# Chubb Global Casualty

## F) Program Aggregate Protection
**NOT APPLICABLE**

## G) Non-Premium Surcharges and Assessments

Non-Premium surcharges and assessments will be adjusted at audit and concurrently with any other applicable premium adjustment. The rates used to adjust the non-premium surcharges and assessments are set by the states and will be reflected on the declarations, Extension of Information (the "State Schedule"), endorsement, or audit of each policy. The adjustment bases used to adjust the non-premium surcharges and assessments are also set by each State. The written description of the adjustment base is provided for your information to aid in understanding the result of the application of that adjustment base.

| Policy Number(s) | State | Description | Adjustment Base | Adjustment Base ($) | Estimated Surcharge ($) |
|------------------|-------|-------------|-----------------|--------------------|------------------------|
| HDOG7109490A     | KY    | Kentucky Domestic, Foreign and Alien Insurers | Written Premium | 454                | 8                      |
| HDOG7109490A     | NJ    | New Jersey Insurance Guarantee | Written Premium | 1,464              | 9                      |
| HDOG7109490A     | WV    | West Virginia Insurance Premium | Written Premium | 809                | 4                      |
| ISAH25157564     | AZ    | Arizona Auto Theft Prevention Surcharge | Number of PPT's and Light and Medium Trucks | 11                  | 11                     |
| ISAH25157564     | CA    | California Auto Fraud Assessment | Number of Vehicles | 32                  | 56                     |
| ISAH25157564     | CO    | Colorado Automobile Theft Prevention Authority Fee | Number of Vehicles | 26                  | 26                     |
| ISAH25157564     | KY    | Kentucky Domestic, Foreign and Alien Insurers | Written Premium | 867                | 16                     |
| ISAH25157564     | MI    | *Michigan Catastrophic Claims Association | Number of Power Units | 18                  | 3,060                  |
| ISAH25157564     | MI    | Michigan Automobile Theft Prevention Authority Fee | Number of Vehicles | 18                  | 18                     |
| ISAH25157564     | NJ    | New Jersey Insurance Guarantee | Written Premium | 1,913              | 11                     |
| ISAH25157564     | NY    | New York Vehicle Law Enforcement Fee | Number of Power Units | 341                | 3,410                  |
| ISAH25157564     | TX    | Texas Automobile Theft Prevention Authority Fee | Number of Vehicles | 83                  | 166                    |
| ISAH25157564     | WV    | West Virginia Auto | Written Premium | 851                | 5                      |

**TOTAL** | | | | | **6,800** |

*This surcharge is payable to and collected by the Michigan Catastrophic Claims Association (the "MCCA") regardless of whether coverage will be available from the MCCA for PIP losses under your program. The MCCA has stated that its payment obligations do not attach until the applicable statutory retention has been satisfied, and that this retention only attaches in excess of applicable deductibles. Based on this position, coverage from the MCCA may not be available for losses under your program even though you and we have paid the required surcharges to the MCCA.*

International Business Machines Corporation
05/17/2018
Notice of Election Page 7 of 36