15-0505_Bond_SUR21000029_Pacific Point Dev_TR 16751 Premium: $2,637.00
SUBDIVISION FAITHFUL PERFORMANCE BOND
(GOVERNMENT CODE 66499.2)
Bond No. SUR21000029
Replaces Bond No.SUR20000336
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:
Street subdivision improvements within Tract 16751 as defined within Amendment#1 and
Reinstatement of the Subdivision Improvement Areement for Tract 16751
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
Three Hundred Fifty One Thousand Five Hundred Eighty Nine Dollars and 00/100 Dollars, ($351,589.00 ) 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 dayof 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: J1r1[ a r
SURETY:
Ironshore Indemnity Inc.
j — (NOTARIZATION AND SEAL)
Margaret . Ginem , Attorney-in-Fact
Surety Phone No.
Cb MLLIS OF(FLORIDA,
4211 W BCV SCOUT BLVD,#IWO
TAMNQUI I�S'(s13)28pzo95 Page 2 of 3
APPROVED AS TO FORM:
By:
NOTE: Please attach Acknowledgement and Power of Attorney
Page 3 of 3
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§1189
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the
document to which this certificate is attached,and not the truthfulness,accuracy,or validity of that document.
State of California )
Coun of )
On before me,
Dat
eh'�, 3 He Insert Name and l c� the Officerpersonally appeared -
Name(s)of Signer(s)
who proved to me on the basis of satisfactory evidence to be the person(s) whose narne(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
Id1his true and correct.
W.CORDI
Commission#2088325 WITNESS my hand and official seal.iik;7
Notary Public-California
' Orange County
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(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 official seal on
the date in this certificate first above written.
Signature
Anett Cardinale
.ti�Y+ ANETT CARDINALE
Commission#FF 238482
_ s= Expires July 28,2018
R,,, ` Bonded 7lru Troy Fan lnnjwKed003B5.1p1&
This area for Oficial Notarial Seal
'Seuat� Bill 10$0, �r'zex�ds:�`ectioris :x-189 sin .119$oVtbie:CIYI lade d recti 9- lZ of'tfie
Gbve a*CQk.relatingl#o notohes-pq6lii r-TYie:belp v-1 ys cal format of tti�rieav disclosure
-notice is.an exa nplee,,far pur�p ses f iIlaas#ra#riO�
A rinfa*.pti6hc off'ether Mi'der eoi ipldeting this
cerfifi�ateuetifies only the identity'fth
ind idual Who..s fined the de arpent,t a v i :tb3
.certificate.is atkached�and not-thetnithbiness,
AfArgy,0 VkWjty of tbaf:dci umeM
Siam of California
G�iunty�f •--- --
Qii before ine, .
ihsert name and title of officer j,'personally appWer3 w ho.
'prOV94 t�Xt�sil the bass of-satisfaettrzy-evidence td Lie`thtpersQn(s)Whose narrie(i)kl#b.siz4�cr'bedtji:
:flee within-risamnent -and acknowledged to mem'that helshdthey exeouted the.same .in .hislher/their
.1' ' paky(res), thatby.his/hOrAfi `ssWatr.pD.(, -on,�Ottufai� a V rsan(s), itr tie
entity tipoh.behalf of whiQh1k persons)acted,e.kegited tJieirist a xsent
I Corti fy'40der PENi4X.,'�' )F' V-rR,'URX'ti.nder t le Jaws pt the.Stawo,a Cal lfmxita°fihat the foxiego dg
para .mph is true and correct
WITNESS-iti.}+hAnd and.officRa-seal: r
Sigafuie (Sea]).
r
POWER OF ATTORNEY
III- 21000029
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
deliverfor,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
22"d 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 Dhector 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.
