# ENDORSEMENT NO.

This endorsement, effective 12:01 AM:

Forms a part of Policy No.:

Issued to:

By:
EXCESS LIABILITY

**ACT OF TERRORISM PREMIUM CHARGE ENDORSEMENT**

The Act of Terrorism charge is **$1,832** and is included in the Premium shown on the Declarations Page of this policy.

As used in this endorsement, "Act of Terrorism" means any act that is certified by the Secretary of the Treasury, in consultation with the Secretary of Homeland Security, and the Attorney General of the United States:

a. to be an act of terrorism;

b. to be a violent act or an act that is dangerous to:

i. human life

ii. property; or

iii. infrastructure;

c. to have resulted in damage within the United States, or outside of the United States in the case of:

i. an air carrier or vessel [described in TRIA], or

ii. the premises of a United States mission; and

d. to have been committed by an individual or individuals as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion.

All other terms, definitions, conditions, and exclusions of this policy remain unchanged.

Authorized Representative or
Countersignature (Where Applicable)

125034 (07/18)
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