MWCIA Circular 15-1667 - NCCI Item P-1412
Transcription
MWCIA Circular 15-1667 - NCCI Item P-1412
Minnesota Workers’ Compensation Insurers Association, Inc. 7701 France Avenue South Suite 450 Minneapolis, MN 55435-3200 February 24, 2015 ALL ASSOCIATION MEMBERS Circular Letter 15-1667 RE: NCCI Item P-1412─ Terrorism Risk Insurance Program Reauthorization Act of 2015 Endorsements The Minnesota Department of Commerce has approved the above filing to become effective, 12:01 a.m., January 1, 2015, for new, renewal, and outstanding policies issued on and after 12:01 a.m. on January 1, 2015. This item revises and withdraws endorsements in the Minnesota Forms Manual as a result of the recent enactment of the Terrorism Risk Insurance Program Reauthorization Act of 2015 (TRIPRA of 2015). The Terrorism Risk Insurance Act of 2002 (“TRIA” or the “Act”) was implemented as a result of the US Congress recognizing that terrorism is a catastrophe exposure that is real and significant for insurers of workers’ compensation and other lines of insurance. It initially provided a temporary program under which the Federal government would share in the payment of insured losses caused by certain acts of terrorism. TRIA was scheduled to expire on December 31, 2005. It was renewed as the Terrorism Risk Insurance Extension Act (TRIEA) in 2005, and as the Terrorism Risk Insurance Program Reauthorization Act (TRIPRA) in 2007. MWCIA filed and adopted several national items that proposed the necessary miscellaneous values, rules, and policy forms to implement the original TRIA and each of its renewals Recognizing that terrorism is a catastrophe exposure that continues to be significant for insurers of workers’ compensation and other lines of insurance, the US Congress enacted TRIPRA of 2015. The key provisions are as follows: The Act was extended for six years and will expire December 31, 2020 An act of terrorism must be certified by the Secretary of the Treasury, in consultation with the Secretary of Homeland Security, and the Attorney General of the United States Beginning on January 1, 2016: The current 85% Federal share of compensation under the Terrorism Insurance Program (Program) decreases by one percentage point per calendar year until it is equal to 80% The current Program trigger for aggregate industry insured losses to exceed $100 million increases by $20 million per calendar year until it is equal to $200 million The current $27.5 billion insurance marketplace aggregate retention amount increases by $2 billion per calendar year, beginning in 2015, until it is equal to $37.5 billion, and is subject to further revision thereafter. 952.897.1737 PH 952.897.6495 FX www.mwcia.org To implement the changes as a result of the enactment of TRIPRA of 2015, the following revisions will be made to the Minnesota Forms Manual: 1. The Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement (WC 00 04 22 A) must be revised to: Update the TRIPRA references to TRIPRA of 2015 Revise the definitions to conform to TRIPRA of 2015 Revise the Insurer Deductible provisions Revise the Program trigger amounts and the Federal share of compensation provisions 2. The Notification Endorsement of Pending Law Change to Terrorism Risk Insurance Program Reauthorization Act of 2007 (WC 00 01 14) must be withdrawn. The purpose of this endorsement was to notify policyholders of the impending expiration of TRIPRA. However, with the enactment of TRIPRA of 2015, this endorsement is no longer needed. Exhibits 1, 3, and 3A illustrate all necessary changes to the Minnesota Forms Manual. As in past filings, strikethroughs indicate deleted text and underlining indicates new or added text. A copy of National Council’s original filing memorandum is also included. Please direct any questions you may have concerning this item to MWCIA’s Underwriting staff at 952.897.1737 (Option 1) or via email at [email protected]. A NOTICE TO MEMBERSHIP: MWCIA would like to remind our membership who have filed a Limited Power of Attorney with the Minnesota Department of Commerce that no materials referenced in the Circular Letter are required to be independently filed with the Department. EXHIBIT 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY Original Printing 2nd Reprint Effective September 1, 2008 January 1, 2015 WC 00 04 22 A B Standard TERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION ACT DISCLOSURE ENDORSEMENT This endorsement addresses the requirements of the Terrorism Risk Insurance Act of 2002 as amended and extended by the Terrorism Risk Insurance Program Reauthorization Act of 2007 2015. It serves to notify you of certain limitations under the Act, and that your insurance carrier is charging premium for losses that may