# Disclosure Pursuant to Terrorism Risk Insurance Act

## Schedule

### Schedule – Part I

**Terrorism Premium (Certified Acts)**
- $ Included
- This premium is the total Certified Acts premium attributable to the following Coverage Part(s), Coverage Form(s) and/or Policy(ies):
  - CG0001 04-13

### Additional Information, if any, concerning the terrorism premium:

### Schedule – Part II

**Federal share of terrorism losses**
- 80%
- (Refer to Paragraph B. in this endorsement.)

**Information required to complete this Schedule, if not shown above, will be shown in the Declarations.**

## A. Disclosure Of Premium

In accordance with the federal Terrorism Risk Insurance Act, we are required to provide you with a notice disclosing the portion of your premium, if any, attributable to coverage for terrorist acts certified under the Terrorism Risk Insurance Act. The portion of your premium attributable to such coverage is shown in the Schedule of this endorsement or in the policy Declarations.

## B. Disclosure Of Federal Participation In Payment Of Terrorism Losses

The United States Government, Department of the Treasury, will pay a share of terrorism losses insured under the federal program. The federal share equals a percentage (as shown in Part II of the Schedule of this endorsement or in the policy Declarations) of that portion of the amount of such insured losses that exceeds the applicable insurer retention. However, if aggregate insured losses attributable to terrorist acts certified under the Terrorism Risk Insurance Act exceed $100 billion in a calendar year, the Treasury shall not make any payment for any portion of the amount of such losses that exceeds $100 billion.

## C. Cap On Insurer Participation In Payment Of Terrorism Losses

If aggregate insured losses attributable to terrorist acts certified under the Terrorism Risk Insurance Act exceed $100 billion in a calendar year and we have met our insurer deductible under the Terrorism Risk Insurance Act, we shall not be liable for the payment of any portion of the amount of such losses that exceeds $100 billion, and in such case insured losses up to that amount are

**Endorsement Number:** 50
**Policy Number:** HDO G48898919
**IL 09 85 12 20**

© Insurance Services Office, Inc., 2020
Page 1 of 2