Backup Documents 09/10/2019 Item #16A35 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 6 3 5
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting.
**NEW** ROUTING SLIP
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the
exception of the Chairman's signature,draw a line through routing lines 111 through 112,complete the checklist,and forward to the County Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1.
2.
3. County Attorney Office County Attorney Office 11--) 1(V*, '
4. BCC Office Board of County 1 r) ` t31--,,76.
Commissioners j.4 f
5. Minutes and Records Clerk of Court's Office
NA) )l ) 9005 i15S '
PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the addressees
above,may need to contact staff for additional or missing information.
Name of Primary Staff Melissa Nute—Development Review Phone Number X 2361
Contact/ Department
Agenda Date Item was 9/10/2019 Agenda Item Number 16A35
Approved by the BCC
Type of Document Plat Dore. Q iftry C-4-V- - Number of Original 1
Attached Documents Attached
PO number or account
number if document is
to be recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not
appropriate. (Initial) Applicable)
1. Does the document require the chairman's original signature? MN
2. Does the document need to be sent to another agency for additional signatures? If yes, N/A
provide the Contact Information(Name;Agency;Address; Phone)on an attached sheet.
3. Original document has been signed/initialed for legal sufficiency. (All documents to be
signed by the Chairman,with the exception of most letters,must be reviewed and signed
by the Office of the County Attorney. MN
4. All handwritten strike-through and revisions have been initialed by the County Attorney's N/A
Office and all other parties except the BCC Chairman and the Clerk to the Board
5. The Chairman's signature line date has been entered as the date of BCC approval of the MN
document or the final negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's MN
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip
should be provided to the County Attorney Office at the time the item is input into SIRE.
Some documents are time sensitive and require forwarding to Tallahassee within a certain
time frame or the BCC's actions are nullified. Be aware of your deadlines!
8. The document was approved by the BCC on 9/10/2019 and all changes made 'A'ts not
during the meeting have been incorporated in the attached document. The County �, j option for
Attorney's Office has reviewed the changes,if applicable. V 'r is line.
9. Initials of attorney verifying that the attached document is the version approved by the 4" , et
BCC,all changes directed by the BCC have been made,and the document is ready for the (`
Chairman's signature.
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12
5
ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 16 A 3
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. The completed routing slip and original documents arc to be forwarded to the County Attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting.
**NEW** ROUTING SLIP
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the
exception of the Chairman's signature,draw a line through routing lines 41 through#2,complete the checklist,and forward to the County Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1.
2.
3. County Attorney Office County Attorney Office 1 )17/Z
4. BCC Office Board of County 'US
Commissioners J ttii f i--3['
5. Minutes and Records Clerk of Court's Office
NA) t 3 l WPO :ark
PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the addressees
above,may need to contact staff for additional or missing information.
Name of Primary Staff Melissa Nute Phone Number x-2361
Contact/ Department
Agenda Date Item was 9/10/2019 Agenda Item Number 16A35
Approved by the BCC
Type of Document Bond,Maintenance Agreement Number of Original 2
Attached Documents Attached
PO number or account
number if document is
to be recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not
appropriate. (Initial) Applicable)
1. Does the document require the chairman's original signature? MN
2. Does the document need to be sent to another agency for additional signatures? If yes, N/A
provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet.
3. Original document has been signed/initialed for legal sufficiency. (All documents to be
signed by the Chairman,with the exception of most letters,must be reviewed and signed
by the Office of the County Attorney. MN
4. All handwritten strike-through and revisions have been initialed by the County Attorney's N/A
Office and all other parties except the BCC Chairman and the Clerk to the Board
5. The Chairman's signature line date has been entered as the date of BCC approval of the MN
document or the final negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's MN
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip
should be provided to the County Attorney Office at the time the item is input into SIRE.
Some documents are time sensitive and require forwarding to Tallahassee within a certain
time frame or the BCC's actions are nullified. Be aware of your deadlines!