occur in the event of an Act of Terrorism. Your policy provides coverage for workers compensation losses caused by Acts of Terrorism, including workers compensation benefit obligations dictated by state law. Coverage for such losses is still subject to all terms, definitions, exclusions, and conditions in your policy, and any applicable federal and/or state laws, rules, or regulations. Definitions The definitions provided in this endorsement are based on and have the same meaning as the definitions in the Act .If words or phrases not defined in this endorsement are defined in the Act, the definitions in the Act will apply. “Act” means the Terrorism Risk Insurance Act of 2002, which took effect on November 26, 2002, and any amendments thereto, including any amendments resulting from the Terrorism Risk Insurance Program Reauthorization Act of 2007 2015. “Act of Terrorism” means any act that is certified by the Secretary of the Treasury, in concurrence with the Secretary of State, consultation with the Secretary of Homeland Security, and the Attorney General of the United States as meeting all of the following requirements: a. The act is an act of terrorism. b. The act is violent or dangerous to human life, property or infrastructure. c. The act resulted in damage within the United States, or outside of the United States in the case of the premises of United States missions or certain air carriers or vessels. d. The act has 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. “Insured Loss” means any loss resulting from an act of terrorism (and, except for Pennsylvania, including an act of war, in the case of workers compensation) that is covered by primary or excess property and casualty insurance issued by an insurer if the loss occurs in the United States or at the premises of United States missions or to certain air carriers or vessels. “Insurer Deductible” means, for the period beginning on January 1, 2008 2015, and ending on December 31, 2014 2020, an amount equal to 20% of our direct earned premiums, over the calendar year during the immediately preceding calendar year. the applicable Program Year. “Program Year” refers to each calendar year between January 1, 2008 and December 31, 2014, as applicable. Page 1 of 2 EXHIBIT 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY Original Printing 2nd Reprint WC 00 04 22 A B Effective September 1, 2008 January 1, 2015 Standard Limitation of Liability The Act limits our liability to you under this policy. If aggregate Insured Losses exceed $100,000,000,000 in a Program Year calendar year and if we have met our Insurer Deductible, we are not liable for the payment of any portion of the amount of Insured Losses that exceeds $100,000,000,000; and for aggregate Insured Losses up to $100,000,000,000, we will pay only a pro rata share of such Insured Losses as determined by the Secretary of the Treasury. Policyholder Disclosure Notice 1. Insured Losses would be partially reimbursed by the United States Government. If the aggregate industry Insured Losses exceed: a. $100,000,000, with respect to such Insured Losses occurring in calendar year 2015, the United States Government would pay 85% of our Insured Losses that exceed our Insurer Deductible. b. $120,000,000, with respect to such Insured Losses occurring in calendar year 2016, the United States Government would pay 84% of our Insured Losses that exceed our Insurer Deductible. c. $140,000,000, with respect to such Insured Losses occurring in calendar year 2017, the United States Government would pay 83% of our Insured Losses that exceed our Insurer Deductible. d. $160,000,000, with respect to such Insured Losses occurring in calendar year 2018, the United States Government would pay 82% of our Insured Losses that exceed our Insurer Deductible. e. $180,000,000, with respect to such Insured Losses occurring in calendar year 2019, the United States Government would pay 81% of our Insured Losses that exceed our Insurer Deductible. f. $200,000,000, with respect to such Insured Losses occurring in calendar year 2020, the United States Government would pay 80% of our Insured Losses that exceed our Insurer Deductible. $100,000,000 in a Program Year, the United States Government would pay 85% of our Insured Losses that exceed our Insurer Deductible. 2. Notwithstanding item 1 above, the United States Government will not make any payment under the Act for any portion of Insured Losses that exceed $100,000,000,000. 