15-0505_Bond_SUR21000031_Pacific Point Dev_TR 16751 Premium: $225.00
SUBDIVISION FAITHFUL PERFORMANCE BOND
(GOVERNMENT CODE 66499.2)
Bond No. SUR21000031
Replaces Bond No.SUR20000338
KNOW ALL MEN BY THESE PRESEN S, 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:
Sanitary Sewer 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
Twenty Two Thousand Seventy Three Dollars and 00/100 Dollars, $22,073.00 ) 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:
c
Its: Q2� C,c i r�r
SURETY:
Ironshore Indemnity Inc.
p (NOTARIZATION AND SEAL)
By: Nql�'aL '6��
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 this certificate is attached,and not the truthfulness,accuracy,or validity of that document.
State of California )
Countv of )
On before me, Y)AfVN Ok &_)
at re insert Name andtit1d of the Officer
personally appeared , dcw
Name(s)of Signer(s)
_7
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 WITNESS my hand and official seal.
• Notary Public-California
z OrangeCounty
M Comm.f_x alres Oct 31,2018 Signature
Signature of Notary Public
Place Notary Seal Above
OPTIONAL
Though this section is optional, completing this information can deter alteration of the document or
fraudulent reattachment of this form to an unintended document.
Description of Attached Document
Title or Type of Document: -_ _ Document Date:
Number of Pages: Signer(s) Other Than Named Above:
Capacity(les) Claimed by Signer(s)
Signer's Name: Signer's Name:
❑Corporate Officer — Title(s): _ ❑Corporate Officer — Title(s):
❑ Partner — ❑ Limited ❑General ❑ Partner — ❑ Limited ❑General
❑ Individual ❑Attorney in Fact ❑ Individual ❑Attorney in Fact
❑Trustee ❑Guardian or Conservator ❑Trustee ❑Guardian or Conservator
❑Other: ❑ Other:
Signer Is Representing: Signer Is Representing:
02014 National Notary Association •www.NationalNotary.org • 1-800-US NOTARY(1-800-876-6827) Item#5907
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
Q!s ` Bonded Thru Troy Fein Insurance B00-395.7019
This area for Oficial Notarial Seal
—Wiate-13M 105.0; aruefiO Sections 1-:199 ani. 119.5 gf;thie:Gini 1. ode-=d seot pt i 9- of the
ra 'TPM4(:.Cade,reiafipgAo nQta4es.pAbjf6r.' e bcJowajSbysical format of tie new disclosure
iiptice.;is an example,,,,f(?r pm r ses of ilXustrat*
f public off'other b#ftcer plefiat tis
certifieate Xedfies.only the identity`of the
indiyr dual Who.signed,the dbooe'tto wlil
.certificate.is atfachedr and not the truthfulness;
accc�,ox^validity r��'t,�ag:�o►�upien�.
Statd bfC,aliforimia
County.df
(tri , me,
'ihsert name and-fide of'Officer),,personally 4,ppeared Aa.
'prcMP4 t¢1ti o1)'tM'basis ofsatisfaatnry evidence txa bWtlai:':'Won s)'Whose iiam"l J
sy xs/are suliscrjb'edv
r,l7 � .
the" vvithiri.-i>_*ument and acknowledged -to me-'that helshelthey.executed the same` in his/ber/their,
au- qip ',capaGii}(ies), and #hat-by is/hexiCh 's acute s) 'qit7 the istru t ht tie p�sop(s),:'or tfie
--Atity tipoii,it ehalf of which t ie petspd('s)acted,ekecuted-th6.-irkstruineat
l Peiki j+'00&r PENALTY OF.',P lt1OkY under Elie laws o ilie.StAtd qT al3fnrnia 4t tie foii goixe
paragraph-i' true and,correO
WITNESS mg IAW and.official-sear;
Sigz�atdte (Seal),
POWER OF ATIFORNEY
Ironshore Indemnity Inc. III- 21000031
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-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.
