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California: (Attach D1 or D2) <br />Surplus Lines Broker Name: Alliant Insurance Services, Inc <br />Address of the Licensee: <br />701 B Street, 6th Floor <br />San Diego, CA 92101 <br />License number: <br />OC36861 <br />Surplus Lines Premium: <br />$200.00 <br />Surplus Lines Tax: <br />$6.00 <br />Surplus Lines Stamping Fee: <br />$0.36 <br />�� xrekM�gema�euwdon <br />ah REVIM &AwRw Elr. <br />A.�' AaV44 <br />ROW . Ruk Management SpedAist <br />