 31,840,141 Loss adjustment expenses $10,384,957 Mortgage loans on real estate.Fust kens 0 Commissions payable,contingent commissions and othersimRar charges $1,020,80S Mortgage Irons on real estate;Other than first liens 0 Other expergas(excluding taxes.Runes and fees) $5,435,126 Properties occupied by the company 0 Taxes licenses and fees(exdudahg federal and foreign Income taxes) $2,383,909 Properties held for the production of Income 0 Current federal and foreign Income fixes Properties held for We 0 Net deferred tax liability $2,434,392 (ash,ash equivalents and short-term investments $15,6321.951 Unearned premiums 0 Contract loans $29,158,576 0 Advance premium Derivatives 0 Ceded reinsurance premiums payable(net of ceding commissions) Other unrested assets $58,222,187 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 write-Ins forinvested assets 0 Provision for reinsurance $1,545,075 Subtotals.cash and Invested assets $226,614,039 Net adjustments In assets and liabilities due to foreign exchange rates Title plants less$..;Charged off 0 Drafts oubtanding Investment Income due and accrued $99060 Payable to parent,subsidiaries and offillates Uncollected prent ums and agents'balances in the course of collection $73,567,547Derivative: $12,458,110 Deferredremlum 0 p s<aged'balances and Installments booked but defamed and not 0 Payable for securitiesyet due D Accrued retrospective premimms 0 Payable for securities lending 0 Amounts recovenbie 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 $4,185,929 Other amounts receivable under reinsurance contracts o Total liabilities excluding protected cell llabiftles $190 811131 Amounts receivab a 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 TotatBabilRies $190,811,131 Guaranty funds receivable or on deport 0 Furniture and equipment,Including health are delivery assets 0 POLJCY140LDEWSSURPLUS Net adjustment In assets and liabilities due to foregn exchange rates 0 Aggregate wnte-Ins for special surplus funds Receivables from parent subsidiaries and affiliates 0 0 Health are and other amounts receivable 0 Common erytal stock 5,000,0D0 000 0D0 Aggregate write-Ins for other than Invested assets $7124,971 Preferred capital stock Total assets excluding Separate Accounts,Segregated Accounts and Protected Cel, $347,414,511 Aggregate write:n for other than special surplus Accounts 0 From Separate Accounts,Segregated Accounts and Protected Cell Accounts 0 Surplus Notes TOTALS Gross aid In and contributed surplus $347,414jG11 p $156,938,671 Unassigned funds isurplusl ($513351190) Surp`ur as regards policyholders $156,603,481 TOTALS $347,414,611 SUBSCR1BEDandswomtomethisyday ofHq4 /' ,� --►. ry MY anmmlise.a eslxres: I'v-ILf—/S,r !-ti.._.__ Notary Public CERTIFICATE r Printed Name ALYSSA TURKOVIIZ I certify that the above financial statements tothebestof my Notuy Public,State Of New York knowledge are atrue and accurate reflection ofthe0nanclal ALYr ATuAKOVrrz NO.OITLt6044$14 condition of the Company as of December 31,2014,Addy C}tJelitiBd In Westchester{�+otJ(Itt( InagrenaentwItlly,I hthefy htaat ttroryFina above Financialnancial msfiledents f. , ,,�� ifs � Commit JUi�,t0.r20t8 M agreement with the Statutory Flnanclal Statements filed with the,Texas �NObap� bl lc,Stan Of New York `? Department of Insurance as of the same date, No.01TU6WS14 William J Gleason Qualified In Westchester County MP Ttm Sf Commission Expires July 10,2014