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* S9 * 06/11/2021 * GLP 3961460 00 GREAT AMERICAN ASSURANCE COMPANY <br />*D/B* 072977484 262428 <br />IL 73 68 (Ed. 01/20) <br />THIS ENDORSEMENT IS ATTACHED TO AND MADE PART OF YOUR POLICY IN <br />RESPONSE TO THE DISCLOSURE REQUIREMENTS OF THE TERRORISM RISK <br />INSURANCE ACT. THIS ENDORSEMENT DOES NOT GRANT ANY COVERAGE OR <br />CHANGE THE TERMS AND CONDITIONS OF ANY COVERAGE UNDER THE POLICY. <br />DISCLOSURE PURSUANT TO TERRORISM RISK INSURANCE ACT <br />Schedule <br />Schedule - Part I <br />Terrorism Premium (Certified Acts) $ 0 . 00 <br />This premium is the total Certified Acts premium attributable to the following Coverage Part(s), Coverage Form(s) <br />and/or Policy(ies): GLP 396 - 1 4 - 60 - 00 <br />Additional information, if any, concerning the terrorism premium: <br />Schedule - Part II <br />Federal share of terrorism losses is 80% <br />(Refer to Paragraph B. in this endorsement.) <br />Information required to complete this Schedule, if not shown above, will be shown in the Declarations. <br />A. Disclosure of Premium <br />In accordance with the federal Terrorism Risk Insurance Act, we are required to provide you with a notice <br />disclosing the portion of your premium, if any, attributable to coverage for terrorist acts certified under the <br />Terrorism Risk Insurance Act. The portion of your premium attributable to such coverage is shown in the <br />Schedule of this endorsement or in the policy Declarations. <br />Includes copyrighted material of Insurance Services Office, Inc., with it <br />IL 73 68 (Ed. 01/20) (Page 1 of 2) <br />HORaN <br />� z <br />RiskMmWmentDMsian <br />REVIEWED & APPROVED BY.- <br />f R. V;d <br />Risk Management Analyst <br />