a, seat
4Yii
By,
Dan e t Suss n
Director
ACKNOWLEDGEMENT
On this 7111 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 C.TAYLOR .�
_ _ Notary Public-Stale of Tennessee
'• � �- _ DaviUson County
� , Hly eammltsbn E,pew.61�9-1e Amy L.Ta
"'•:;taw :`� 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 20 15
:�QNo� nr
tiFAb
l��y4R y
Pauls.iii lona � �
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 Asa
$63,562,066
Preferred stocks
p Reinsurance payable on paid losses and loss adjustment expenses
0
Common stocks
31,840141 toss adjustment expenses $10,384,957
Mortgage loans on real estate.First bens 0 Commissions payable,contingent commissions and other similar charges $1,020,805
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 fees(excluding federal and foreign Income taxes) $2,383,909
Properties held for the production of income 0 Current federal and foreign Income taxes $2,434,392
Properties held for see 0 Net deferred tax liability D
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 coding commissions) $59,222,187
Other invested assets 0 Funds held by company under reinsurance treaties
0
Receivables forsecurities 0 Amounts withhold or retained bycompany for accountofothers
Securities lending reinvested colhtem,assets 0 Remittances and items not allocated
Aggregate write-ins fortnveitedassets 0 Provision for reinsurance $1,545,075
Subtotals.cash and Invested assets $226,6140039 Nei adjustments In assets and tabilitles due to foreign exchange rites
Title plants less$..,Charged off 0 Draf 3 oubtandln8
Investment Income due and accrued $990960 Payable to parent,subsidiaries and ofRhates $12,458,110
Uncollected prenEums and agents'balances In the course of collection $73,567,547 Derivatives
0
Deferred premiums,germ'balances and installments booked but deferred and not 0
yet due Payable for securities 0
Accrued retrospective prerniums 0 Payable for securities leading 0
Amounts recoveroWe from reinsurers $33,58k257 liability foramountsheld under uninsured plans p
Furls held by or deposited with reinsured companies 0 Aggregate write-Ins for liabilities
$4,185,928
Other amounts rw&Wbleunder reinsurance contracts 0 Total liabilities excluding protected call liabilities $M,811,131
Amounts receivabe 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 Totel.labjlities
$190,811,131
Guaranty funds receivable or on deposit 0
Furniture and equlpment,Including health tare delivery assets 0 POUCYHQLDEWSR;RPLUS
Net adjustment In assets and liabilities due to foregn exchange Fates 0 Aggregate waste-Ins for special surplus funds
0
Receivables from parent,subsidiaries and affiliates 0
Health care and other amounts receivable 0 Common capital stock 5,0D0.000
Aggregate write-Ins for other than lnvestedassets $7„124,971 Preferred capital stock
Segregated Accounts and Protected Cat $347,414,611
Tool assets exdudi ng Separate Accounts,Segregated write-ins for other than special surplus 0
Accounts
From Separate Accounts,Segregated Accounts and Protected Call Accounts 0 Surplus Notes
TOTAL$ 4�147,did,611 Gross paid In and contributed surplus $156,938,671
Unassigned funds o urplusj ($5,335,190)
SuWur as regards policyholders $156,603,481
TOTALS $347,414,611
SUBSCRIBED and swam to me this%day of M/�y ,'G' (j
r/f Mymmmisscnesplrtss: 7-/U—/5T
Notarypublic
CERTIFICATE Printed Name ALYSSA TURKOVI1Z
I certHy that the above financial statementsstatementsNotary Public,State of New York to the bestof my No.Q�jTU�S�4
knowkdgeareatrue and acuatereflectionofthe financial AL S&TURKOV
condition of the Company as of December 31,2014, /' Oualllted In Westchester County
Additionally,I certify that the above financial statement are IA4 — COMMl it l IE01;PiMS JUly M 2DIS
in agreement with the Statutory Financial Statements filed with the Texas N"h4i__ic,Spee of New York
Department of insurance as of the same date,
No.OITU6044514
William Gleason Qualified In Westchester County
CFO.Vp&Treast- Commission Expires July 10,2014
SUBDIVISION LABOR AND MATERIAL BOND
(GOVERNMENT CODE 66499.2)
Bond No. SUR21000031
Replaces Bond No. SUR20000338
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:
Sanitary Sewer 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
Twenty Two Thousand Seventy Three Dollars and 00/100 —Dollars ($2zm.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 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
(NOTARIZATION AND SEAL)
By. S
Its: -�•.o�' - r
SURETY:
Ironshore Indemnity Inc.
r (NOTARIZATION AND SEAL)
By:
Margare k 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
ENQUIRIES:(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
document to which this certificate is attached,and not the truthfulness,accuracy,or validity of that document.
State of California )
County of &M )
_Nd �Offlcer�
On before me,Date R ere Insert Name an t e of th
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 capacity(es),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 WITNESS my hand and official seal.
Z Notary Public•California a
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:
�:+w a�v_L-•�'aC. ?kr�-'.�.'- ��'^:e�{.:r�4.''�^ti=4"Thr.=G.�.G+�4ST=�"�3'z•-�' -> '. --4��"'C_-x.%�`.�'3Gt:�s¢4^Tom.'Y:r�'.`S`%'C^�" CS�'i.'�;:�5"x4.�.' �''
02014 National Notary Association •www.NationalNotary.org • 1-800-US NOTARY(1-800-876-6827) Item#5907
f
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.
,ly
., I
A+
Signature
Anett Cardinale
:rs ANETT CARDINALE
Commission#FF 138482
Expires July 28,2018
Bonded Thre Troy Feln Ineuronoe 800a6-7019
This area for Oficial Notarial Seal
R"'-C Q& an e,ion f the
Siatat&NIT 110$0, =wgis.-$pttl lig -1-:199 iind 119$-'Of1hd:C.-Ia dg.et 91 b
'060.-,fiew(hsosure
rmat
-jqq?#%js-an,qpTple,-for pur of. mustm#�m
mtory.POUe or other 056of cah*l ting tfifs-
cerfifibale verifies only the i4ntity-of the
individ4a.i vvho,signed,the doptocrit.fq whi&ihig
.certificate.is attahed,an I d not the tnithfidnessi
:.40 y;Ot IaSegy Of Ib4t-d6qu�em.
