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sal ;{ ?Ro`I titAAkib NWEALTH OF PENNSYLVANIA
;O � hF gfTM Of fENN6 APR 22 INSURANCE DEPARTMENT
Cjf�BERLANO A04"
PENNSYL
Harrisburg, PA April 1, 2013
Whereas, the SELECTIVE INSURANCE COMPANY OF AMERICA, located at Branchville, N.J.,
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 17 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, 1, Michael Consedine, Insurance Commissioner of the Commonwealth of
Pennsylvania, do hereby certify, in accordance with Section 1, of the Act of Assembly approved June 29,
1923 and known as act No. 373 of the Laws of 1923, that the Selective Insurance Company of America,
of Branchville, N. J., 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.
Insurance Commissioner
Ck sip U4 s1
Selective Insurance Company of America
40 SELECTIVE ® Br Wantage Avenue
Branchville, New Jersey 07890
973 - 948 -3000
STATEMENT OF FINANCIAL CONDITION
I hereby certify that the following information is contained in the Annual Statement of Selective Insurance Company of
America ( "SICA ") to the New Jersey Department of Banking and Insurance as of December 31, 2012:
ADMITTED ASSETS (in thousands) LIABILITIES AND SURPLUS (in thousands)
Bonds $ 1,054,961 Reserve for losses and loss expenses $849,414
Preferred stocks at convention value 0 Reserve for unearned premiums 269,462
Provision for unauthorized
Common stocks at convention values 103,138 reinsurance 3,753
Subsidiary common stock at Commissions payable and
convention values 0 contingent commissions 16,737
Short-term investments 1 11,103 Other accrued expenses 13,457
Mortgage loans on real estate
(including collateral loans) 37,443 Other liabilities 185,534
Other invested assets 86,685 Total liabilities 1,338,357
Interest and dividends due or accrued 11,771
369,92
Premiums receivable 233,536 Surplus as regards policyholders
Other admitted assets 69,641
Total liabilities and surplus as
Total admitted assets 1708.2._78 regards policyholders MD
1 further certify that the following is a true and exact excerpt from Article VII, Section 1 of the By -Laws of SICA, which is
still valid and existing.
The Chairman of the Board, President, Chief Executive Officer, any Executive Vice President,
any Senior Vice President or any Corporate Secretary may, from time to time, appoint attorneys
in fact, and agents to act for and on behalf of the Corporation and they may give such appointee
such authority, as his/her certificate of authority may prescribe, to sign with the Corporation's
name and seal with the Corporation's seal, bonds, recognizances, contracts of indemnity and
other writings obligatory in the nature of a bond, recognizance or conditional undertaking, and
any of said Officers may, at any time, remove any such appointee and revoke the power and
authority given him/her.
IN WITNESS WHEREOF, I hereunto subscribe my name and a the seal of SI is 11 ay of
�a t: ;� 1
S C. c. •,
Michael H. Lanz Z ; r t 1 s
SICA Corporate Secretato LW f
1926
STATE OF NEW JERSEY : �~
:ss. Branchville --- '
COUNTY OF SUSSEX '
On this ILday of 2013, before me, the undersigned officer, personally appeared Michael H. Lanza w 1116,
acknowledged himself to be the Corporate Secretary of SICA, and that he, as such Corporate Secretary, bW6ria,�
to do, executed the foregoing instrument for the purposes therein c n , by signing the name of the Qaration by' • 6�'
himself as Corporate Secretary. _ pTAg '� =
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