15-0505_Bond_SUR21000030_Pacific Point Dev_TR 16751 Premium: $225.00
SUBDIVISION FAITHFUL PERFORMANCE BOND
(GOVERNMENT CODE 66499.2)
Bond No. SUR21000030
Replaces Bond No.SUR20000337
KNOW ALL MEN BY THESE PRESENTS, that Pacific Point Development Partners,LLC
(hereafter designated as "Principal"), and Ironshore Indemni 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:
Storm Drain subdivision im rovements within Tract 16751 as defined within Amendment#1 and
Reinstatement of the Subdivision improvement Agreement 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
Eighteen Thousand Seven Hundred Ninety Dollars and 00/100 Dollars, ($1$,790,00 ) 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: _S.
Its: �� �
SURETY:
Ironshore Indemnity Inc.
(NOTARIZATION AND SEAL)
Margare . 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 t. s--certificate_is-attached,-and_not..the_truthfulness,-accuracy,v--validity-of-that-,decument.
State of California )
County of )
On before me, J j
Dae ere Insert Name an' tie of the Officer
personally appeared _ U'
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 sante in
his/her/their authorized capacity(ies),and that by his/her/their signature(s)an 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 OI is true and correct.
Commisslon N 2088325 WITNESS m hand and official seal.
a _-m Notary Public-California a y
Z ° Orange County
My Comm.Ex €res 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:
e�—'."�iA rarrxx>rarrra•.��im�awp�'{ i.ayCRrr1i�'SFzr✓nsF��y��ls^d�..,{�n-'�'�-ll� R-a�/i*- Z�rl�ayri-.,q..
02014 National Notary Association •www.NationalNotary.org • 1-800-US NOTARY(1-800-876-6827) Item#5907
ACKNOWLEDGEMENT BY SURETY
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 CARDINALS
Commission#FF 138482
's Expires July 28,2018
Bonded Thor Troy Feln Inournnco BM385-7018
This area for Official Notarial Seal
�4xi��e ,Code;ielafzz�,�•to�Q ;ie�:�uis�icr.'I'kie,bel�'`wysca�,format o�"t}e��r:disclosure
Mice, s..an example; for pm. qs ofMUSIratio-ri<
A hot.ayt pli Iic of other officer 6oi#Ming til$;,
certificate verifies oniythe identity of the
indEyidual who.'sigtted the dQ,t�ixie'it.ta wEi d)i
certifioate.is attached,and not the truthfulness,
acciira, y,or VaMity ofthat.doeuuimt.
Sf.�te p�(�alifornia.
¢unty.of
Oii_ _ . . :befard rne, '
•insert name and title dfofficerj,,personally app=ed b
provcd tO W oil'the basis of satisfactory.ey[dertce to th:i:E,persan{s}yhose nanie(s}isles sulzscr�6e to
fbe w.9t1'tiri -instrument and acknowledged to .mc•'that:hexshe/they ex=uted alae.same:'Iii hislherltheir-
au#lira zed ci Gl.yZio),.Arid that,by �islfier/thgW`4pa. te( the t.erson(s),:'oir the,
,entity uponbehalf ofw3aich tiie persons),actedl,.cxecAedtFi&7instruraaent.
1; cit y itrider P£NAT,`!' OP ;Pl~12JE.lRY tirider alae laws of fide. ti to of Cali orn' that thie far(egoir>
paragpph is true and,correct
n_
WITNESS Tin,06nd aiad.official seal,
Sigrtattire 4Sea1�
POWER OF ATTORNEY
III- 21000030
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
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-Pact to execute on behalf of the Company any bonds,undertakings,policies,contracts of indemnity or other writings obligatory
aturl"If-&-bond-riot to exceed S 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 shali,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.
a�Ay*,r tM'`s
it`ts5AL F{'
sale
By:
Dane 1,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
Notary Public-Slate of Tennessee
= Davidson County Am L.Tayl
My Commission Expires 0109-16 k
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 asset forth are now in force.
