2016-325-E Health - The NC Public Health Foundation for smoking cessation counseling

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DocuSign Envelope ID:91 F43AFA-8CB4-4861-887A-F304C7A6614B THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. TERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION ACT DISCLOSURE ENDORSEMENT Policy Number: 22 WEC CN3905 Endorsement Number: Effective Date: 10/01/15 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: NORTH CAROLINA PUBLIC HEALTH FOUNDATION PO BOX 18763 RALEIGH, NC 27619 This endorsement addresses the requirements of "Act of Terrorism" means any act that is certified by the Terrorism Risk Insurance Act of 2002 as the Secretary of the Treasury, in consultation with amended and extended by the Terrorism Risk the Secretary of Homeland Security, and the Insurance Program Reauthorization Act of 2015. It Attorney General of the United States as meeting all serves to notify you of certain limitations under the of the following requirements: Act, and that your insurance carrier is charging a. The act is an act of terrorism. premium for losses that may occur in the event of an Act of Terrorism. b. The act is violent or dangerous to human life, property or infrastructure. Your policy provides coverage for workers compensation losses caused by Acts of Terrorism, c. The act resulted in damage within the United including workers compensation benefit obligations States, or outside of the United States in the dictated by state law. Coverage for such losses is case of the premises of United States missions still subject to all terms, definitions, exclusions, and or certain air carriers or vessels. conditions in your policy, and any applicable federal d. The act has been committed by an individual or and/or state laws, rules,or regulations. individuals as part of an effort to coerce the Definitions civilian population of the United States or to influence the policy or affect the conduct of the The definitions provided in this endorsement are United States Government by coercion. based on and have the same meaning as the definitions in the Act. If words or phrases not defined "Insured Loss" means any loss resulting from an act in this endorsement are defined in the Act, the of terrorism (and, except for Pennsylvania, including definitions in the Act will apply. an act of war, in the case of workers compensation) that is covered by primary or excess property and "Act" means the Terrorism Risk Insurance Act of casualty insurance issued by an insurer if the loss 2002, which took effect on November 26, 2002, and occurs in the United States or at the premises of any amendments thereto, including any amendments United States missions or to certain air carriers or resulting from the Terrorism Risk Insurance Program vessels. Reauthorization Act of 2015. "Insurer Deductible" means, for the period beginning on January 1, 2015, and ending on December 31, 2020, an amount equal to 20% of our direct earned premiums, during the immediately preceding calendar year. Form WC 00 04 22 B Printed in U.S.A. Page 1 of 2 Process Date: 08/01/15 Policy Expiration Date: 10/01/16