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<br />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 <br />Date <br />Policy Number <br />LMA9184 <br />09 January 2020 <br />  <br />  <br />City Council 15 – 52 8/5/2025