2005-17•
***Replaces Bond 5297199*~`*
LICENSE BOND
Bond Number: 557653
•
•
KNOW ALL MEN BY THESE PRESENTS, that we, Onyx Waste Services Southeast, Inc., 109 Sampey
Road, Groveland, FL 34736, as Principal, and Evergreen National Indemnity Company, 6140 Parkland
Boulevard, Suite 300, Cleveland, Ohio 44124, as Surety, are held and firmly bound unto the City of
Cle_r_mont, 924 W. Minneola Avenue, Clermont, FL 34712, as Obligee, in the penal sum of FIVE
THOUSAND AND 00/100 DOLLARS ($5,000.00) for the payment of which we jointly and severally bind
ourselves, our heirs, executors, successors and assigns.
WHEREAS, the Principal has applied for a Scavenger License for the term beginning July 1, 2005 and
ending July 1, 2006, and this bond is to cover the term of said License.
NOW, THEREFORE, the condition of this obligation is such that if the aforesaid Principal shall indemnify
and save harmless the Obligee against loss to which the Obligee may be subject by reason of the
Principal's breach of any ordinance, rule or regulation relating to the above described license, then this
obligation shall be null and void, otherwise to remain in full force and effect.
PROVIDED, however, that the liability of the Surety hereunder shall in no event exceed the penal sum of
this bond as stated above.
It is further understood and agreed that if the Surety shall so elect, the bond may be cancelled by giving
thirty (30) days notice in writing to the Obligee. This bond may be extended for additional terms at the
option of the Surety by Continuation Certificate executed by the Surety.
Signed, sealed and dated this 15th day of June 2005.
Onyx Waste Services Southeast, Inc.
Princip I
By:
Henry P. ha s, Assistant Treas~~~^r
By: I ' ~~~
eidi J. Pot
Evergreen National Indemnity Company
Surety ~'~~`4'
~;
By:
Nicole Skedel, Attorney-in-F~ct ,
B i~
Y
Maria Jackson `"
EVERGREEN NATIONAL INDEMNITY COMPANY
` COLUMBUS, OHIO
POWER OF ATTORNEY
.PRINCIPAL Onyx [-7aste Services Southeast., Inc. EFFECTIVE DATE July 1, 2005
CONTRACT AMOUNT AMOUNT OF BOND $ 5 ~ 000.00
POWER NO. ~ ~ 7 `,
KNOW ALL MEN BY THESE PRESENTS: That the Evergreen National Indemnity Company, a corporation in the State of Ohio does
hereby nominate, constitute and appoint:
Maria Jackson, Kathleen P. Price, Nicole Skedel, Patricia A. Temple
its true and lawful Attorney(s)-In-Fact to make, execute, attest, seal and deliver for and on its behalf, as Surety, and as its act and deed,
where required, any and all bonds, undertakings, recognizances and written obligations in the nature thereof, PROVIDED, however, that the
obligation of the Company under this Power of Attorney shall not exceed One Million Five Hundred Thou sand Dollars ($1,500,000.00).
This Power of Attorney is granted and is signed by facsimile pursuant to the following Resolution adopted by its Board of Directors on the
23rd day of July, 2004:
"RESOLVED, That any two officers of the Company have the authority to make, execute and deliver a Power of Attorney constituting as
Attorney(s)-in-fact such persons, firms, or corporations as may be selected from time to time.
FURTHER RESOLVED, that the signatures of such officers and the Seal of the Company may be affixed to any such Power of Attorney
or any certificate relating thereto by facsimile; and any such Power of Attorney or certificate bearing such facsimile signatures or
facsimile seal shall be valid and binding upon the Company; and any such powers so executed and certified by facsimile signatures and
facsimile seal shall be valid and binding upon the Company in the future with respect to any bond or undertaking to which it is attached."
IN WITNESS WHEREOF, the Evergreen National Indemnity Company has caused its corporate seal to be affixed hereunto, and these
presents to be signed by its duly authorized officers this 151h day of September, 2004.