By:
Vane 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
.7 — near L TAYLOR
_ Notary Public-Slate of Tennessee
Davldson County% raa MY eummlxwrnn£+avast of.aa.s6 Amy L.ley
'r.; �,1•• Notary Pubac
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 20 15
f Af9
Paul S.& dano Y
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 mosses $63,582,066
Preferred stocks0 Reinsurance D e
yable on paid tosses and Inns adjustment expenses D
Common smocks 31,840,141 loss adjustment expenses
$10,384,957
Mortgage loans on real estate.tent Cent 0 Commissions payable,contingent eommhslons and other similar charges $1,020,805
Mortgage loans on real estate;Other than flrst liens 0 Other expenses(exgsrding taxes.licenses and fees) $5,435,126
Properties occupied by the company 0 Taxes,l causes and fees(exdudmg federal and foreign Income taxes) $2,383,909
Properties held for the production of Income 0 Current federal and foreign ksoome taxes $2,434,392
Properties held for sCe 0 Not deferred tar liability 0
Cash.cash equivalents and short-term Investments $15,632,951 Untamed premiums $29,158,576
Contract loans 0 Advance premium
Derlv;s Wes D Coded reinsu ance premiums pavobk(net of ceding commissions) $58,222,787
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
Aggregate write-Inv f0drivested assets 0 Provision for relnsuranc s $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 S..Charged off 0 Drafts oubtandbtg
Investment Income due and accrued $990,960 Payable to parent subsidiaries and affiliates
Uncollected prenr.umsand agents'balances inthe course ofcollection $73,567,547 Derivatives $12,458110
D
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 recovenhte 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 $4,185,928
Other amounts receivable under reinsurance contracts 0 Total liabilities excluding protected cell ItablUties $190,811,131
Amounts recelvahe relating to uninsured plans 0 Protected cell liabilities
current federal and foreign Income ox recoverable and interest thereon 0
Net deferred tax asset $5,530,837 Total liabilities
$190,81t,131
Guaranty funds receivable or on deposit 0
Furniture and equipment,Including health care delivery assets 0 POUCYHOLDEWS SURPLUS
Net adjustment In assets and liabilities due to fore gn exchange rates 0 Aggregate vette-Ins for special surplus funds 0
Receivables from parent,subsidiaries and of llllates 0
Health are and other a mounts receivable 0 Common apical stock 5000000
Aggregate write-Ins for otherthan Invested assets $7,124,971 Preferred aplblstock
Total assets excluding Separate Accounts,Segregated Accounts and Protected Cat $347,414,611
Accounts Aggrettetevrrtte nsforotherthanspecialsurplus 0
From Separate Accounts,Segregated Accounts and Protected Cell Accounts 0 Surplus Notes
TOTALS _ iy347 414,G11 Gross paid In and contributed surplus $156,938,671
Unassigned tunas fiurplus) ($5,335,190)
Surp us as regards pollcyholders $156,603,481
TOTALS $347,414,611
SUBSCRIBED and sworn to me ONsYday of
MYtammlfsenexpires ']` /0—/5,g'
Notary Public
r
CERTIFICATE r _ pn; ted Name ALYSSA TUAKOVITZ
I certify that the above financial statements to the bestof my iVotwy Public,State of New York4514
NO.01TU604
knowledge area true and accurate reflection of the Rnsoclal {LYSSA TURKO14 2 g1181If19d t Westchester C:ratlrTty
condition of the Company as of December 31,2014, .r /
Additionally,I certify that the above Manclal statements are , .-� I l e Y'7 J CUMMIBsiof'E EXOM July 10.2010
In agreement with the Statutory Financial Statements filed with theTexla Nota bllr:State of New York }
Department of insurance as of the same date, r'
No.02YU6044514
Wllllam.1Gleason Qualified In Westchester County
Q0.YPA_Tr!ZUVaL Coramisslon Expires July 10,2014
SUBDIVISION LABOR AND MATERIAL BOND
(GOVERNMENT CODE 66499.2)
Bond No. SUR21000029
Replaces Bond No.SUR20000336
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 subdivision improvements within Tract 16751 as defined within Amendment#1 and
Reinstatement of the Subdivision improvement A reement for Tract 16751
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
Three Hundred Fifty One Thousand Five Hundred Eighty Nine Dollars and 00/100 Dollars ($351,589.00 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
A (NOTARIZATION AND SEAL)
By: L�,�1
Its:
SURETY:
Ironshore Indemnity Inc.
(NOTARIZATION AND SEAL)
By: d_z'!'
Margar A. Ginem , Attorney-in-Fact
Surety Phone No.
G/C}VALLIS OF FLORIDA
>211 W,BOY SCOUT BLVD,#IWO Page 2 Of 3
TAMPA, FL 33607 J
EES UIRIFS.(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 kl� before me,
Date r Hara fns rt Narfle anWle heOfficer
personally appeared f
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.COR DI is true and correct.
Commission#2088325 Z WITNESS m hand and official seal.
.- Notary Public-California n y
z Orange County
My Comm.8x fires 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.NationaiNotary.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
ANETT CARDINALE
Commission#FF 138482
Expires July 28,2018
'�Rr;,.. ' bonded Trxu TnoyFeh Innuruicr •TPig
This area for Official Notarial Seal
debate 13ill 105.0, atnehds.gectious.1:180 ani �19� of tiie Civ ��ot�e and 8eCti�ii 920-of the
40Y,. C4'60'aej.telating-to not ries:pAbj,0 'The.lielip'v -mss ca7 format o e heW disclosure
notice-.is an exatnple; iEar purposes of iqustra m,
A hbt public ot other officer 60Wri Ipting this:
ceriifi�ate vetifies.only the identity cif the
individual who.sioie4 the do gineato whi6UIxis
certificate,is attached and not the trdthfulness�
cct rviay;cx vaizdity Of t.hat_ -ooumen't,
-8tap bfCalifornia
C.Qunty.df
Oh . .:before the, , -.—. -- fF►
ifisert name and title pfofficerj,persprkalIy appeamd
proved }hig o tb basis of satisfactory evidesxce to 6 tli persou(t;)whose riarne(s)is/$re su� jbei t
tie withiri instrument.and acknowledged -to me,'that beJshelthey executed "the same in. .his/her/their
author r i capacit-YOO), OW.that:t}y hislfier/ttzefr 4 # t s ' ,:fine"itistrura lit ire , tsop(s),.at the
entity tipbk behalf of w4ph'6e persari�§).aetieci;.ekdcuted ftinstrLdnent,
tiler PENALTY OV PEEt 1 AY tinder.tae ]awes 'of thie State off"dal,forma that't}►e fa*goiria
paragraph is true and correct
WUNESS*Y.hAM aiidoffi.clak seat,
Ss aturc (Sea)):
POWER OF ATTORNEY
III- 21000029
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 Attorneys)-In-Fact to make,execute,seal and
deliverfor,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.
