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Hanover Jnsurance Croup- OH3A140814 1001637 THIS NOTICE IS PROVIDED IN RESPONSE TO THE DISCLOSURE REQUIREMENTS OF THE TERRORISM RISK INSURANCE ACT. THIS NOTICE DOES NOT GRANT COVERAGE OR CHANGE THE TERMS AND CONDITIONS OF COVERAGE UNDER THE POLICY. IF THERE IS A CONFLICT BETWEEN THIS NOTICE AND THE POLICY, THE PROVISIONS OF THE POLICY SHALL APPLY. DISCLOSURE PURSUANT TO TERRORISM RISK INSURANCE ACT SCHEDULE DISCLOSURE OF PREMIUM: Total Terrorism Premium $ 50.00 Fire Following Premium $ 15.00 Other than Fire Following Premium $ 10.00 Disclosure of Terrorism Coverage Available You are hereby notified that under the Terrorism Risk Insurance Act, as amended, you have a right to purchase insurance coverage for losses resulting from "acts of terrorism" defined in Section 102(1) of the Act as follows: Any act or acts that are certified by the Secretary of the Treasury, in accordance with the provisions of the federal Terrorism Risk Insurance Act, to be an act of terrorism; to be a violent act or an act that is dangerous to human life, property, or infrastructure; to have resulted in damage within the United States, or outside the United States in the case of certain air carriers or vessels or the premises of a United States mission; and to have been committed by an individual or individuals, as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion. The premium charged for this coverage is provided in the SCHEDULE above and does not include any charges for the portion of loss that may be covered by the Federal Government as described below. This premium has been added to your policy and unless this form is signed and returned to us to reject terrorism coverage, coverage for Certified Acts of Terrorism is provided by your policy. Your policy may contain other exclusions which could affect your coverage, such as an exclusion for Nuclear Events or Pollution. Please read your policy carefully. Note for Commercial Property or Commercial Inland Marine Policyholders in Standard Fire States: In Standard Fire states, terrorism exclusions make an exception for (and therefore provide coverage for) fire losses resulting from an act of terrorism. Any policyholder with a location that we insure in a Standard Fire State that rejects our offer of terrorism coverage in this form will still have coverage with us for fire losses resulting from an act of terrorism. Explanation of Premium If a dollar amount is shown for Fire Following Premium in the SCHEDULE above that means we insure a location of yours in a Standard Fire State. Fire Following Premium is shown in the SCHEDULE above regardless of whether a policyholder with a location that we insure in a Standard Fire State accepts or rejects terrorism coverage with us. Fire Following Premium represents the charge for the coverage we provide for fire losses resulting from acts of terrorism. Fire Following Premium does not include Other Than Fire Following Premium. All Other Than Fire Following Premium is shown in the Other Than Fire Following Premium field in the SCHEDULE above. If a dollar amount is shown for Other Than Fire Following Premium in the SCHEDULE above that means you have accepted terrorism coverage with us. Other Than Fire Following Premium represents the charge for terrorism coverage. Other Than Fire Following Premium does not include Fire Following Premium. If applicable, all Fire Following Premium is shown in the Fire Following Premium field in the SCHEDULE above. MA mmsgemmtDhislan RE+neWED&APPRov®By: 401-1374 12 20 Includes copyrighted material of Insurance Services Office, Inc., with its permiE A--p Auwda ® Risk Management SpeaAist