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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 04 22 B
<br />(Ed, 1-16)
<br />TERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION ACT DISCLOSURE ENDORSEMENT
<br />This endorsement addresses the requirements of the Terrorism Risk Insurance Act of 2002 as amended and extended by
<br />the Terrorism Risk Insurance Program Reauthorization Act of 2015, it serves to notify you of certain limitations under the
<br />Act, and that your Insurance carrier is charging a premium for losses that may occur in the event of an Act of Terrorism.
<br />Your policy provides coverage for workers compensation losses caused by Act of Terrorism, Including workers
<br />compensation benefit obligations dictated by state law. Coverage for such losses is still subject to all terms, definitions,
<br />exclusions, and conditions In your policy, and any applicable federal and/or state laws, rules, or regulations.
<br />Definitions:
<br />The definitions provided In this endorsement are based on and have the same meaning as the definitions In the Act. If
<br />words or phrases not defined In this endorsement are defined In the Act, the definitions In the Act will apply.
<br />"Act" means the Terrorism Risk Insurance Act of 2002, which took effect on November 26, 2002 and any amendments
<br />thereto, Including any amendments resulting from the 'Terrorism Risk Insurance Program Reauthorization Act of 2016.
<br />"Act of Terrorism" means any act that Is certified by the Secretary of the Treasury, in consultation with the Secretary of
<br />Homeland Security, and the Attorney General of the United States as meeting all of the following requirements:
<br />a. The act is an act of terrorism,
<br />b. The act is violent or dangerous to human life, properly or Infrastructure.
<br />c. The act resulted In damage within the United States, or outside of the United States in the case of the premises of
<br />United States missions or certain air carriers or vessels.
<br />d. The act has been committed by an Individual or Individuals as part of an effort to coerce the civilian population of
<br />the United States or to Influence the policy or affect the conduct of the United States Government by coercion.
<br />"Insured Loss" means any loss resulting from an act of terrorism (and, except for Pennsylvania, Including an act of war, in
<br />the case of workers compensation) that Is covered by primary or excess property and casualty insurance Issued by an
<br />insurer if the loss occurs in the United States or al the premises of United Slates missions or to certain air carriers or
<br />vessels.
<br />"Insurer Deductible" means, for the period beginning on January 1, 2015, and ending on December 31, 2020, an amount
<br />equal to 20% of our direct earned premiums, during the Immediately preceding calendar year.
<br />Limitation of Liability
<br />The Act limits our liability to you under this policy. If aggregate Insured Losses exceed $100,000,000,000 in a calendar year
<br />and if we have met our Insurer Deductible, we are not liable for the payment of any portion of the amount of Insured
<br />Losses that exceeds $100,000,000,000; and for aggregate Insured Losses up to $100,000,000,000, we will pay only a pro
<br />rate share of such Insured Losses as determined by the Secretary of the Treasury.
<br />Policyholder Disclosure Notice
<br />1. Insured Losses would be partially reimbursed by the United States Government. If the aggregate Industry Insured
<br />Losses exceed:
<br />a. $100,000,000, with respect to such Insured Losses occurring in calendar year 2015, the United States
<br />Government will pay 85%of our Insured Losses that exceed our Insurer Deductible.
<br />b. $120,000,000, with respect to such Insured Losses occurring In calendar year 2016, the United States
<br />Government will pay 84%of our Insured Losses that exceed our Insurer Deductible.
<br />c. $140,000,000, with respect to such Insured Losses occurring In calendar year 2017, the United States
<br />Government will pay 83% of our Insured Losses that exceed our Insurer Deductible.
<br />d. $160,000,000, with respect to such Insured Losses occurring in calendar year 2018, the United States
<br />Government will pay 82% of our Insured Losses that exceed our Insurer Deductible.
<br />a. $180,000,000, with respect to such Insured Losses occurring in calendar year 2019 Bd t�d P
<br />Government will pay 81%of our Insured Losses that exceed our Insurer Deduct�Fe� reN HYrRQVILN
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<br />L $200,000,000, with respect to such Insured Losses occurring in calendar year 202�J,'fH UH�ied States
<br />Government will pay 80% of our Insured Losses that exceed our Insurer Deductible. � 1 9 R g019
<br />o Copyrlght 2e16 National Council on Compensation Insurance, Inc. All Nights ne lervdd. � I 0tfUs ,Lc...iF.0908a%
<br />FRANCINE R, VILLAREAL
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