Santa Ana City Council
August 6, 2024

Arthur J. Gallagher Risk Management Services, LLC BATMI1San Francisco, CA 94105Invoice #51954701 of 3Phone:(415)546-9300 ACCOUNT NUMBER DATESANTAANA-17/15/2024 BALANCE DUE ON AMOUNT DUE7/8/2024$3,473,573.47 City of Santa Ana20 Civic Center Plaza, M-28Risk Management, 4th FloorSanta Ana, CA 92701Excess Workers CompPolicyNumber:ABL100000805Company:Response Indemnity Company of CaliforniaEffective:7/1/2024to7/1/2025 Item #Trans Eff DateDue DateTransDescriptionAmount 348748687/1/20247/8/2024RENBWC Buffer - $500K xs $1.5M SIR$300,027.00Difference in ConditionsPolicyNumber:ESP30001763404Company:Endurance American Specialty Ins CoEffective:7/1/2024to7/1/2025 Item #Trans Eff DateDue DateTransDescriptionAmount 348749127/1/20247/8/2024RENBPrimary EM/Flood - $5M part of $10M$370,000.00 348749167/1/20247/8/2024SLTXSurplus Lines Taxes$11,100.00 348749197/1/20247/8/2024STFXStamping Fees$666.00Excess LiabilityPolicyNumber:IXG677029ACompany:General Star Indemnity CompanyEffective:7/1/2024to7/1/2025 Item #Trans Eff DateDue DateTransDescriptionAmount 349828837/1/20247/15/2024RENBExcess Liability Buffer - $1M xs $2M SIR$1,750,000.00 349828857/1/20247/15/2024SLTXSurplus Lines Taxes - CA$52,500.00 349828877/1/20247/15/2024STFXStamping Fees - CA$3,150.00Difference in ConditionsPolicyNumber:LHD944859Company:Landmark American Insurance CompanyEffective:7/1/2024to7/1/2025 Item #Trans Eff DateDue DateTransDescriptionAmount 348749687/1/20247/8/2024RENBPrimary EM/Flood - $2.5M part of $10M$185,000.00 348749707/1/20247/8/2024CFEECarrier Policy Fee$1,500.00 348749847/1/20247/8/2024SLTXSurplus Lines Taxes$5,595.00 348749897/1/20247/8/2024STFXStamping Fees$335.70Excess Difference in ConditiPolicyNumber:MCQ0101224Company:Mt Hawley Insurance CompanyEffective:7/1/2024to7/1/2025 Item #Trans Eff DateDue DateTransDescriptionAmountPlease return this portion with your payment. Include your invoice number on your remittance to expedite processing. BATMI1City of Santa AnaInvoice #519547020 Civic Center Plaza, M-28Risk Management, 4th FloorSanta Ana, CA 92701 ACCOUNTNUMBER DATESANTAANA-17/15/2024 BALANCE DUE ON AMOUNT DUE7/8/2024$3,473,573.47 AMOUNT PAIDPlease send your remittance to:Arthur J. Gallagher Risk Management Services, LLCP.O. Box 39735Chicago, IL 60694-9700 PAY ONLINE AT: WWW.AJG.COM/EZPAY
Arthur J. Gallagher Risk Management Services, LLC BATMI1San Francisco, CA 94105Invoice #51954702 of 3Phone:(415)546-9300 ACCOUNT NUMBER DATESANTAANA-17/15/2024 BALANCE DUE ON AMOUNT DUE7/8/2024$3,473,573.47 City of Santa Ana20 Civic Center Plaza, M-28Risk Management, 4th FloorSanta Ana, CA 92701 348750227/1/20247/8/2024RENBXS EM/FL - $5M xs $10M$229,100.00 348750257/1/20247/8/2024CFEECatastrophe Analysis Fee$500.00 348750297/1/20247/8/2024SLTXSurplus Lines Taxes$6,888.00 348750337/1/20247/8/2024STFXStamping Fees$413.28Excess Difference in ConditiPolicyNumber:PE705469Company:Palomar Excess and Surplus Insurance CompanEffective:7/1/2024to7/1/2025 Item #Trans Eff DateDue DateTransDescriptionAmount 348750477/1/20247/8/2024RENBXS EM/FL - $10M xs $15M$338,338.00 348750497/1/20247/8/2024CFEECatastrophe Analysis Fee$600.00 348750547/1/20247/8/2024SLTXSurplus Lines Taxes$10,168.14 348750597/1/20247/8/2024STFXStamping Fees$610.09Difference in ConditionsPolicyNumber:PLM0084424Company:Palms Insurance Company, LimitedEffective:7/1/2024to7/1/2025 Item #Trans Eff DateDue DateTransDescriptionAmount 348749447/1/20247/8/2024RENBPrimary EM/Flood - $2.5M part of $10M$185,000.00 348749527/1/20247/8/2024CFEECarrier Policy Fee$1,500.00 348749557/1/20247/8/2024SLTXSurplus Lines Taxes$5,595.00 348749587/1/20247/8/2024STFXStamping Fees$335.70Terrorism StandalonePolicyNumber:W27D07240601Company:Lloyd's Syndicate 3623 (Beazley Furlonge LimiteEffective:7/1/2024to7/1/2025 Item #Trans Eff DateDue DateTransDescriptionAmount 348748447/1/20247/8/2024RENBTerrorism Standalone - $10M$14,200.00 348748467/1/20247/8/2024SLTXSurplus Lines Taxes$426.00 348748507/1/20247/8/2024STFXStamping Fees$25.56Total Invoice Balance:$3,473,573.47Please return this portion with your payment. Include your invoice number on your remittance to expedite processing. BATMI1City of Santa AnaInvoice #519547020 Civic Center Plaza, M-28Risk Management, 4th FloorSanta Ana, CA 92701 ACCOUNTNUMBER DATESANTAANA-17/15/2024 BALANCE DUE ON AMOUNT DUE7/8/2024$3,473,573.47 AMOUNT PAIDPlease send your remittance to:Arthur J. Gallagher Risk Management Services, LLCP.O. Box 39735Chicago, IL 60694-9700 PAY ONLINE AT: WWW.AJG.COM/EZPAY
Arthur J. Gallagher Risk Management Services, LLC BATMI1San Francisco, CA 94105Invoice #51954703 of 3Phone:(415)546-9300 ACCOUNT NUMBER DATESANTAANA-17/15/2024 BALANCE DUE ON AMOUNT DUE7/8/2024$3,473,573.47 City of Santa Ana20 Civic Center Plaza, M-28Risk Management, 4th FloorSanta Ana, CA 92701 Please return this portion with your payment. Include your invoice number on your remittance to expedite processing. BATMI1City of Santa AnaInvoice #519547020 Civic Center Plaza, M-28Risk Management, 4th FloorSanta Ana, CA 92701 ACCOUNTNUMBER DATESANTAANA-17/15/2024 BALANCE DUE ON AMOUNT DUE7/8/2024$3,473,573.47 AMOUNT PAIDPlease send your remittance to:Arthur J. Gallagher Risk Management Services, LLCP.O. Box 39735Chicago, IL 60694-9700 PAY ONLINE AT: WWW.AJG.COM/EZPAY