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DocuSign Envelope ID: 17405374-3F52-4EE3-A40B-COBD1 EOB0058 <br /> R ESPONSE TO RFQ#5328 FOR INSURANCE BROKER AND RM CONSULTING SERVICES <br /> ORANGE COUNTY,NC I SEPTEMBER 30,2021 <br /> APPENDIX <br /> DISCLOSURES <br /> A. Surplus Lines Fees and Taxes. In certain circumstances, placement of insurance services made by <br /> Alliant Insurance Services, Inc. ("Alliant") on behalf of a client, with the prior approval of that client, <br /> may require the payment of surplus lines assessments, taxes, and/or fees to state regulators, <br /> boards, and associations. Such assessments, taxes, and/or fees will be charged to the client and <br /> identified separately on invoices covering these placements. The client shall be responsible for all <br /> such assessments, taxes, and fees, whether or not separately invoiced. Alliant shall not be <br /> responsible for the payment of any such fees,taxes, or assessments, except to the extent such fees, <br /> taxes or assessments have already been collected from the client. <br /> B. Third Party Brokers. Alliant may determine from time to time that it is necessary or appropriate <br /> to utilize the services of third party brokers (such as surplus lines brokers, underwriting managers, <br /> London market brokers, and reinsurance brokers)to assist in marketing the insurance programs of <br /> a client. These third party brokers may be affiliates of Alliant (e.g., other companies of Alliant that <br /> provide services other than those included within the scope of services covered in this proposal), <br /> or may be unrelated third party brokers. Compensation to such third party brokers will not be part <br /> of Alliant's fee. <br /> C. Indirect Income. "INDIRECT INCOME" means insurance carrier contingency arrangements.Alliant <br /> will accept these compensation incentives from insurers, if any, including contingent commissions, <br /> market service agreements (MSA), volume-based commission incentives and rebates on business <br /> placed on behalf of a client. Alliant producers who solicit, negotiate, or place insurance products, <br /> or services for clients, do not negotiate indirect income agreements with the carriers, nor do they <br /> receive any portion of the indirect income paid to Alliant. Nonetheless, the client may opt-out of <br /> having its premiums included in the calculation of indirect income by accessing the "opt-out"form <br /> from the link on Alliant's website: http://alliantinsurance.com/Legal-Notices/Pages/Disclosure- <br /> Policy.aspx. The "opt out" provision applies only to those accounts served directly by Alliant as a <br /> retail agent or broker. It does not apply to account placements for which Alliant's role is that of a <br /> wholesaler, MGA, or program administrator working with non-Alliant brokers who represent the <br /> client. Indirect Income, if any, is determined by insurance carriers, and if the client does not opt- <br /> out, it remains the carriers' exclusive decision to include or exclude certain premiums in any <br /> calculation. The availability of information regarding the make-up of any indirect income payment <br /> is at the carrier's discretion. <br /> D. Alliant Specialty Insurance Services (ASIS). In addition to the compensation that Alliant receives <br /> for providing services to a client, its related entity, Alliant Specialty Insurance Services (ASIS) and <br /> its underwriting operations, Alliant Underwriting Services (AUS), may receive compensation from <br /> Alliant and/or carriers for providing underwriting services. The financial impact of the <br /> compensation received by ASIS is a cost included in the premium. Compensation received by ASIS <br /> will be disclosed in writing to a client.Alliant and ASIS maintain an arm's length relationship.While <br /> Alliant represents a client as an individual entity, ASIS independently administers its program as a <br /> whole and not on behalf of any particular member. <br /> Affiant <br /> -62 - <br />