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DocuSign Envelope ID:91 F43AFA-8CB4-4861-887A-F304C7A6614B <br /> POLICY NUMBER: <br /> IL 09 99 01 15 <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. THIS ENDORSEMENT DOES NOT GRANT ANY COVERAGE OR <br /> CHANGE THE TERMS AND CONDITIONS OF ANY COVERAGE UNDER THE POLICY. <br /> DISCLOSURE OF PREMIUM AND ESTIMATED PREMIUM <br /> FOR CERTIFIED ACTS OF TERRORISM COVERAGE <br /> (PURSUANT TO TERRORISM RISK INSURANCE ACT) <br /> SCHEDULE <br /> SCHEDULE—PART I <br /> Terrorism Premium (Certified Acts) <br /> (A) Premium through end of year(12/31/ ) $ See Declarations <br /> (B) Estimated Premium beyond the date specified above $ See Declarations <br /> (Refer to Paragraph D. in this endorsement.) <br /> This premium is the total Certified Acts premium attributable to the following Coverage Part(s), <br /> Coverage Form(s)and/or Policy(ies): <br /> All coverage parts other than: <br /> Social Service Professional Liability Endorsement; and <br /> Business Auto Coverage <br /> Additional information, if any,concerning the terrorism premium: <br /> SCHEDULE—PART II <br /> Federal share of terrorism losses %Year: 20 <br /> (Refer to Paragraph B. in this endorsement.) <br /> SCHEDULE—PART II <br /> Federal share of terrorism losses 85% Year: 2015 <br /> Federal share of terrorism losses 84% Year: 2016 <br /> Federal share of terrorism losses 83% Year: 2017 <br /> Federal share of terrorism losses 82% Year: 2018 <br /> Federal share of terrorism losses 81% Year: 2019 <br /> Federal share of terrorism losses 80% Year: 2020 <br /> (Refer to Paragraph B. of this endorsement) <br /> Federal share of terrorism losses %Year: 20 <br /> (Refer to Paragraph B. in this endorsement.) <br /> Information required to complete this Schedule, if not shown above, will be shown in the Declarations. <br /> IL 09 99 01 15 © Insurance Services Office, Inc., 2015 Page 1 of 2 <br />