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CHUaBe <br />POLICYHOLDER <br />DISCLOSURE NOTICE OF <br />TERRORISM INSURANCE <br />COVERAGE <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. As defined in Section 102(1) of the Act: The term <br />"act of terrorism" means any act or acts that are certified by the Secretary of the Treasury ---in consultation with the <br />Secretary of Homeland Security, and the Attorney General of the United States ---to be an act of terrorism; to be a <br />violent act or an act that is dangerous to human life, property, or infrastructure; to have resulted in damage <br />within the United States, or outside the United States in the case of certain air carriers or vessels or the <br />premises of a United States mission; and to have been committed by an individual or individuals as part of an effort <br />to coerce the civilian population of the United States or to influence the policy or affect the conduct of the <br />United States Government by coercion. <br />YOU SHOULD KNOW THAT WHERE COVERAGE IS PROVIDED BY THIS POLICY FOR LOSSES <br />RESULTING FROM CERTIFIED ACTS OF TERRORISM, SUCH LOSSES MAY BE PARTIALLY <br />Y <br />REIMBURSED BY THE UNITED STATES GOVERNMENT UNDER A FORMULA ESTABLISHED BY <br />FEDERAL LAW. HOWEVER, YOUR POLICY MAY CONTAIN OTHER EXCLUSIONS WHICH <br />MIGHT AFFECT YOUR COVERAGE, SUCH AS AN EXCLUSION FOR NUCLEAR EVENTS. UNDER <br />THE FORMULA, THE UNITED STATES GOVERNMENT GENERALLY REIMBURSES So% , OF <br />COVERED TERRORISM LOSSES EXCEEDING THE STATUTORILY ESTABLISHED DEDUCTIBLE <br />PAID BY THE INSURANCE COMPANY PROVIDING THE COVERAGE. THE PREMIUM CHARGED <br />FOR THIS COVERAGE IS PROVIDED BELOW AND DOES NOT INCLUDE ANY CHARGES FOR <br />THE PORTION OF LOSS THAT MAY BE COVERED BY THE FEDERAL GOVERNMENT UNDER <br />THE ACT. <br />YOU SHOULD ALSO KNOW THAT THE TERRORISM RISK INSURANCE ACT, AS AMENDED, <br />CONTAINS A <br />$too BILLION CAP THAT LIMITS U.S. GOVERNMENT REIMBURSEMENT AS WELL AS <br />INSURERS' LIABILITY FOR LOSSES RESULTING FROM CERTIFIED ACTS OF TERRORISM <br />WHEN THE AMOUNT OF SUCH LOSSES IN ANY ONE CALENDAR YEAR EXCEEDS $100 <br />BILLION. IF THE AGGREGATE INSURED LOSSES FOR ALL INSURERS EXCEED $100 BILLION, <br />YOUR COVERAGE MAY BE REDUCED. <br />Aecrntnner ar ReieMinn of TrrrnAvm tncnranee rnvPmaP <br />I hereby elect to purchase terrorism coverage fora prospective premium of $ 8 <br />I hereby decline to purchase terrorism coverage for certified acts of terrorism. I understand that I will <br />have no coverage for losses resulting from certified acts of terrorism. <br />ACE Property & Casualty Insurance Companv <br />Policyholder/Applicant's Signature Insurance Company <br />INTERVIEW NOW INC. <br />Print Name <br />2022-05-04 <br />Date <br />TR-196O4c (O8/xo) <br />TECCAD961090033N <br />Policy Number <br />at REwEi)ncgem¢ovED y; a <br />BI REvlevrep 4fe Apaw, <br />I � FIG+'4/ <br />`101M <br />Rlsk Management Spcoalnt > <br />