8. The document was approved by the BCC on 9/10/2019 and all changes made during
the meeting have been incorporated in the attached document. The County
Attorney's Office has reviewed the changes,if applicable. ,q ,'ne.
9. Initials of attorney verifying that the attached document is the version approved by the '1<A is ii
BCC,all changes directed by the BCC have been made,and the document is ready for the *• t. tax
Chairman's signature.
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12
16A35 A 3 5
CONSTRUCTION AND MAINTENANCE AGREEMENT FOR SUBDIVISION IMPROVEMENTS
THIS CONSTRUCTION AND MAINTENANCE AGREEMENT FOR SUBDIVISION IMPROVEMENTS
entered into this L 3 day of Ur i J r , 20 `1 between FC Coracle, FCC Avl.3,„ar hereinafter
referred to as `Developer", and Board of County Commissioners of Collier County, Florida, hereinafter
referred to as the"Board".
RECITALS:
A. Developer has, simultaneously with the delivery of this Agreement, applied for the approval by the Board
of certain plat of a subdivision to be known as: Dorado at Fiddler's CreeK
B Chapter 4 and 10 of the Collier County Land Development Code required the Developer to post
appropriate guarantees for the construction of the improvements required by said subdivision
regulations, said guarantees to be incorporated in a bonded agreement for the construction of the
required improvements.
NOW, THEREFORE, in consideration of the foregoing premises and mutual covenants hereinafter set
forth, Developer and the Board do hereby covenant and agree as follows:
1 Developer wil' cause to be constructed: Drainage and Utility Modifications to existing facilities
within 24 months from the date of approval said subdivision plat, said improvements hereinafter
referred to as the required improvements.
2 Developer herewith tenders its subdivision performance security (attached hereto as Exhibit "A" and by
reference made a part hereof) in the amount of$366,901 70 which amount represents 10% of the total
contract cost to complete the construction plus 100% of the estimated cost of to complete the required
improvements at the date of this Agreement.
3. In the event of default by the Developer or failure of the Developer to complete such improvements
within the time required by the Land Development Code, Collier County, may call upon the subdivision
performance security to insure satisfactory completion of the required improvements.
4. The required improvements shall not be considered complete until a statement of substantial completion
by Developer's engineer along with the final project records have been furnished to be reviewed and
approved by the County Manager or his designee for compliance with the Collier County Land
Development Code.
5. The County Manager or designee shall, within sixty (60) days of receipt of the statement of substantial
completion, either: a) notify the Developer in writing of his preliminary approval of the improvements; or
b) notify the Developer in writing of his refusal to approve improvements, therewith specifying those
conditions which the Developer must fulfill in order to obtain the County Manager's approval of the
improvements. However, in no event shall the County Manager or designee refuse preliminary approval
of the improvements if they are in fact constructed and submitted for approval in accordance with the
requirements of this Agreement.
6. The Developer shall maintain all required improvements for a minimum period of one year after
preliminary approval by the County Manager or his designee. After the one-year maintenance period by
the Developer has terminated, the Developer shall petition the County Manager or designee to inspect
the required improvements. The County Manager or designee shall inspect the improvements and, if
found to be still in compliance with the Land Development Code as reflected by final approval by the
Board, the Board shall release the remaining 10% of the subdivision performance security. The
Developer's responsibility for maintenance of the required improvements shall continue unless or until
the Board accepts maintenance responsibility for and by the County.
i 6 A
.,,i` 5,
7 Six (6) months after the execution of this Agreement and once within every six (6) months thereafter the
Developer may request the County Manager or designee to reduce the dollar amount of the subdivision
performance security on the basis of work complete. Each request for a reduction in the dollar amount of
the subdivision performance security shall be accompanied by a statement of substantial completion by the
Developer's engineer together with the project records necessary for review by the County Manager or
designee. The County Manager or designee may grant the request for a reduction in the amount of the
subdivision performance security for the improvements completed as of the date of the request.
