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Aifiant <br />Alliant Insurance Services, Inc. <br />Newport Beach - Alliant Insurance Services, Inc. <br />1301 Dove Street, Ste. 200 <br />Newport Beach <br />CA 92660-2436 <br />Phone: (949) 756-0271 <br />City of Santa Ana <br />PO Box 1988 <br />Santa Ana, CA 92702 <br />Client: City of Santa Ana <br />Policy Number: SEP41026 <br />Insurance Carrier: Evanston Insurance Company <br />Item # <br />Trans Eff Data <br />3279214 <br />1/1/2018 <br />3279215 <br />1/1/2018 <br />3279216 <br />1/1/2018 <br />3279217 <br />1/1/2018 <br />3279218 <br />1/1/2018 <br />Invoice # 869837 <br />Page 1 of 1 <br />ACCOUNTNUMBER --- <br />1 DATE ..J <br />SANTANA-08 <br />_ <br />6/28/2018 <br />aAL NCE DUE ON ___T <br />AGENCYCODE <br />7/28/2018 <br />200 <br />AMOUNTPAID <br />AMOUNT DUE <br />$1, 395.00 <br />Special Events Program <br />Policy: Special Event Liability <br />Effective: 1/1/2018 to 1/1/2019 <br />Due Data <br />Trans <br />Description <br />7/28/2018 <br />ENDT - <br />Premium 4th of July Celebration <br />7/28/2018 <br />SURT <br />Surplus Lines Taxes <br />7/28/2018 <br />SURF <br />Surplus Lines Stamping Fees <br />7/28/2018 <br />OFEE <br />Other Fees & Services <br />7/28/2018 <br />BNKF <br />Bank Fee <br />Total Invoice Balance: <br />Amount <br />$1,298.61 <br />$38.96 <br />$2.60 <br />$12.98 <br />$41.85 <br />$1,395.00 <br />IMPORTANT NOTICE: The Nonadmitted & Reinsurance reform act (NRRA) went into effect July 21, 2011. Accordingly, surplus lines tax rates and <br />regulations are subject to change which could result in an increase or decrease of the total surplus lines taxes and/or fees owed on this placement. If a <br />change is required, we will promptly notify you. Any additional taxes and/or fees owed must be promptly remitted to Alliant Insurance Services, Inc. <br />IMPORTANT NOTICE: The Foreign Account Tax Compliance Act (FATCA) requires the notification of certain financial accounts to the United States Internal <br />Revenue Service. Alliant does not provide tax advice. Please contact your tax consultant for your obligations regarding FATCA. <br />Alliant embraces a policy of transparency with respect to its compensation from insurance transactions. Details on our compensation policy, including the <br />types of income Alliant may earn on a placement, are available at www.alliant.com. For a copy of our policy or for inquiries regarding compensation issues <br />pertaining to your account contact: Alliant Insurance Services, Inc., Attn: General Counsel, 701 B St., 6th Floor, San Diego, CA 92101 <br />