EVERGREEN NATIONAL INDEMNITY COMPANY
~,y.I INOfM ~(K,~~G.~ ~~(.I~~
• ~G~AppgiTF\~,~ Roswell P. Ellis, President
w a,
SEAL~,a, I,tA. ~ ~~/
~ ~~ 193a /r?~
~y*oH~o., Craig L. tout, Vice President
Notary Public)
State of Ohio) SS:
On this 151h day of September, 2004, before the subscriber, a Notary for the State of Ohio, duly commissioned and qualified,
personally came Roswell P. Ellis and Craig L. Stout of the Evergreen National Indemnity Company, to me personally known to be the
individuals and officers described herein, and who executed the preceding instrument and acknowledged the execution of the same and
being by me duly sworn, deposed and said that they are the officers of said Company aforesaid, and that the seal affixed to the preceding
instrument is the Corporate Seal of said Company, and the said Corporate Seal and signatures as officers were duly affixed and subscribed
to the said instrument by the authority and direction of said Corporation, and that the resolution of said Company, referred to in the
preceding instrument, is now in force.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my official seal at Columbus, Ohio, the day and year above
written.
4'p1A1 SF
_° ,.~ . '' SUE E. DUFFY ~ -' _ ~ l~~C ~// ~Lf _
MCiAB'{Pp9llC. STAFE Of OHIG ~~ ~ ~ "~"
~,r o IAiCUMhUSS10NfXPIRESAUG.5,2I109
''F.oJ Notary Public State of Ohio
State of Ohio) SS: My Commission expires August 5, 2009
I, the undersigned, Secretary of the Evergreen National Indemnity Company, a stock corporation of the State of Ohio, DO HEREBY
CERTIFY that the foregoing Power of Attorney remains in full force and has not been revoked; and furthermore that the Resolution of the
Board of Directors, set forth herein above, is now in force.
Signed and sealed in Columbus, Ohio this 15t.h day of Jane 2005 ~
. Via"''"NO~+,,~ Curt C. Anderson, Secretary
W °o~~R";TF~'~~ Any reproduction or facsimile of this form is void and invalid.
• ~;~
~ ~ SE~// tea!
~.~~ /8~9/ Y= ..
'- OHlO ~/
~~
•
EVERGREEN NATIONAL INDEMNITY CC~-MPANY
EVERGREEN NATIONAL INDEMNITY COMPANY
Certificate
2004
The following financial information was excerpted from the Statutory Annual Statement filed by
Evergreen National Indemnity Company with the Ohio Department of Insurance on March 1, 2005.
STATEMENT OF tNCOME
Direct Written Premium $ 30,624,973
Reinsurance Assumed 9,896,759
Reinsurance Ceded 19,329,001
Net Written Premium 1,399,213
Chan e in Unearned 6,454,555
Net Earned Premium 7,853,768
Losses &LAE incurred 1,190,445 '
Commission Ex ense 3,445,438
Other Ex enses 2,488,943
Underwritin Loss 728,942
Investment Gain 1,182,626
Other Income/ Ex ense 39,973
Income Before FIT 1,871,595
Federal Income Tax 94,700
Net income $ 1,966,295
BALANC E SHEET
Assets
Invested Assets $ 39,992,365
A ents' Balances 1,721,439
Reinsurance Recoverable 1,979,195
Other Assets 4,320,624
Total Assets $ 48,013,623
Liabilities & Sur lus
Unearned Premium Reserve $ 2,568,178
Loss &LAE Reserves 3,391,917
Other Liabilities 12,001,090
Total Liabilities 17,9fi1,185
Surplus
Total Liabilities and Sur lus
$ 30,052,438
48,013,623
I hereby certify that the above information is that contained in the Statutory Annual Statement
filed by Evergreen National Indemnity Company with the Ohio Department of Insurance for the year
endin December 31, 2004. w--
~~ L INOFMy
' 2R PORAT ~~~
Gp~•~ ~ n
Roswell P. Ellis President & Secrets ` "' ~j~~ ; i
• ry i o 5E~ a'~
~~'~ 18 ~~~tr
'~ OH`0 ~~
2800 Corporate Exchange Drive, Suite 130 ~ Co{umbus,flhio 43231 ~ 614.839.1 S00 Office ~ 614.839.1810 Fax ~ www.evergreen-naHonaLcom