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COMMONWEALTH OF PENNSYLVANIA
INSURANCE DEPARTMENT
Harrisburg, P A April 1, 2001
Whereas, the PACIFIC INDEMNITY COMPANY, located at Milwaukee, Wisconsin, has filed in this
Department a certified copy of its charter and a detailed statement of its Assets and Liabilities,
and otherwise complied with the requirements of Section 661 of the Act of Assembly of the Commonwealth of
Pennsylvania, entitled "An act relating to insurance; amending, revising and consolidating the Law &c.,"
approved the 17th day of May, A.D. 1921, as well as with the requirements of the laws of this Commonwealth
applicable to such company in doing business herein.
Now Therefore, I, M. Diane Koken, Insurance Commissioner of the Commonwealth of Pennsylvania, do
hereby certify, in accordance with Section I, ofthe Act of Assembly approved June 29, 1923 and known as act
No. 373 of the Laws of 1923, that the Pacific Indemnity Company, of Milwaukee, Wisconsin, is duly
authorized to become and be accepted as sole surety on all bonds, undertakings and obligations required or
permitted by law or the ordinances, rules or regulations of any municipality, board, body, organization, or
public officer.
In Witness Whereof, I have hereunto set my hand and
affixed my official seal, the day and year first above written.
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PACIFIC INDEMNITY COMPANY
STATEMENT OF ASSETS, LIABILITIES AND SURPLUS TO POLICYHOLDERS
Statutory Basis
DECEMBER 31, 2000
(in thousands of dollars)
LIABILITIES
AND
SURPLUS TO POLICYHOLDERS
ASSETS
$ (4,864)
Cash ..........................,................................
United States Government, State and
Municipal Bonds ......................................
Other Bonds ...............................................
Stocks .................... .... ...................... ...........
Short Term Investments..............................
Other Invested Assets ................................
Outstanding Losses and Loss Expenses.....
Unearned Premiums ....................................
Provision for Reinsurance ............................
Other Liabilities................. .......... ..................
$ 1,496,691
470,370
13,396
61,309
1,888,997
301,969
29,425
6,686
66,893
TOTAL INVESTMENTS ...........................
2,289,106
TOTAL LIABILITIES ...................................
2,041,766
Investments in Affiliates ..............................
Net premiums Receivable ..........................
Other Assets ...............................................
40,426
156,065
89,169
Capttal Stock ................................................
Paid-In Surplus ..... ...................... ..................
Unassigned Funds .......................................
Unrealized Appreciation of Investments .......
5,535
110,020
415,931
1,514
SURPLUS TO POLICYHOLDERS ............
533,000
TOTAL LIABILITIES AND SURPLUS
TO POLICYHOLDERS ........................... $ 2,574,766
TOTALADMITTED ASSETS .................... $ 2,574.766
Investments are valued in accordance wtth requirements of the National Association of Insurance Commissioners.
Investments vaiued at $6,944 are depostted wtth govemment authorities as required by law.
A CORRECT STATEMENT:
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KAREN A. PRICE
Notary Public, Stata of New Jersay
No. 2231647
Commission Expires Oct. 28. 2004
Form 2.7.11J-1J07~ (Rev. 4-01)
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