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UH3 A664942 07 1001631 <br />THIS NOTICE IS PROVIDED IN RESPONSE TO THE DISCLOSURE REQUIREMENTS OF THE <br />TERRORISM RISK INSURANCE ACT. THIS NOTICE DOES NOT GRANT COVERAGE OR CHANGE THE <br />TERMS AND CONDITIONS OF COVERAGE UNDER THE POLICY. IF THERE IS A CONFLICT BETWEEN <br />THIS NOTICE AND THE POLICY, THE PROVISIONS OF THE POLICY SHALL APPLY. <br />DISCLOSURE PURSUANT TO TERRORISM RISK INSURANCE ACT <br />SCHEDULE <br />DISCLOSURE OF PREMIUM: <br />Total Terrorism Premium $ 0 <br />Fire Following Premium $ <br />Other than Fire Following Premium $ <br />Disclosure of Terrorism Coverage Available <br />You are hereby notified that under the Terrorism Risk Insurance Act, as amended, you have a right to purchase <br />insurance coverage for losses resulting from "acts of terrorism" defined in Section 102(1) of the Act as follows: <br />Any act or acts that are certified by the Secretary of the Treasury, in accordance with the <br />provisions of the federal Terrorism Risk Insurance Act, to be an act of terrorism; to be a violent <br />act or an act that is dangerous to human life, property, or infrastructure; to have resulted in <br />damage within the United States, or outside the United States in the case of certain air carriers or <br />vessels or the premises of a United States mission; and to have been committed by an individual <br />or individuals, as part of an effort to coerce the civilian population of the United States or to <br />influence the policy or affect the conduct of the United States Government by coercion. <br />The premium charged for this coverage is provided in the SCHEDULE above and does not include any charges <br />for the portion of loss that may be covered by the Federal Government as described below. This premium has <br />been added to your policy and unless this form is signed and returned to us to reject terrorism coverage, <br />coverage for Certified Acts of Terrorism is provided by your policy. <br />Your policy may contain other exclusions which could affect your coverage, such as an exclusion for Nuclear <br />Events or Pollution. Please read your policy carefully. <br />Note for Commercial Propertv or Commercial Inland Marine Policvholders in Standard Fire States: <br />In Standard Fire states, terrorism exclusions make an exception for (and therefore provide coverage for) fire <br />losses resulting from an act of terrorism. Any policyholder with a location that we insure in a Standard Fire State <br />that rejects our offer of terrorism coverage in this form will still have coverage with us for fire losses resulting from <br />an act of terrorism. <br />Explanation of Premium <br />If a dollar amount is shown for Fire Following Premium in the SCHEDULE above that means we insure a location <br />of yours in a Standard Fire State. Fire Following Premium is shown in the SCHEDULE above regardless of <br />whether a policyholder with a location that we insure in a Standard Fire State accepts or rejects terrorism <br />coverage with us. Fire Following Premium represents the charge for the coverage we provide for fire losses <br />resulting from acts of terrorism. Fire Following Premium does not include Other Than Fire Following Premium. All <br />Other Than Fire Following Premium is shown in the Other Than Fire Following Premium field in the SCHEDULE <br />above. <br />If a dollar amount is shown for Other Than Fire Following Premium in the SCHEDULE <br />have accepted terrorism coverage with us. Other Than Fire Following Premium rep <br />terrorism coverage. Other Than Fire Following Premium does not include Fire Following <br />all Fire Following Premium is shown in the Fire Following Premium field in the SCHEDU f <br />401-1374 12 20 Includes copyrighted material of Insurance Services Office, Inc., with its permi <br />above that means you <br />esents the charge for <br />'remium. If applicable, <br />Ride Muagmad DlMsian <br />E <br />REVIEWED & APPROVED BY: <br />e Aeevaa <br />'�--'Rfsk Management Specialist <br />