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15.08.2019 15:22 17145999996 #0217 P 7/19 W es FARMERS INSURANCE California Offer of Terrorism Coverage Namedlnsured;ERIC GRUVER AgentNumber:97-15-520 Address; 2021 E FOURTH STE 116 Policy Number:01504-40-07 SANTA ANA CA 92705 Q� Read Carefully Before Signing DearValued Customer, (V v Our records indicate that you a pre iously declined coverage for "Certified Acts of Terrorism." Effectivejanuary1,2015th deralTerr rismRisk insurance Act defines a"certified act of terrorism" as an act that is certified eSecretar ftheTreasury,inaccordance with the provisions ofthe Act tobe an act of terrorism. a criteria co tained in the Terrorism Risk Insurance Act for a "certified act of terrorism"inclu hefollowing: 1. The act,rofulted in insured losses in excess of $5 million in the aggregate, attributable to all types of insupricesubjecttotheTerrorismRiskInsuranceAct;and 7_yRe act is a violent act or an act that is dangerous to human life, property or infrastructure and is committed by an Individual or Indlvlduals as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of Its government bycoercion. You should know that coverage for losses caused by "certified acts of terrorism" is partially reimbursed by the United States government under a formula established by federal law. Under this formula, the U.S. government pays a percentage of covered terrorism losses exceeding the statutorily established deductible paid by the insurer providing the coverage. The Act contains a $100 billion cap that limits government reimbursement and insurer liability for losses resulting from Certified Acts of Terrorism when the amount of such losses in anyone calendar year exceeds S100 billion. If the aggregate insured losses for all insurersexceed $100 billion, terrorism coverage may be reduced. The premium charged for this coverage does not include any charges for the portion of loss covered by the federal government under the Act. The premium cost for such coverage for "certified acts of terrorism" Is calculated as a percentage of our final premium for certain coverages, per the following schedule: Coverage Los Angeles, Orange and All OtherCountles San Francisco Counties Property 1.5% 1.0% General Liability 1.5% 1.0% Umbrella 1.0% 1-0% In no event will the premium be greater than 1.5%of your property/ Iiabillty premium. You have the right to Include this coverage for "certified acts of terrorism." If you choose to do so, you must sign this form and return It In the enclosed envelope within 30 days of the effective date of this policy. No Reply Is Necessary To Decline This Offer. I ACCEPT "Certified Acts of Terrorism" coverage. Signatu Date UA. 14 A 25-6301 1-15 Sign And Keep This Copy With Your policy A6301301 page I of 1