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PI-TER-DN1 (1/21) <br />Policy Number: PHPK2324258-000 <br />Named Insured: mtorres alvarez <br />PHILADELPHIA <br />INSURANCE COMPANIES <br />A Member of the Tokio Marine Group <br />Terrorism Premium (Certified Acts) $ <br />One Bala Plaza, Suite 100 <br />Bala Cynwyd, Pennsylvania 19004 <br />610.617.7900 Fax 610.617.7940 <br />PHLY.com <br />DISCLOSURE NOTICE OF TERRORISM INSURANCE COVERAGE REJECTION OPTION <br />You are hereby notified that underthe TerrorismRisk Insurance Act, as amended, you have a right to purchase insurance <br />coverage for losses resulting fromacts ofterrorism As defined in Section 102 (1) ofthe Act: The term "act ofterroristd' means <br />any act or acts that are certified by the Secretary ofthe Treasury —in consultation with the SecretaryofHomeland Security, and <br />the Attorney General of the United States-4o be an act oftezrorism; to be a violent act or an act that is dangerous to human <br />life, property, or in rastmcture; to have resulted in damage within the United States, or outside the United States in the case of <br />certain air carriers or vessels or the premises of a United States mission; and to have been committed by an individual or <br />individuals as part ofan effort to coerce the civilian p opulation ofthe United States or to influence the p ohcy or affect the conduct <br />of the United States Government by coercion. <br />YOU SHOULD KNOW THAT WHERE COVERAGE IS PROVIDED BY THIS POLICY FOR LOSSES RESULTING FROM <br />CERTIFIED ACTS OF TERRORISM, SUCH LOSSES MAYBE PARTIALLY REIMBURSED BY THE UNITED STATES <br />GOVERNMENT UNDER A FORMULA ESTABLISHED BY FEDERAL LAW. HOWEVER, YOUR POLICY MAY <br />CONTAIN OTHER EXCLUSIONS WHICH MIGHT AFFECT YOUR COVERAGE, SUCH AS AN EXCLUSION FOR <br />NUCLEAR EVENTS. UNDER THE FORMULA, THIS UNITED STATES GOVERNMENT'S FEDERAL SHARE OF <br />TERRORISM LOSSES IS 80%OF COVERED TERRORISM LOSSES EXCEEDING THE STATUTORILY ESTABLISHED <br />DEDUCTIBLE PAID BY THE INSURANCE COMPANY PROVIDING THE COVERAGE THE PREMIUM CHAR® <br />FOR THIS COVERAGE IS PROVIDED BELOW AND DOES NOT INCLUDE ANY CHARGES FOR THE PORTION OF <br />LOSS THAT MAYBE COVERED BY THE FEDERAL GOVERNMENT UNDER THE ACT. <br />YOU SHOULD ALSO KNOW THAT THE TERRORISM RISK INSURANCE ACT, AS AMENDED, CONTAINS A $100 <br />BILLION CAP THAT LIMITS U.S. GOVERNMENT REIMBURSEMENT AS WELL AS INSURERS' LIABILITY FOR <br />LOSSES RESULTING FROM CERTIFIED ACES OF TERRORISM WHEN THE AMOUNT OF SUCH LOSSES IN ANY <br />ONE CALENDAR YEAR EXCEEDS $100 BILLION. IF THE AGGREGATE INSURED LOSSES FOR ALL INSURERS <br />EXCEED $100 BILLION, YOUR COVERAGE MAYBE REDUCED. <br />Your attached proposal (or policy) includes a charge for terrorism. We will issue (or have issued) your <br />policywith terrorism coverage unlessyou decline by placing an "X" in the box below. <br />NOTE 1: If "included" is shown on your proposal (or policy) for terrorism you WILL NOT have the option to reject <br />the coverage. <br />NOTE 2: You will want to check with entities that have an interest in your organization as they may require that you <br />maintain terrorism coverage (e.g. mortgagees). <br />EXCEPTION: If you have property coverage on your policy, the following Standard Fire Policy states do not permit <br />an Insured to reject fire ensuing from terrorism: CA, CT, GA, HI, IA, IL, MA, ME, MO, NJ, NY, NC, OR, Rl, VA, <br />WA, WV, W I. Therefore, if you are domiciled in the above states and reject terrorism coverage, you will still be <br />charged for fire ensuingfrom terrorism as separately designated on your proposal. <br />Page 1 of 2 <br />RhkMouganadDMdan <br />�y REVIEWED& APPROVED r. <br />' DO <br />1®•. <br />Risk Management Marys[ <br />