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POLICYNUMBER: <br />68TCNGQ:797 <br />THISENDORSEMENTISATTACHEDTOANDMADEPARTOFYOURPOLICYIN <br />RESPONSETOTHEDISCLOSUREREQUIREMENTSOFTHETERRORISMRISK <br />INSURANCEACT. <br />DISCLOSUREPURSUANTTOTERRORISMRISK <br />INSURANCEACT <br />SCHEDULE <br />TerrorismPremium: <br />$ <br />%4/11 <br />A.DisclosureOfPremium <br />UnitedStatesortoinfluencethepolicyor <br />affecttheconductoftheUnitedStates <br />InaccordancewiththefederalTerrorismRisk <br />Governmentbycoercion <br />InsuranceAct,asamended(TRIA),wearerequired <br />C.DisclosureOfFederalShareOfTerrorism <br />toprovideyouwithanoticedisclosingtheportionof <br />Losses <br />yourpremium,ifany,attributabletocoveragefor <br />"certifiedactsofterrorism"underTRIA.Theportion <br />TheUnitedStatesDepartmentoftheTreasurywill <br />ofyourpremiumattributabletosuchcoverageis <br />reimburseinsurersforaportionofinsuredlosses, <br />shownintheScheduleofthisendorsement. <br />asindicatedinthetablebelow,attributableto <br />B. <br />Thefollowingdefinitionisaddedwithrespecttothe <br />"certifiedactsofterrorism"underTRIAthatexceeds <br />provisionsofthisendorsement: <br />theapplicableinsurerdeductible: <br />1.A"certifiedactofterrorism"meansanactthatis <br />CalendarYearFederalShareof <br />certifiedbytheSecretaryoftheTreasury,in <br />TerrorismLosses <br />accordancewiththeprovisionsofTRIA,tobe <br />201585% <br />anactofterrorismunderTRIA.Thecriteria <br />containedinTRIAfora"certifiedactof <br />201684% <br />terrorism"includethefollowing: <br />201783% <br />a. <br />Theactresultsininsuredlossesinexcess <br />201882% <br />of$5millionintheaggregate,attributableto <br />201981% <br />alltypesofinsurancesubjecttoTRIA;and <br />b.TheactresultsindamagewithintheUnited <br />2020orlater80% <br />States,oroutsidetheUnitedStatesinthe <br />caseofcertainaircarriersorvesselsortheHowever,ifaggregateindustryinsuredlossesunder <br />premisesofanUnitedStatesmission;andTRIAexceed$100billioninacalendaryear,the <br />Treasuryshallnotmakeanypaymentforany <br />c. <br />Theactisaviolentactoranactthatis <br />portionoftheamountofsuchlossesthatexceeds <br />dangeroustohumanlife,propertyor <br />$100billion.TheUnitedStatesgovernmenthasnot <br />infrastructureandiscommittedbyan <br />chargedanypremiumfortheirparticipationin <br />individualorindividualsaspartofaneffort <br />coveringterrorismlosses. <br />tocoercethecivilianpopulationofthe <br />FormSS83760115Page1of2 <br />©2015,TheHartford <br /> <br />(IncludescopyrightedmaterialoftheInsuranceServicesOffice,Inc.,withitspermission.) <br /> <br />