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DocuSign Envelope ID:30CFBA21-DC65-423A-A674-7D24A692C6ED
<br /> WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 04 22 B
<br /> (Ed. 1-15)
<br /> TERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION ACT DISCLOSURE ENDORSEMENT
<br /> This endorsement addresses the requirements of the Terrorism Risk Insurance Act of 2002 as amended and extended
<br /> by the Terrorism Risk Insurance Program Reauthorization Act of 2015. It serves to notify you of certain limitations
<br /> under the Act, and that your insurance carrier is charging premium for losses that may occur in the event of an Act of
<br /> Terrorism.
<br /> Your policy provides coverage for workers compensation losses caused by Acts of Terrorism, including workers
<br /> compensation benefit obligations dictated by state law. Coverage for such losses is still subject to all terms,
<br /> definitions, exclusions, and conditions in your policy, and any applicable federal and/or state laws, rules, or
<br /> regulations.
<br /> Definitions
<br /> The definitions provided in this endorsement are based on and have the same meaning as the definitions in the Act. If
<br /> words or phrases not defined in this endorsement are defined in the Act,the definitions in the Act will apply.
<br /> "Act" means the Terrorism Risk Insurance Act of 2002, which took effect on November 26, 2002, and any
<br /> amendments thereto, including any amendments resulting from the Terrorism Risk Insurance Program
<br /> Reauthorization Act of 2015.
<br /> "Act of Terrorism" means any act that is certified by the Secretary of the Treasury, in consultation with the Secretary of
<br /> Homeland Security, and the Attorney General of the United States as meeting all of the following requirements:
<br /> a. The act is an act of terrorism.
<br /> b. The act is violent or dangerous to human life, property or infrastructure.
<br /> c. The act resulted in damage within the United States, or outside of the United States in the case of the premises of
<br /> United States missions or certain air carriers or vessels.
<br /> d. The act has been committed by an individual or individuals as part of an effort to coerce the civilian population of
<br /> the United States or to influence the policy or affect the conduct of the United States Government by coercion.
<br /> "Insured Loss" means any loss resulting from an act of terrorism (and, except for Pennsylvania, including an act of
<br /> war, in the case of workers compensation)that is covered by primary or excess property and casualty insurance
<br /> issued by an insurer if the loss occurs in the United States or at the premises of United States missions or to certain
<br /> air carriers or vessels.
<br /> "Insurer Deductible" means, for the period beginning on January 1,2015, and ending on December 31, 2020, an
<br /> amount equal to 20% of our direct earned premiums, during the immediately preceding calendar year.
<br /> Limitation of Liability
<br /> The Act limits our liability to you under this policy. If aggregate Insured Losses exceed$100,000,000,000 in a calendar
<br /> year and if we have met our Insurer Deductible, we are not liable for the payment of any portion of the amount of
<br /> Insured Losses that exceeds$100,000,000,000; and for aggregate Insured Losses up to$100,000,000,000, we will
<br /> pay only a pro rata share of such Insured Losses as determined by the Secretary of the Treasury.
<br /> Policyholder Disclosure Notice
<br /> 1. Insured Losses would be partially reimbursed by the United States Government. If the aggregate industry Insured
<br /> Losses exceed:
<br /> a. $100,000,000,with respect to such Insured Losses occurring in calendar year 2015, the United States
<br /> Government would pay 85%of our Insured Losses that exceed our Insurer Deductible.
<br /> b. $120,000,000,with respect to such Insured Losses occurring in calendar year 2016, the United States
<br /> Government would pay 84%of our Insured Losses that exceed our Insurer Deductible.
<br /> c. $140,000,000,with respect to such Insured Losses occurring in calendar year 2017, the United States
<br /> Government would pay 83%of our Insured Losses that exceed our Insurer Deductible.
<br /> d. $160,000,000,with respect to such Insured Losses occurring in calendar year 2018, the United States
<br /> Government would pay 82% of our Insured Losses that exceed our Insurer Deductible.
<br /> e. $180,000,000,with respect to such Insured Losses occurring in calendar year 2019, the United States
<br /> Government would pay 81% of our Insured Losses that exceed our Insurer Deductible.
<br /> f. $200,000,000,with respect to such Insured Losses occurring in calendar year 2020, the United States
<br /> Government would pay 80% of our Insured Losses that exceed our Insurer Deductible.
<br /> b Copyright 2015 National Council on Compensation Insurance,Inc.All Rights Reserved.
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