Signed and Sealed at this 19th Day of,May20 15
�44pvoy�:3,
6F'AL
141$
Paul S.GI dano r
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 INC
FINANCIAL STATEMENT SUMMARY
As of December 31,2014
ASSETS LIABILITIES
Bonds
$179,140,947 losses $63,582,066
Preferred stocksReinsurance
0 Payable on paid lasses and bis adjustment expenses 0
Gammon stocks 31,840,141 loss adjustment expenses
$10,384,957
Mortgafeloans onreal estata•.first kens 0 Commissions payable,cortinllentaommisslwss and other similar charges $1,020,805
Mortgage loans on real estate;Other than first Hens 0 Other expenses(exchsdnsg taxes,licenses and fees) $5,435,126
Properties occupied by the company 0 Tues,licenses and fees(exdudmg federal and foreign Income taxes) $2383
Peope es held for the producWn 61 Income 0 Curtent federal and forelgn Income taxes $2,434,392
Properties held for sale 0 Net deferred tax liability
0
Cash.cash equhalents and short-term investment $15,632,951 Unearned premiums
$29,158,576
Contract bans 0 Advance premium
Derivatives 0 Ceded reinsurance premiurm Payable(net of ceding commissions) $58,22;187
Other invested assets 0 Funds held by company under relnsunstce treaties
0
Receivables for securities 0 Amounts withheldor retained by company for aecountof other
Securities lending reinvested collater*assets 0 Remittances and items not allocated
Aggregate write-ins forinvestedanM 0 Provision for reinsurance $1,545,075
Subtob Is.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 outstanding
Investment Income due and accrued $990,,960 Payable to parent,subsidiaries and affiliates
$12,458,110
Uncollected prerrtums and agents'balances in the course of collection $73,567,547 Derivatives
0
Deferred premiums,perm'balances and Installments booked but deferred and not 0
yet due Payable for securities 0
Accrued retrospective premiums 0 Payable for securities[ending 0
Amounts recoveraWe from reinsurers $33,586,257 Liability for amounts held under uninsured plans 0
Funds held by ordeWltedwith relrsuredcompanies 0 Aggregatewrte-Ins for11ahIlMes $4,185,928
Other amounts receivable under reinsurance contracts 0 Total liabilities excludrsg protected cell f1ablHtles
$190,811,131
Amounts recelvab;e relating to uninsured plans 0 Protected cell liabilities
Current federal and foreign Income tax recoverable and interest thereon 0
Net deferred tax asset $5,530,837 Total liabilities
$190,831,131
Guaranty funds receivable or on deposit 0
Furritureand equipment,Indudighealth aredelivery assets 0 POLICYHOLDERYSSURPLUS
Net adjustment In assets and liabilities due to foWgn 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 5 000 000
Aggregate write-Ins for other than Invested assets $7,124,971 Preferred capital stock
Total assets excludingrate Accounts, $347,414,611
Account Sopa Segregated Accounts and protected Cel. Aggregate write+ns for other than special surplus 0
From Separate Account,Segregated Accounts and Protected Cell Accounts 0 Surplus Notes
TOTALSd$347,414,611 Gross paid In and contributesurplus
_ $156,938,671
Unassigned funds(surplusj ($5,335,190)
Surp:us as regards poikyholders $156,603,481
TOTALS $347,414,611
.,J
WSSCRIRFD and sworn to me lhls gday of HY/ '
> My comrncssca expires ] /,V F
Notary Public
CERTIFICATE v Pri ited Name ALYSSA TURKOVM
I certify that the above financial statement to the bestaf my Notary Public,State of Now York
knowledge area true and accurate reflection of the financial ALYSSA TUUOVtt2 NO.01TU6044514
condition of the Company as of December 31,2014, // QUBIHIBd in Westchester Cal r y
Additionally,Icertify that the above financial statements are �.i-f:3:��y /! '"t Cc�Won iExpiretlJuly 10,2018
M agreement with the Statutory FlnanUal Statement filed with the Texas NatatfttPtxbtlC Stets of New ytlrlr
Department of Insurance as of the same date: e
No.MTU6044514
William 1 Gleason Quallfled in Westchester County
CTO.VP&T,e
P,1S+SSC, Commission Expires Jury 10,2014
SUBDIVISION LABOR AND MATERIAL BOND
(GOVERNMENT CODE 66499.2)
Bond No.SUR21000030
Replaces Bond No.SUR20000337
KNOW ALL MEN BY THESE PRESENTS, that Pacific Point Development partners, LLQ
(hereafter designated as "Principal"), and Ironshore Indemnity Inc.
