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Arthur J. Gallagher Risk Management Services, LLC <br />San Francisco, CA 94105 <br />Phone: (415)546-9300 <br />City of Santa Ana <br />20 Civic Center Plaza, M-28 <br />Risk Management, 4th Floor <br />Santa Ana, CA 92701 <br />34875022 <br />7/1/2024 <br />7/8/2024 <br />RENB <br />34875025 <br />7/1/2024 <br />7/8/2024 <br />CFEE <br />34875029 <br />7/1/2024 <br />7/8/2024 <br />SLTX <br />34875033 <br />7/1/2024 <br />7/8/2024 <br />STFX <br />Excess Difference in Conditi PolicyNumber: <br />Item # <br />Trans Eff Date <br />34875047 <br />7/1/2024 <br />34875049 <br />7/1/2024 <br />34875054 <br />7/1/2024 <br />34875059 <br />7/1/2024 <br />Difference in Conditions <br />PolicyNumber: <br />Item # <br />Trans Eff Date <br />34874944 <br />7/1/2024 <br />34874952 <br />7/1/2024 <br />34874955 <br />7/1/2024 <br />34874958 <br />7/1/2024 <br />Terrorism Standalone <br />PolicyNumber: <br />Item # <br />Trans Eff Date <br />34874844 <br />7/1/2024 <br />34874846 <br />7/1/2024 <br />34874850 <br />7/1/2024 <br />PE705469 <br />Due Date <br />7/8/2024 <br />7/8/2024 <br />7/8/2024 <br />7/8/2024 <br />PLM0084424 <br />Due Date <br />7/8/2024 <br />7/8/2024 <br />7/8/2024 <br />7/8/2024 <br />W27DO7240601 <br />Due Date <br />7/8/2024 <br />7/8/2024 <br />7/8/2024 <br />Trans <br />RENB <br />CFEE <br />SLTX <br />STFX <br />Trans <br />RENB <br />CFEE <br />SLTX <br />STFX <br />Trans <br />RENB <br />SLTX <br />STFX <br />BATM11 <br />Invoice # 5195470 <br />2 of 3 <br />ACCOUNT NUMBER <br />DATE <br />SANTAANA-1 <br />7/15/2024 <br />BALANCE DUE ON <br />AMOUNT DUE <br />7/8/2024 <br />$3,473,573.47 <br />Gallagher <br />Insurance I Risk Management I Consulting <br />XS EM/FL - $5M xs $10M <br />Catastrophe Analysis Fee <br />Surplus Lines Taxes <br />Stamping Fees <br />Company: Palomar Excess and Surplus Insurance Compan Effective: 7/1/2024 <br />Description <br />XS EM/FL - $10M xs $15M <br />Catastrophe Analysis Fee <br />Surplus Lines Taxes <br />Stamping Fees <br />Company: Palms Insurance Company, Limited Effective: 7/1/2024 <br />Description <br />Primary EM/Flood - $2.5M part of $10M <br />Carrier Policy Fee <br />Surplus Lines Taxes <br />Stamping Fees <br />Company: Lloyd's Syndicate 3623 (Beazley Furlonge Limite Effective: 7/1/2024 <br />Description <br />Terrorism Standalone - $10M <br />Surplus Lines Taxes <br />Stamping Fees <br />Total Invoice Balance: <br />Please return this portion with your payment. Include your invoice number on your remittance to expedite processing. <br />City of Santa Ana <br />20 Civic Center Plaza, M-28 <br />Risk Management, 4th Floor <br />Santa Ana. CA 92701 <br />Please send your remittance to: <br />Arthur J. Gallagher Risk Management Services, LLC <br />P.O. Box 39735 <br />Chicago, IL 60694-9700 <br />$229,100.00 <br />$500.00 <br />$6,888.00 <br />$413.28 <br />to 7/1/2025 <br />Amount <br />$338,338.00 <br />$600.00 <br />$10,168.14 <br />$610.09 <br />to 7/1/2025 <br />Amount <br />$185,000.00 <br />$1, 500.00 <br />$5,595.00 <br />$335.70 <br />to 7/1/2025 <br />Amount <br />$14,200.00 <br />$426.00 <br />$25.56 <br />$3,473,573.47 <br />BATM11 <br />Invoice # 5195470 <br />ACCOUNTNUMBER DATE <br />SANTAANA-1 7/15/2024 <br />7/8/2024 $3,473,573.47 <br />AMOUNT PAID <br />PAY ONLINE AT: WWW.AJG.COM/EZPAY <br />Gallagher <br />Insurance I Risk Management I consulting <br />