R2017-116 Liability Insurance Coverage for Transit System

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POLICYHOLDER DISCLOSURE NOTICE OF TERRORISM INSURANCE COVERAGE FlYouare,hereby notified that under the Terrorism Risk Insurance Act,as amended,(the"Act"),you have a right to purchase insurance losses resulting from acts of terrorism,as defined in Section 102(1)ofrhe Act:The term "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—to be an act of terrorism; to be a violent act or an act that is dangerous to human life,property,or infrastructure; to have resulted in damage within the United States, or outside the United States in the case of certain air carriers or vessels or the premises of a United States mission;and 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. overage under your policy may be affected as follows: YOU SHOULD KNOW THAT WHERE COVERAGE IS PROVIDED BY THIS POLICY FOR LOSSES RESULTING FROM CERTIFIED ACTS OF TERRORISM, SUCH LOSSES N&AY BE PARTI Iff REIMBURSED BY THE UNITED STATES GOVBRNZ\g7v`T UNDER A FORMULA ESTABLISHED BY FEDERAL, LAW. HOWEVER, YOUR POLICY MAY CONTAIN OTHER EXCLUSIONS WHICH MIGHT AFFECT YOUR COVERAGE, SUCH AS AN EXCLUSION FOR NUCLEAR EVENTS. UNDER THE FORMULA, THE UNITED STATES GOVERNMEENT GENERALLY RE SS°/o THROUGH 20315: $4°fo BEGINNING ON JANUARY I, 2016; 83°do BEGINNING ON 1ANAUARY 1, 2017; 82%BEGINNING ON JANUARY 1, 2018; 811'0 BEGINNING ON JANUARY 1, 2019 ANl? 80'a BEGINNING USI JANUARY 1, 21120 OF COtfERED TERRORISM LOSSES EXCEEDING THE STATUTORILY ESTABLISHED DEDUCTIBLE PAID BY THE INSURANCE COMPANY PROVIDING THE COVERAGE. THE PIIE,MIU'.vI CHARGED FOR THIS CO�rERAGE IS PROVIDED BELOW AND DOES NOT INCLUDEGOVERNMENT ANY CHARGES FOR THE PORTIO�3 OF LOSS THAT MAY BE COVERED BY THE FEDERAL GOl�RNI�2ENT t?NDER THE ACT. YOU SHOULD ALSO KN01At THAT THE ACT, CONTAINS A $100 BILLION CAP THAT LI_-WTS U.S. GOVER-NMENIT REI.MBURSEMIrN`l` AS WELL AS INSURERS' LIABILITY FOR LOSSES RESULTING FROM CERTIFIED ACTS OF TERRORISM t�'HEN THE AMOUNT OF SUCH LOSSES IN AIS'ON"E CALENDAR YEAR EXCEEDS S 100 BILLION. IF THE AGGREGATE INSURED LOSSES FOR ALL INSURERS EXCEED$100 BILLION,YOUR COVERAGE MAY BE REDUCED. Acc Lance or Re*ction of Terrorism Insurance Coverage I hereby elect to purchase terrorism coverage,subject to the limitations of the.qct for acts of terrorism as defined in the Act fora ros cove remium of$881 I hereby declin purchase terrorism coverage for certified acts of terrorism.I understand that I will have no cover a for resuhm' from certified acts of terrorism. Policyholder/Applicant's S lure Admiral Insurance Comoanv Insurance Company print Name Policy Number .,� C1 -2D -r 7 Date BCIM 050104 15 0 2015 National Association of Insurance Commissioners