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iant <br /> Invoice # 1931392 Page , of 1 <br /> 441lAccouni Number Date <br /> SEMACON-01 I 4/13/2022 <br /> BALANCE DUE ON <br /> Greenwood Village-Alliant Ins Svc Inc. 7/27/2022 <br /> AMOUNT PAID Amount Due <br /> Alliant Insurance Services, Inc. —8377 $910.00 <br /> PO Box 8377 <br /> Pasadena, CA 91109-8377 <br /> Phone: Email: <br /> SEMA Construction,Inc. Pay your Invoice via ACH <br /> 73S3 S.Eagle Street using AlliantPay: <br /> Parker,CO 80134 <br /> https;//billpay.alliant.com <br /> Insured Payment Information Only <br /> SURETY <br /> Surety Co. Policy Number(s) + Bond Type Policy Term Transaction Description Amount <br /> i <br /> I Zurich(Domestic) 9285892 I Miscellaneous Bond 6/27/2022 _ 6/27/2023 2022-2023 Renewal Business Premium $910.00 <br /> iObligee, Bond AmounL Description: <br /> Obligee:State of Colorado, Division of Reclamation, Mining and Safety-$45,500 Mining Permit-6th Ave Pkwy Borrow Pit <br /> Total Invoice Balance: �-- $910.00 <br /> PLEASE MAIL A COPY OF THIS INVOICE WITH PAYMENT <br /> REMITTANCE ADDRESS <br /> Alliant Insurance Services,Inc. 8377 <br /> PO Box 8377 <br /> Pasadena,CA 91109-8377 <br /> OVERNIGHT/COURIER ADDRESS <br /> Aliiant Insurance Services,Inc.- Lockbox#8377 <br /> Comerica Bank <br /> 5th Floor <br /> 2321 Rosecrans Ave <br /> El Segundo,CA 90245 <br /> E-mail remittances to AccountsReceivable@alliant_com, <br /> Pay your Invoice via ACH using AlliantPay https://bilipay.alliant,00m <br /> MPORTANT NOTICE: The Nonadmitted 8 Reinsurance reform act(NRRA)went into effect July 21,2011.Accordingly,surplus lines tax rates and regulations are subject to change which <br /> :ould result in an increase or decrease of the total surplus lines taxes and/or fees owed on this placement.If a change is required,we will promptly notify you.Any additional taxes and/or <br /> ees owed must be promptly remitted to Alliant Insurance Services.Inc <br /> MPORTANT NOTICE:The Foreign Account Tax Compliance Act(FATCA)requires the notification of certain financial accounts to the United States Internal Revenue Service.Alliant does <br /> iot provide tax advice.Please contact your tax consultant for your obligations regarding FATCA. <br /> Milani embraces a policy of transparency with respect to its compensation from insurance transactions.Details on our compensation policy,including the types of income Alliant may earn <br /> ,n a placement,are available at www.alliant.com. For a copy of our policy or for inquiries regarding compensation issues pertaining to your account contact:Alliant Insurance Services,Inc., <br />