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is <br />LlY <br />(V <br />ca <br />4� <br />rl <br />M <br />W <br />l0 <br />IX1 <br />Y-i <br />u� <br />w <br />ra <br />r� <br />0 <br />s <br />POLICYNUNIBER: 65 SBM IX8683 <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. — <br />i� INSURANCE ACT <br />SCHEDULE <br />Terrorism Premium (Certified Acts); <br />$ $5.00 <br />A. Disclosure Of Premium <br />In accordance with the federal Terrorism Risk <br />Insurance Act, as amended ( "TRIA"), we are <br />required to provide you with a notice disclosing the <br />portion of your premium, if any,. attributable to <br />coverage for Certified acts of terrorism under TRIA. <br />The portion of your premium attributable to such <br />coverage is shown in the Schedule of this <br />endorsement. <br />B. Disclosure of federal Share Of Terrorism <br />Losses <br />The United States Department of the Treasury will <br />reimburse Insurers for 85% of that portion of insured <br />losses attributable to "certified acts of terrorism" <br />under TRIA that exceeds the applicable insurer <br />deductible. <br />However, if aggregate industry insured losses Linder <br />TRIA exceed $100 billion in a Program Year <br />(January 1 through December 31), the Treasury <br />shall not make any payment for any portion of the <br />amount of such tosses that exceeds $100 billion. <br />The United States government has not charged any <br />premium for their participation In covering terrorism <br />losses. <br />Form SS 83 76 03 12 <br />C. Cap On Insurer Liability for Terrorism Losses <br />If aggregate Industry insured losses attributable to <br />"certified acts of terrorism" under TRIA exceed $100 <br />billion in a Program Year (January 1 through <br />December 31) and we have met, or will meet, our <br />insurer deductible under TRIA, we shall not be liable <br />for the payment of any portion of 11110 amount of such <br />losses that exceed $100 billion, In such case, your <br />coverage for terrorism losses may be reduced on a <br />pro-rata basis In accordance with procedures <br />established by the Treasury, based on its estimates <br />of aggregate industry losses and our estimate that <br />we will exceed our insurer deductible. In accordance <br />with the Treasury's procedures, amounts paid for <br />IosaOS may be subject to further adjustments based <br />on differences between actual losses and estimates. <br />D, All other terms and conditions remain the same. <br />0 2012, The Hartford <br />(Includes copyrighted material of the Insurance Services Office, Inc., with its permission.) <br />Page 1 of 1 <br />