# DocuSign Envelope ID: 36857BF5-BFB0-4F33-ACA9-8EE38BEA37BB
Chubb Global Casualty

*Canadian premiums and taxes, fees and commission will be billed locally in Canada and must be paid locally in Canada in Canadian dollars. The premiums and limits for the Canadian policies above are in US Dollars.
*Chubb Canada will duplicate the limits and coverages as permitted by Canadian regulation.

Non-premium surcharges and assessments are summarized in this section for illustration purposes only to show the total estimated cost associated with your insurance purchase. More detail about the calculation of each individual surcharge is located in Section II A) Non-Premium Surcharges and Assessments of this Notice of Election.

## C) Claims Administration and Expense

### A. Claims Adjusting Service

| Policy Number | Claims Adjusting Service |
|---------------|--------------------------|
| HDO G7296360A | ESIS                     |
| ISA H25579070 | ESIS                     |
| CGL 326131    | ESIS                     |
| ORP G72963647 | ESIS                     |

### D) Reimbursable Losses

| Policy Number(s) | Retention Type | Retained Amount ($) | ALAE Reimbursement | Expected Reimbursable Amount ($) |
|------------------|----------------|--------------------|--------------------|----------------------------------|
| HDO G7296360A, ORP G72963647, CGL 326131 | High Deductible | 25,000,000         | 100% borne by Insured | 375,157                          |
| ISA H25579070    | High Deductible | 5,000,000          | 100% borne by Insured | 2,057,628                        |

### E) Collateral & Paid Loss Deposit Fund

The collateral and paid loss deposit funds are subject to all the terms and conditions of the Collateral Agreement executed by you and us.

| Amount ($) | Collateral Form |
|------------|-----------------|
| Collateral Currently Held | 6,000,000 Letter of Credit |
|            | 1,500,000 Surety* |
| Total Held  | 7,500,000       |

| Amount ($) | Collateral Form | Due Date |
|------------|-----------------|----------|
| Additional Required Collateral | 4,000,000 Letter of Credit | 05/21/2023 |
|            | 1,000,000 Surety* | 05/21/2023 |
| Total Requirement | 5,000,000 | 05/21/2023 |

* The Company will permit the Insured to provide a portion of the total required amount of collateral in the form of a Surety Bond in an amount and form (including beneficiaries) and from an issuer acceptable to the Company. Nothing herein shall in any way affect or limit the Company's ability to require any additional or replacement amount of security from the Insureds pursuant to the Collateral Agreement.

INTERNA_05212023_William Overby
04/28/2023
Notice of Election Page 5 of 55