U SEAL n 1
A 160
By:
Dane I.,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.
AMY L TAYLOry. + ,
Nolary
Pu
blla Slate of Tennessee 44 61'
Davidson tawny
Ay Com mission 2pm al.a8.18 Amy L,Tay]
Notary F"u611c
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 20 15
wv,�Oq�Zf
T 5£AL
1P]C
Paul S.61 darw
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
$179,149,947 Losses
$63,582,066
Preferred stocks 0 Reinsurance payable on paid losses and loss adjustment expenses D
Common stocks, 31,840,141 Loss adjustrnentexpenses $10,394,957
Mortgage loans on real estate:first gens 0 Commissions payable,contingent commissions and other similar charges $1,020"
Mortgage loans on real estate,Other than first liens 0 Other expenses(excluding taxes.licenses and fees) $5,435,126
Properties occupied by the company 0 Taxes,licenses and fen(excluding federal and foreign Income taxes) $2,383,909
Properties held for the production of income 0 Current federal and foreign income taxes
Properties held for We 0
$2,434,392
Net dalerrad tax liability 0
Cash.cash equivalents and short-term Investments $15,632,951 Unearned premiums
$29,158,576
Contract baro 0 Advance premium
Derivatives 0 Ceded reinsurance premiums payable(net of ceding commissions) $58,222,187
Other invested assets 0 Funds held by oompany under reinsurance treaties
0
Rccelvataesfor seturkkes 0 Amounts withheld orretelnedbycanpanyfor account ofothers
Securities lending reinvested collateral assets 0 Remittances and Items not allocated
Aggregate write-Insforinvestedassets 0 Provision for reinsurance
$1,545,075
Subtotals.cash and Invested assets $226,61039 Net adjustments In assets and Rabllltles due to foreign exchange rates
Ydle plants less S.,Charged off 0 Drafts outstanding
Investment Income due and accrued $990,960 Payable to parent,subsidiaries and affiliates
$12,158110
Uncollected premums and agents'balances In the course of collection $73,567,547 DldyitiYn
D
Deferred premiums,agents'balances and Installments booked but deferred and not 0
yet due Payable for securitles 0
Accrued retrospective prerrsums 0 Payable for securities lending
0
Amounts recoveake from reinsurer $33,586,257 LIablRty foramounts held under uninsured plans 0
Funds held by or deposited Mth reinsured companies 0 Aggregate write-Ira for liabilities
$4,185,929
Otter amounts receivable under reinsurance contracts 0 Total liabilities excluding protected cell liabilities $190,811,131
Arroultts reeeivake relating to uninsured plans 0 Protected cell liabllltles
Current federal and foreign income tax recoverable and interest thereon 0
Net deferred tax asset $5,530,837 Totalflablitles
$190,811,131
Guaranty funds receivable or on deposit D
Furniture and equipment,Including health are delivery assets 0 P000YHOLDE'RSSSURPLUS
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 are and other vmow a receivable 0 Common caotal stock
5,000,000
Aggregate wrHe4nsfor other than invested assets $7124,971 Preferred capital stock
Total assets excluding Separate Accounts;Segregated Accounts and Protected Cel $347,414,611
Aggregate wrlW.ro for other than special surplus 0
Accounts
From Separate Accounts-Segregated Accounts and Protected Cell Accounts 0 Surplus Notes
TOTALS $347-d1d,611 Gross paid In and $156,938,671
Unassigned funds(surplus; ($5,335,190)
Surp us as regards policyholders $156,603,481
TOTALS $347,414,611
S1185CR{Bf D and sworn tc ma ttds'��ay of M/��.�?(>f cy
` eA�/ � Mycomrrrlisenexptres 7./O-7S'
Notary Public
CERTIFICATE Printed Name ALYSSA TURKOVITZ
I certify that the above financial statements to the besto.f my Notary public,State of New YorkNQ,Q�TI,f���4
knowledgeareatrue and accurate reflectionoftheflnaicial ALYSSA'FUKKOVTl2 QL}�((((0�IFI 1TU6�afstt;rGC3�11Tty
condition of the Company as of December 31,2014, �' �/�
Additionally,I certify that the above financial statements are .ay^_ � y CrOTTifT08810n ExPirW July 10,201
In agreement with the Statutory Financial Statements filed vAth the Tezat H blh,Soto efNAw York
Department of Insurance as of the same date: c
No.O1TU6044514
WRllam 1 Gleeson Quallfled In Westchester County
.VP 8.Trete L Comrnlssion Expires July 10,2014