# Chubb Global Casualty

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 |
|---------------|--------------------------|
| ISA H2556571A  | ESIS                     |
| HDO G72491816  | ESIS                     |
| CGL 326131     | ESIS                     |
| ORP G72951281  | ESIS                     |

### D) Reimbursable Losses

| Policy Number(s) | Retention Type | Retained Amount ($) | ALAE Reimbursement | Expected Reimbursable Amount ($) |
|------------------|----------------|--------------------|--------------------|----------------------------------|
| ISA H2556571A    | High Deductible   | 5,000,000          | 100% borne by Insured | 164,051                          |
| HDO G72491816    | High Deductible   | 15,000,000         | 100% borne by Insured | 283,482                          |
| CGL 326131       | High Deductible   | 15,000,000         | 100% borne by Insured | 31,906                           |

### 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 | Letter of Credit |
| 6,000,000  | Surety Bond*     |
| Total Held  | 7,500,000       |

| Amount ($) | Collateral Form | Due Date |
|------------|-----------------|----------|
| Additional Required Collateral | Letter of Credit | 05/21/2022 |
| 0          | Surety Bond*     | 05/21/2022 |

* 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.

### F) Program Aggregate Protection

NOT APPLICABLE

### G) Program – Payment Terms

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INTERNA_05212021_
04/26/2021
Notice of Election Page 6 of 49