# ACE Risk Management

## Policy Number(s)
- CGL 325142

## Premium Component
| Premium Component | Estimated Premium ($) | Minimum | Rate | Basis of Adjustment |
|-------------------|-----------------------|---------|------|---------------------|
| Estimated General Liability Premium | 3,000 | 100% | N/A | Flat Charge |
| Broker Commission | 0 | | | |
| Total Estimated Written Premium | 3,000 | | | |
| Provincial Taxes/Surcharges | Included | | | |
| Total Estimated Cost | 3,000 | | | |

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 G – Non-Premium Surcharges and Assessments of this Notice of Election.

## C) CLAIMS ADMINISTRATION AND EXPENSE

| Policy Number | Claims Adjusting Service |
|---------------|--------------------------|
| ISA H09042854 | ESIS                     |
| HDO G27852105 | ESIS                     |
| CGL 325142    | ESIS                     |

### ESIS Claim Service Fees
ESIS will bill a non-refundable Claims Service Fee Minimum of $52,097 in a single, annual installment at Agreement inception. The Claims Service Fee Minimum will be exhausted by Claim Service Fee charges in amounts calculated by multiplying each Claim and Allocated Loss Expense payment issued by 6%. The total Claim Service Fee charges for any one claim will not exceed $10,000. Once the Claim Service Fee Minimum is fully exhausted, additional Claim Service Fee charges will be billed as incurred on a semiannual basis.

## D) REIMBURSABLE LOSSES

| Policy Number(s) | Retention Type | Retained Amount ($) | AIAE Reimbursement | Expected Reimbursable Amount ($) |
|------------------|----------------|--------------------|--------------------|----------------------------------|
| ISA H09042854    | High Deductible | 5,000,000          | 100% borne by Insured | 893,216                          |
| HDO G27852105    | High Deductible | 15,000,000         | 100% borne by Insured | 645,895                           |
| CGL 325142       | High Deductible | 15,000,000         | 100% borne by Insured | Included in HDO G27852105 above. |

INTERNAT_05212016
05/16/2016
Notice of Election Page 3 of 17