8. In the event the Developer shall fail or neglect to fulfill its obligations under this Agreement, upon
certification of such failure, the County Manager or designee may call upon the subdivision performance
security to secure satisfactory completion, repair and maintenance of the required improvements. The
Board shall have the right to construct and maintain, or cause to be constructed or maintained, pursuant to
public advertisement and receipt and acceptance of bids, the improvements required herein. The
Developer, as principal under the subdivision performance security, shall be liable to pay and to indemnify
the Board, upon completion of such construction, the final total cost to the Board thereof. including; but not
limited to, engineering, legal and contingent costs, together with any damages, either direct or
consequential, which the Board may sustain on account of the failure of the Developer to fulfill all of the
provisions of this Agreement.
9. All of the terms, covenants and conditions herein contained are and shall be binding upon the Developer
and the respective successors and assigns of the Developer.
IN WITNESS WHEREOF, the Board and the Developer have caused this Agreement to be executed by
their duly authorized representatives this - day of •. _ , 20 '1 .
I SIGNED IN THE PRESENCE OF: 1(Name of Entity) '
I
AS TO ALL OWNERS" I FC Dorado. LO
i.., Cld 1.4441(1
By. — — — —
Printed Name: A A_b-Ay 1 Fe. a — —
4#t771t/O,V Y t/Y 1' Q-O C7 ?'e� �e . 3 'd CFO o'Pc Dorado, LLC a^d nJ1 -
Witness: ,(Name of Entity)
/AA FCC Av amar LLC
Printed N me, ) 3:
• 1 � .F, a' 1 C : - / a.
ATTEST: By: V
CRYSTAL K. KINZE'L, CLERK BOARD OF COUNTY COMMISSIONERS
i I' OF
C LIER COUNTY, F RIDA
1
i `
1
' --- 64 , I 4e1•40,1006.6 !
Deputy Clerk f '
Burt L. Saunders, Chairman
Approved as to form anSlgt ' ' �i.
I
Sall sh r
Assistant County Attorney --
J
3 5
16A35
EXHIBIT A
COLLIER COUNTY LAND DEVELOPMENT CODE
PERFORMANCE BOND NO. K15468488
KNOW ALL PERSONS BY THESE PRESENTS: that
FC DORADO, LLC&FCC AVIAMAR, LLC
8156 FIDDLER'S CREEK PKWY
NAPLES, FL 34114
(hereinafter referred to as "Owner")and
WESTCHESTER FIRE INSURANCE COMPANY
436 WALNUT STREET
PHILADELPHIA, PA 19106
(hereinafter referred to as "Surety") are held and firmly bound unto Collier County, Florida, (hereinafter referred to as
"County") in the total aggregate sum of Three Hundred Sixty Six Thousand Nine Hundred One.& 70/100 Dollars
($366,901.70) in lawful money of the United States, for the payment of which sum well and truly to be made, we bind
ourselves, our heirs, executors, administrators, successors and assigns,jointly and severally, firmly by these presents.
Owner and Surety are used for singular or plural,as the context requires.
THE CONDITION OF THIS OBLIGATION is such that whereas, the Owner has submitted for approval by the Board a
certain subdivision plat named Dorado at Fiddler's Creek and that certain subdivision shall include specific
improvements which are required by Collier County Ordinances and Resolutions (hereinafter "Land Development
Regulations"). This obligation of the Surety shall commence on the date this Bond is executed and shall continue until
the date of final acceptance by the Board of County Commissioners of the specific improvements described in the Land
Development Regulations(hereinafter the"Guaranty Period")
NOW, THEREFORE, if the Owner shall well, truly and faithfully perform its obligations and duties in accordance with
the Land Development Regulations during the guaranty period established by the County,and the Owner shall satisfy all
claims and demands incurred and shall fully indemnify and save harmless the County from and against all costs and
damages which it may suffer by reason of Owner's failure to do so, and shall reimburse and repay the County all outlay
and expense which the County may incur in making good any default, then this obligation shall be void, otherwise to
remain in full force and effect.
