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POLICYHOLDER DISCLOSURE <br /> NOTICE OF TERRORISM <br /> INSURANCE COVERAGE <br /> You are hereby notified that under the Terrorism Risk Insurance Act of 2002,as amended("TRIA"),that you now have a right to <br /> purchase insurance coverage for losses arising out of acts of terrorism,as defined in Section 102(1)of the Act,as amended:The term <br /> "act of terrorism"means any act that is certified by the Secretary of the Treasury,in consultation with the Secretary of Homeland <br /> Security and the Attorney General of the United States,to be an act of terrorism;to be a violent act or an act that is dangerous to <br /> human life,property,or infrastructure;to have resulted in damage within the United States,or outside the United States in the case of <br /> an air carrier or vessel or the premises of a United States mission;and to have been committed by an individual or individuals,as part <br /> 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 <br /> Government by coercion.Any coverage you purchase for"acts of terrorism"shall expire at 12:00 midnight December 31,2027,the date <br /> on which the TRIA Program is scheduled to terminate,or the expiry date of the policy whichever occurs first,and shall not cover any <br /> losses or events which arise after the earlier of these dates. <br /> YOU SHOULD KNOW THAT COVERAGE PROVIDED BY THIS POLICY FOR LOSSES CAUSED BY CERTIFIED ACTS OF TERRORISM IS PARTIALLY <br /> REIMBURSED BY THE UNITED STATES UNDER A FORMULA ESTABLISHED BY FEDERAL LAW. HOWEVER,YOUR POLICY MAY CONTAIN OTHER <br /> EXCLUSIONS WHICH MIGHT AFFECT YOUR COVERAGE,SUCH AS AN EXCLUSION FOR NUCLEAR EVENTS. UNDER THIS FORMULA,THE UNITED <br /> STATES PAYS 80%OF COVERED TERRORISM LOSSES EXCEEDING THE STATUTORILY ESTABLISHED DEDUCTIBLE PAID BY THE INSURER(S) <br /> PROVIDING THE COVERAGE.YOU SHOULD ALSO KNOW THAT THE TERRORISM RISK INSURANCE ACT,AS AMENDED,CONTAINS A USD100 <br /> BILLION CAP THAT LIMITS U.S.GOVERNMENT REIMBURSEMENT AS WELL AS INSURERS' LIABILITY FOR LOSSES RESULTING FROM CERTIFIED <br /> ACTS OF TERRORISM WHEN THE AMOUNT OF SUCH LOSSES IN ANY ONE CALENDAR YEAR EXCEEDS USD100 BILLION.IF THE AGGREGATE <br /> INSURED LOSSES FOR ALL INSURERS EXCEED USD100 BILLION,YOUR COVERAGE MAY BE REDUCED. <br /> THE PREMIUM CHARGED FOR THIS COVERAGE IS PROVIDED BELOW AND DOES NOT INCLUDE ANY CHARGES FOR THE PORTION OF LOSS <br /> COVERED BY THE FEDERAL GOVERNMENT UNDER THE ACT. <br /> I hereby elect to purchase coverage for acts of terrorism for a prospective premium of <br /> USD$84,774.50 <br /> X I hereby elect to have coverage for acts of terrorism excluded from my policy. I <br /> understand that I will have no coverage for losses arising from acts of terrorism. <br /> Policyholder/Applicant's Signature Syndicate on behalf of Palms Insurance Company, Limited <br /> Print Name Policy Number <br /> Date <br /> LMA9184 <br /> 09 January 2020 <br />