Surety-(hereinafter ca le�ic'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:
Storm Drain subdivision improvements within Tract 16751 as defined within Amendment#1 and
Reinstatement of the Subdivision improvement Agreement 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
Eighteen Thousand Seven Hundred Ninet Dollars and 00/100 Dollars ($18,790.00 ) 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 ju gmelnt 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 Mav 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
0, (NOTARIZATION AND SEAL)
By: s,
Its: a o r j zzj V\&CV Cr'r`,,
SURETY:
Ironshore Indemnity Inc.
r (NOTARIZATION AND SEAL)
By:
Margaret 6nem , Attorney-in-Fact
Surety Phone No.
CIO WILLIS OF FLORIDA
4211 W BOY SCOUT BLVD,4100(
TAMPA, FL 33607 Page 2 of 3
INQUIRIES:(613)261-2095
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
d=oneat to which this waifirate-is-attwhed;-and-not4te-trethfttinm cctaracy.oi validityen
State of Californlik )
County of
)
On DUW I before me, —LAM ( l.J
Date Here Insert Name and Tit of he Officer
personally appeared 6f(���
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#2088325 WITNESS my hand and official seal.
Notary Public-California z ti
Orange County
My Comm.Expires Oct 31,2018� Signature
uz� I
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 Signers)
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 45907
i
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 rrnr
ANETT CARDINALE
■p Commission#FF 138482
Expires duly 28,2018
RP
80c"Thru buy rein Ineurence 90a3W7019
This area for Oficial Notarial Seal
r 1fiTWs' e-c DI75 Ab . o , e- V1 f3 E 3n Section 8.202 of the
ObvemMe t.Code, rela�g•to vOtafes.pttblie:'I"he, elp`c7v physical format Q. ft n�+i digelosure
xot ce s_anexatnple� for put ,vses�of i)! ustxafion:
A YiWaYpli is of other officer doiriplpting W'$'
certificate vetifes.only the id6ntity ofthe
individual vvho:signed the doqUinpit,itt Whidh.
certificate.is atfaahed,and not the truthfulness,
acciiraCy;vsValidity Of docujiient,
5tstd bf California.
.C.Qtinty.of
Qrt erg
'Thsert name and- itle of afficer5,'Fpersonal]y appeared;
ue�d to oti the basis,a atisfactory-evidenoe to b 'th persors y v�lio a iaarae(s)ss12 sut�,5cr;6e-O-to
;tlje.wiff&'ihilxument.and acknoa edged to mw that:helshe/they exeOuted the samrr air-his/her/their,
authoiize#l_capacity(es), �gd tb4t;by �is/hdrr'their slghgge(s) -Oji the'ms
"truiilOt A&tArsbn(S),.qthe
-ed ity. Up-bit behalf of whiph'th;DO6 bh(s)lacted,-ci ecutedit.instminhnt,
'iirider]'EN;ALIa '( F'FI RJURY*id.O the ]awls ¢f e.Stag,of Callfbriiia that the i*a cgciiri
paragraph is true and.correO
WITNESS rii.�h6md 4nd officiak seal
Signature.
(Seal
POWER OF ATTORNEY
Ironshore Indemnity Inc. 111- 21000030
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 Attomey(s)-rn-Fact to make,execute,seal and
deriver 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
22"a 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 behaff of the Company any bonds,undertakings,policies,contracts of indemnity or ;obligatory
other writ ng
-m-nature dollars,w is t e nmpany 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 seat 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.
o n5
stn�f -
iY1419
By:
Dan a t,Suss n
Director
ACKNOWLEDGEMENT
On this 7'h 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 Ironshare 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 7 I n l
_ - Nolary Public-Slate of Tennessee
x Davidson County
My Commission Expires 01-09-16 A'mY Ta
tlefary Pubk
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
jolt
1914 n I
PauIS.GI dano
Secretary
"WARNING:Any person who knowingly and with intent to defraud any insurance company or other person,files and application for insurance or statement of claim
containing any materially false information, or conceals for the purpose of misleading information concerning any fact material thereto, commits a fraudulent
insurance act,which is a crime and subjects such person to criminal and civil penalties."