8.tgtd'pf Califoriiia
County 6f
0.
'fiiscrt name and-title 6P-officer5,,'person.ally APPWO Who.
P,WVf-d:Fo ffig'Db tho'bg' Ofsatisfktory ey'deji��itolkthe.Verson(*who
-- ' 1 §0 dame(s)jlskrl�9*946edta
fbe WAWA id�ixwnent.and acknowledged lo -me�'tbat, hell'
he/they executed ihe, same-in his/her/fbeir
*00'ptj�'capacity(ies),"d •tot.�y�is/herftfieir s! -�lh�
911*fe(s) '0,: trutko'M gi.6 Orsofi(s),.of the
�fitity bpbh 6ehalf of-)yhM'&;,O&ftbfi(t)-wfed,executed th6,31astrume"ant,
I ixAi-fYvj&r PEN ,TV-O. P "I'URY tinder tae awgpie. WdCaIjfI
paragraph-is true MY and'correct-
WUNESS.- IAM
and.6f—ficid-seal.
(Seal)
POWER OF ATTORNEY
Ironshore Indemnity Inc. III- 21000031
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-ln-Fact to execute on behalf of the Company any bands,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.
+ea�9gi v'•.
�p L:
�eEpL
1979
yet f
By,
Dan a 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.
- - NOWry Publlo-Slale of Tennessee Alt
DaMsont~1
Vis, ra. r A9rCammles!ufEmreiaf-09•re Amy L.Tayl
,,'•',°? °A- Notary PuNk
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 ZD 15
dey
r.FhL
Ipl9 �{tt
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
fInsurance act,which is a crime and subjects such person to criminal and civil penalties."
IRONSHORE tNDEMWTY INC
FINANCIAL STATEMENT SUMMARY
As of December 31,2014
ASSETS LIABILITIES
Bonds
$179,140,947 losses
$63,582,066
Preferred stocks
p Relmurence payable on paid losses and loss adjustment expenses
Common stocks 0
31,840,141 loss adjustment expenses $10,384,957
Mortgage loans on real estate.Fant tem 0 Commissions payable,contingent commissions and other similar charges $1,020,805
Mortgage loans on real estate;Other than first Item 0 Other expenses(excluding taxes.licenses 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 income taxes $2,434,392
Properties 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 bans 0 Advance premium
Derkatives 0 Ceded reinsurance premiums payable(net of ceding commissbns) $58,222,187
Other invested assets 0 Funds held by company under reinsurance treatks 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.cwhand Invested assets $226,614,039 Not adjustments In assets and liabilities due to foreign exchange rates
Title plants less$..,Charged off 0 Drafts outstanding
Investment Income due and accrued $990,960 Payable to parent,subsidiaries and affi8ates
$12,456,110
Uncollected prem ums and agents'balances in the course of collection $73,567,547 Derivative
0
1Defeer ed premiums,agents'balances and Installments booked but deferred and not 0 payable for securities 0
Accrued retrospective premiums 0 Payable for securities lending 0
Amounts recoveraWefrom reinsurers $33,586,257 Uablllty,foramounts 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 recehalaerelating touninsured plans 0 Notecsedcell hablillies
Current federal and foreign Income tax recoverable and interest thereon 0
Net deferred tax asset $5,530,837 Total Rabilitles
$190,811,131
Guaranty funds receivable or on deposit 0
Furniture and equipment,including health pre delivery assets 0 POUCYHOLDERYS SURPLUS
Net adjustment In assets and liabilities due to forGgn exchange rates 0 Aggregate write-ins for special surplus funds 0
Receivables from parent subsidiaries and affiliates 0
Health are and other amounts receivable 0 Common caotal stock 5 D00 000
Aggregate write-Ins for other than Invested assets $7124,971 Preferred capital stock
Total assets excluding Separate Acoounts,Segregated Accounts and Protected Cel: $347,414,611
Aggregate writr m Por other than special surplus 0
Accounts
From Separate Accounts,Segregated Accounts and Protected CellAccounts 0 Surplus Notes
TOTALS 5347,434,611 Gross paid In and contributed surplus $156,938,671
Unauigned funds(surplus) ($5,335,190)
Suri us as regards policyholders $156,603,481
TOTALS $347,414,611
SUBitRIBEDandswomromol#lsdayofM/>?v1Qjrj
hlYcommiv%on expires: 7/V
Notary Public
CERTIFICATE Ngted Name ALYSSA TURKOVITZ
I certify that the above financial statements to the sestet my Notary Public,State of New YorkNO.01 4
TU604451
knowledgeareatrue and accurate reflection oftheRnandal ALYSSATURmiriI Qualified�1ITU6lk 451 (`i11EJf�}y
condition of the Company as of December 31,2014, ." j
Additionally,I certify that the above financial statements are ;"�{,-t.� �A . Cession Exorm July 10.2018
In agreement with the Statutory Financial Statements filed with the Taxa< NOtaeltRrbllc,$tate of New York_-
Department of Insurance as of the same date.
No.01TU6044514
William 1 Gleason Qualified In Westchester County
I UVIOL COmmlaslon Explres July 10,2014