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POLICY NUMBER: 20 SBM BA6984 it THIS ENDORSEMENT IS ATTACHED TO AND MADE PART OF YOUR POLICY IN RESPONSE TO THE DISCLOSURE REQUIREMENTS OF THE TERRORISM RISK INSURANCE ACT. DISCLOSURE PURSUANT TO TERRORISM RISK INSURANCE ACT SCHEDULE Terrorism Premium: $ $11.00 A. Disclosure Of Premium United States or to influence the policy or In accordance with the federal Terrorism Risk affect the conduct of the United States Insurance Act, as amended (TRIA), we are required Government by coercion to provide you with a notice disclosing the portion of C. Disclosure Of Federal Share Of Terrorism your premium, if any, attributable to coverage for Losses certified acts of terrorism under TRIA. The portion The United States Department of the Treasury will of your premium attributable to such coverage is reimburse insurers for a portion of insured fosses, shown in the Schedule of this endorsement. as indicated in the table below, attributable to B. The following definition is added with respect to the "certified acts of terrorism" under TRIA that exceeds provisions of this endorsement: the applicable insurer deductible: 1. A"certified act of terrorism"means an act that is Calendar Year Federal Share of certified by the Secretary of the Treasury, in Terrorism Losses accordance with the provisions of TRIA, to be an act of terrorism under TRIA. The criteria 2015 85% contained in TRIA for a "certified act of 2016 84% terrorism"include the following: 2017 83% a. The act results in insured losses in excess of$5 million in the aggregate, attributable to 2018 82% all types of insurance subject to TRIA; and 2019 81% b. The act results in damage within the United 2020 or later 80% States, or outside the United States in the case of certain air carriers or vessels or the However, if aggregate industry insured losses under premises of an United States mission; and TRIA exceed $100 billion in a calendar year, the c. The act is a violent act or an act that is Treasury shall not make any payment for any dangerous to human life, property or portion of the amount of such losses that exceeds infrastructure and is committed by an $100 billion. The United States government has not individual or individuals as part of an effort charged any premium for their participation in to coerce the civilian population of the covering terrorism losses. Form SS 83 76 01 15 Page 1 of 2 ©2015 , The Hartford (Includes copyrighted material of the Insurance Services Office, Inc., with its permission.)