IRONSHORE;NDEMNrry ITIC
FINANCIAL STATEMENT SUMMARY
As of December 31,2014
ASSETS
LIABILITIES
Bonds
$179,140,947 Lasses
$63,582,066
Preferred stocks 0 Reinsurance payabie on paid losses and loss adjustment expenses 0
Common stocks 31,840,141 loss adjustment expenses
$10,391,957
Mortgage loans on real estate:torst kens 0 Commissions payable,contlngent eorr MISSI rss and otherslmilm charges $1,020,805
Mortgage Irons on real estate;Other than first liens 0 Other expenses(excluding taxes.licenses and fees) $5,435,125
Properties occupied by the company 0 Taxes,licenses and fees jexciudmg federal and foreign incarneteNes] er u�804
Properties held for the production of Inoane D Current federal and foreign Income taxes $2,434,392
Properties held for We 0 Not deferred tax liability
0
Cash.cash equivalents and short-term investments $15,632,951 Unearned premiums $29,158,S76
Contract bans 0 Advance premium
Derivatives 0 Ceded reinsurance premiums payable(net of ceding commissions)
$58,222,787
Other invested assets 0 Funds held by oompersy under reinsurance treaties 0
Receivables for securities 0 Amounts withheld orretalnedbycompanyfor amount ofothers
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 $226,614;039 Net adJustments In assets and tabllltles due to foreign exchange rates
Title plants less$..,Charged off 0 Drafts outstanding
Investment Income due and accrued $990,960 Payable to parent,subsidiaries and affiliates
Uncollected press ums and agents'balances in the course of collection $73,567,547 $12.458,110
Derhratives 0
Deferred premium;egems'balances and Installments booked but deferred and not 0 Payable for securities
yetdue 0
Accrued retrospective prern Tums 0 Payable for securities lending 0
Amounts recovers We 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 $4,1854926
Other amounts receivable under reinsurance contracts 0 Total liabilities excluding protected a0 tlabitldes $190,811,131
Amourds;recelvabse relating to uninsured plans 0 Protected cell liabilities
Current federal and foreign income tax recoverable and interest thereon 0
Net deferred tax asset $5,530,837 Total liabilities
$19D,611,131
Guaranty funds receivable or an deposit 0
Furniture and equipment,including health care defiveryas" 0 POUC(HOtDEWSSURPLUS
Net adjustment In assets and liabilities due to foregn exchange rates 0 Aggregate wnte-Ins for special surplus funds
0
Receivables from parent,subsidiaries and affiliates 0
Health care and other amounts receivable 0 Common capital stock 5 000 ODO
Aggregate write-Ins for other than Invested assets $7,124x971 preferred capital stock
Total assets excluding Separate Accounts,Segregated Accounts and Protected Cel $347,414,611
Accounts Aggregate write mforotherthanspecialsurpus 0
From Separate Accounts.Segregated Accounts and Protected Cell Accounts 0 Surplus Notes
TOTALS $347 414,611 Gross paid In and contobuted surplus
$156,938,671
Onasslgned funds{surplus} ($5,335,190)
Surp to as regards policyholder
$756,603,481
TOTALS
$347,414,611
SUBSCHBEDand swomtome this ay61Mf7)y,
My[rammldscn expnn:
-. - — — ,rt�s•. ����6 e,... NotaryPut$le
CERTIFICATE Printed Name ALYSSA TURKOViTZ
certify y Notary Public,State of NeW York
1 c that the above financial statements to the bettaf rn
knowledge are a true and accurate reflection of the financial ALY55ATURKOYfr2 No.01 TU6044514
condition of the Company as of December 31„2014, Qtial fieri in Westchester Cmnly
Additionally,I certify that the above financial statements are L e-I' fir'+ /A121Z44.-A— iutlIT1JT issim Expires July 10,20113
in agreement with the Statutory Financial Statements filed with the Trxas NWaI4 5ptevf New York
Department of insurance as of the same date,
No.OITU6044514
willlam,lGleason Qualified In Westchester County
a%)tp tRg71 rLL Coramisslon Expires July 30,2014