PROVIDED, FURTHER,that the said Surety, for value received hereby,stipulates and agrees that no change, extension
of time, alteration, addition or deletion to the proposed specific improvements shall in any way affect its obligation on
this Bond, and it does hereby waive notice of any such change, extension of time, alteration, addition or deletion to the
proposed specific improvements.
PROVIDED FURTHER, that it is expressly agreed that the Bond shall be deemed amended automatically and
immediately, without formal and separate amendments hereto, so as to bind the Owner and the Surety to the full and
faithful performance in accordance with the Land Development Regulations. The term "Amendment," wherever used in
this Bond, and whether referring to this Bond, or other documents shall include any alteration, addition or modification
of any character whatsoever.
16 A35
IN WITNESS WHEREOF, the parties hereto have caused this PERFORMANCE BOND to be executed this
14th day of October, 2019.
WITNESSES: Aubrey J. Ferrao
President and CEO of FC Dorado, LLC and not in his
JA
individ.Efal capacity
f
`/ By:
Printed'Name IU!rr b/��,-t/Z„p(J Aubrey J. F6rrao�, President and CEO
\\= 11 � (Provide Proper Evidence of Authority)
..._
�
Printed Name
ACKNOWLEDGEMENT
STATE OF F Tort
COUNTY OF Coal
THE FOREGOING P. RFOR(VjANCE BOND WAS ACKNOWLEDGED BEFOy ME THIS DAY
14A.NT Gem bbtr Z320 1G , BY( A E 8'F ACK�O�NLEDGER) AS(TITLE) OF C e
(NAME OF COMPANY) WHO IS PERSONALLY KNOWN TO ME, OR HAS PRODUCED AS
IDENTIFICATION. _
Notary Public-State of N')ar
EAL) ; LZoY�/L ��SARy4S Savannah Landry Wieczorek
E vL fir( Q e d r-( < NOTARY PUBLIC
0
''STATE OF FLORIDA
Printed Name',, \ 0 5,�=Comm#FF964282
J 4CE Expires 3/18/2020
WIT ESSES: (C/ ` , ' Aubrey J. Ferrao
� � President and CEO of FCC AVIAMAR, LLC and not in
(.4.7his individual capacity A,
14�T1-1 v f/Y!4-tQ-!�a
By:
Printed Na e l , President and CEO
��1 ff -LA '= V cam_ (Provide Proper Evidence of Authority)
Printed Name
1 ACKNOWLEDGEMENT
STATE OF F )0J I ��
COUNTY OF Co((ie,�
�eCE FOREGOING, APERFORMANCEode3, 20 WAS ACKNOWBY(N AME�F ACKi8WLEDGER) ASTIAY TLE) OF{CCS
(NAME OF COMPANY) WHO IS PFRSONALLY KNOWN TO ME, OR HAS PRODUCED AS
IDENTIFICATION.
Notary Public -State of F 10 r, drN
AEAL)
yciA)aN(^ r ��nI \ l LZ n r e-I vii•
Savannah LandryWlkI.FJ� (� ' NOTARY PUBLIC
Printed Name �?STATE OF FLORIDA
—/ / ��+•,• • Comm#FF964282
(...4771('
.I` �
E I' Expires 3/18/2020
16435 A 35
SURETY ACKNOWLEDGEMENT
WIT—NOSE : West flio-r Fire Insurance.Cempap.y__
Krisfi_S. Ben.er Witne s _ Annette Audinot, Attorney-In-Fact
(Provide Proper Evidence of Authority)
ssica I. ••.tta, Witness —--
L-
ACKNOWLEDGEMENT
STATE OF New Jersey
COUNTY OF Morris
THE FOREGOING PERFORMANCE BOND WAS ACKNOWLEDGED BEFORE ME THIS 14th DAY OF October, 2019
BY Annette Audinot, Attorney-In Fact OF Westchester Fire Insurance Company
WHO IS PERSONALLY KNOWN TO ME, OR HAS PRODUCED a Driver's License AS IDENTIFICATION.
