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40 <br />HISCOX <br />encourage Courage - <br />Policy Number: <br />Named Insured: <br />Endorsement Number: <br />Endorsement Effective: <br />P100.325.866.2 <br />KFB Management Inc. <br />23 <br />06/11/2022 <br />Hiscox Insurance Company Inc. <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 <br />INSURANCE ACT <br />SCHEDULE <br />SCHEDULE — PART I <br />Terrorism Premium (Certified Acts) $ 4.00 <br />This premium is the total Certified Acts premium attributable to the following Coverage Part(s), Cover- <br />age Form(s) and/or Policy(ies): <br />Additional information, if any, concerning the terrorism premium: <br />SCHEDULE — PART 11 <br />Federal share of terrorism losses 80 % <br />(Refer to Paragraph B. of this endorsement.) <br />Information required to complete this Schedule, if not shown above, will be shown in the Declarations. <br />Damn <br />rawffiww$ a9 byrynar ft <br />Ts .mri� tP54Y�YtlBk <br />Riffs Muaagmcrtt CleelaaiNde <br />IL 09 86 12 20 © Insurance Services Office, Inc., 2020 <br />