Notary Public -State of New Jersey
SEA!)
Ap '! Perez
APRIL PEREZ
NOTARY PUBLIC
j STATE OF NEW JERSEY
MY COMMISSION EXPIRES APR.16,2024
. ,
16A35
. . ,
Power of Attorney
Westchester Fire Insurance Company 1 ACE American Insurance Company
Know All by These Presents, that WESTCHESTER FIRE INSURANCE COMPANY and ACE AMERICAN INSURANCE COMPANY corporations of the Commonwealth of
Pennsylvania,do each hereby constitute and appoint Annette Audinot, Kristin S. Bender,Jessica lannotta, Kelly O'Malley and April D. Perez of Morristown,
New Jersey;Megan Schlueter of Raleigh,North Carolina
each as their true and lawful Attorney-in-Fact to execute under such designation in their names and to affix their corporate seals to and deliver for and on their behalf as surety
thereon or otherwise,bonds and undertakings and other writings obligatory in the nature thereof(other than bail bonds)given or executed in the course of business,and any
instruments amending or altering the same,and consents to the modification or alteration of any instrument referred to in said bonds or obligations.
In Witness Whereof,WESTCHESTER FIRE INSURANCE COMPANY and ACE AMERICAN INSURANCE COMPANY have each executed and attested these presents and affixed their
corporate seals on this 2°d day of October,2019.
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STATE OF NEW JERSEY
County of Hunterdon
On this 2°d day of October,2019,before me,a Notary Public of New Jersey,personally came Dawn M.Chloros,to me known to be Assistant Secretary of WESTCHESTER FIRE
INSURANCE COMPANY and ACE AMERICAN INSURANCE COMPANY, the companies which executed the foregoing Power of Attorney,and the said Dawn M.Chloros,being by me
duly sworn,did depose and say that she is Assistant Secretary of WESTCHESTER FIRE INSURANCE COMPANY and ACE AMERICAN INSURANCE COMPANY and knows the
corporate seals thereof,that the seals affixed to the foregoing Power of Attorney are such corporate seals and were thereto affixed by authority of said Companies;and that she
signed said Power of Attorney as Assistant Secretary of said Companies by like authority;and that she is acquainted with Stephen M.Haney,and knows him to be Vice President of
said Companies;and that the signature of Stephen M.Haney,subscribed to said Power of Attorney is in the genuine handwriting of Stephen M.Haney,and was thereto subscribed
by authority of said Companies and in deponent's presence.
Notarial Seal
,Ai� '' F KATHERINE J.ADELAAR
1tors r NOTARY PUBLIC OF NEW JERSEY Ir'
I No 2318685
',y)'UBJC+ Commission Expires July 18,2024 / Yoian Public
�i`SE
CERTIFICATION
Resolutions adopted by the Boards of Directors of WESTCHESTER FIRE INSURANCE COMPANY on December II,2006;ACE AMERICAN INSURANCE COMPANY on March 20,
2009:
"RESOLVED,that the following authorizations relate to the execution,for and on behalf of the Company.of bonds,undertakings,recognizances.contracts and other written commitments of the Company
entered into in the ordinary course of business(each a"Written Commitment"):
O) Each of the Chairman,the President and the Vice Presidents of the Company is hereby authorized to execute any Written Commitment for and on behalf of the Company,under the
seal of the Company or otherwise.
(2) Each duly appointed attorney-in-fact of the Company is hereby authorized to execute any Written Commitment for and on behalf of the Company,under the seal of the Company or
otherwise,to the extent that such action is authorized by the grant of powers provided for in such person's written appointment as such attorney-in-fact.
(3) Each of the Chairman.the President and the Vice Presidents of the Company is hereby authorized,for and on behalf of the Company,to appoint in writing any person the attorney-
in-fact of the Company with full power and authority to execute,for and on behalf of the Company,under the seal of the Company or otherwise,such Written Commitments of the
Company as may be specified in such written appointment,which specification may he by general type or class of Written Commitments or by specification of one or more particular
Written Commitments.
(4) Each of the Chairman.the('resident and the Vice('residents of the Company is hereby authorized,for and on behalf of the Company,to delegate in writing to any other officer of the
Company the authority to execute,for and on behalf of the Company,under the Company's seal or otherwise,such Written Commitments of the Company as are specified in such
written delegation,which specification may be by general type or class of Written Commitments or by specification of one or more particular Written Commitments.
(5) The signature of any officer or other person executing any Written Commitment or appointment or delegation pursuant to this Resolution,and the seal of the Company,maybe affixed by
facsimile on such Written Commitment or written appointment or delegation.
FURTHER RESOLVED, that the foregoing Resolution shall not be deemed to bean exclusive statement of the powers and authority of officers,employees and other persons to act for and on behalf of
the Company,and such Resolution shall not limit or otherwise affect the exercise of any such power or authority otherwise validly granted or vested."
I,Dawn M.Chloros,Assistant Secretary of WESTCHESTER FIRE INSURANCE COMPANY and ACE AMERICAN INSURANCE COMPANY(the"Companies")do hereby certify that
(i) the foregoing Resolutions adopted by the Board of Directors of the Companies are true,correct and in full force and effect,
(ii) the foregoing Power of Attorney is true,correct and in full force and effect.
Given under my hand and seals of said Companies at Whitehouse Station,NJ,this 14th Day of October, 2019
�°Offs-f.T9 ":::,t.`'9
oz.!cc. txtv:n\l Chktn .\,.i,t:mt,ccrct:u
IN THE EVEN'('YOU WISH'1'O VERIFY THE AUTHENTICITY OF THIS BOND OR NO'T'IFY US OF ANY OTHER MA'PFER,('LEASE CONTACT US AT:
Telephone(908)903-3493 Fax(908)903-3656 e-mail:surety@chubb.com
WFIC-AAIC(rev 08-18)
16A35
WESTCHESTER FIRE INSURANCE COMPANY
STATEMENT OF ASSETS,LIABIUTIES AND SURPLUS TO POLICYHOLDERS
Statutory Basis
DECEMBER 31,2018
(in thousands)
LIABILITIES AND
ASSETS SURPLUS TO POLICYHOLDERS
Cash and Short Term Investments 3 56,686 Outstanding Losses and Loss Expenses g
•
United States Government,State Reinsurance Payable on Losses and Expenses 146
and Municipal Bonds 108,524 Unearned Premiums
Other Bonds 48.200 Ceded Reinsurance Premiums Payable
Stocks 29 Other Liabilities 120,835
Other Invested Assets 9.875
TOTAL INVESTMENTS 223.314 TOTAL LIABILITIES 120,980
Investments in Affiliates - Capital Stock 5,000
Premiums Receivable Paid-In Surplus 59,856
Other Assets 115.064 Unassigned Funds 152,542
SURPLUS TO POLICYHOLDERS 217,398
TOTAL LIABILITIES AND
TOTAL ADMITTED ASSETS $ 338,378 SURPLUS $ 338,378
Investments are valued in accordance with requirements of the National Association of Insurance Commissioners,At December 31,2018,
investments with a carrying vatue of$15,689,641 were deposited with government authorities as required by law.
STATE OF PENNSYLVANIA
COUNTY OF PHILADELPHIA
John Taylor,being duly sworn,says that he is Senior Vice President of Westchester Fire Insurance Company and that to the best of his knowledge
and belief the foregoing is a true and correct statement of the said Company's financial condition as of the 31 st day of December,2018.
Sworn before met• , j L� ,
enror i -'•resi•ent
Notary Public My commi on expires
COMMONWEALTH OF PENNSYLVANIA
NOTARIAL SEAL
Diane Wright, Notary Public
City of Philadelphia, Philadelphia County
My Commission Expires Aug. 8, 2019
' EMBER,PENNSYLVANIA ASSOCIATION OF NOTAnicS