3. The premium charge for the coverage your policy provides for Insured Losses is included in the amount shown in Item 4 of the Information Page or in the Schedule below. Schedule State Rate Page 2 of 2 Premium EXHIBIT 3 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 01 14 (Ed. 1-14) NOTIFICATION ENDORSEMENT OF PENDING LAW CHANGE TO TERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION ACT OF 2007 This endorsement is being sent to you with respect to your workers compensation and employers liability insurance policy. This endorsement does not replace the separate Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement (WC 00 04 22 A) that is attached to your current policy and which remains in effect as applicable. The Terrorism Risk Insurance Act of 2002 (TRIA) as previously amended and extended by the Terrorism Risk Insurance Program Reauthorization Act of 2007 (TRIPRA), provides for a program under which the federal government will share in the payment of insured losses caused by certain acts of terrorism. In the absence of affirmative US Congressional action to extend, update, or otherwise reauthorize TRIPRA, in whole or in part, TRIPRA is scheduled to expire December 31, 2014. Since the timetable for any further Congressional action respecting TRIPRA is unknown at this time, and exposure to acts of terrorism remains, we are providing our policyholders with relevant information concerning their workers compensation policies in effect on or after January 1, 2014 in the event of TRIPRA’s expiration. Your policy provides coverage for workers compensation losses caused by acts of terrorism or war, including workers compensation benefit obligations dictated by state law, except in Pennsylvania where injuries or deaths resulting from certain war-related activities are excluded from workers compensation coverage. Coverage for such losses is still subject to all terms, definitions, exclusions, and conditions in your policy. The premium charge for the coverage your policy provides for terrorism or war losses is shown in Item 4 of the Information Page or the Schedule in the Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement (WC 00 04 22 A) that is attached to your policy, and this amount may continue or change for new, renewal, and in-force policies in effect on or after December 31, 2014 in the event of TRIPRA’s expiration, subject to regulatory review in accordance with applicable state law. You need not do anything further at this time. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Policy No. Insured Insurance Company Endorsement No. Premium: Countersigned by __________________________________________ WC 00 01 14 (Ed. 1-14) Copyright 2013 National Council on Compensation Insurance, Inc. All Rights Reserved. EXHIBIT 3A P-1412 INDEX MINNESOTA FORMS MANUAL The following forms and endorsements in this Minnesota Forms Manual have been approved by the Minnesota Commerce Department and are available for use in Minnesota. Introduction Workers’ Compensation and Employers Liability Insurance Policy Rules WC 00 00 00 C Workers Compensation and Employers Liability Insurance Policy WC 00 01 01 A Defense Base Act Coverage Endorsement WC 00 01 04 A Federal Employers’ Liability Act Coverage Endorsement WC 00 01 06 A Longshore and Harbor Workers’ Compensation Act Coverage Endt WC 00 01 08 A Nonappropriated Fund Instrumentalities Act Coverage Endorsement WC 00 01 09 C Outer Continental Shelf Lands Act Coverage Endorsement WC 00 01 11 Migrant and Season Agricultural Worker Protection Act Coverage Endorsement WC 00 01 14 Notification Endorsement of Pending Law Change to Terrorism Risk Insurance Program Reauthorization Act of 2007 WC 00 02 01 B Maritime Coverage Endorsement WC 00 02 03 Voluntary Compensation Maritime Coverage Endorsement WC 00 02 04 Limited Maritime Coverage Endorsement WC 00 03 01 A Alternate Employer Endorsement WC 00 03 02 Designated Workplaces Exclusion Endorsement WC 00 03 03 C Employers Liability Coverage Endorsement WC 00 03 04 Insurance Company as Insured Endorsement WC 00 03 05 Joint Venture as Insured Endorsement WC 00 03 08 Partners, Officers and Others Exclusion Endorsement WC 00 03 09 B Rural Utilities Service Endorsement WC 00 03 10 Sole Proprietors, Partners, Officers and Others Coverage Endorsement WC 00 03 11 A Voluntary Compensation and Employers Liability Coverage Endt. WC 00 03 13 Waiver of Our Right to Recover from Others Endorsement WC 00 04 03 Experience Rating Modification Factor Endorsement WC 00 04 05 Policy Period Endorsement WC 00 04 06 A Premium Discount Endorsement © Minnesota Workers’ Compensation Insurers Association, Inc. Rev 01/2015 Page 1 of 3 EXHIBIT 3A P-1412 WC 00 04 09 Premium Determination Endorsement─ Former Self Insurers 1 WC 00 04 10 Premium Determination Endorsement─ Former Self Insurers 2 WC 00 04 12 Contingent Experience Rating Modification Factor Endorsement WC 00 04 14 Notification of Change in Ownership Endorsement WC 00 04 19 Premium Due Date Endorsement WC 00 04 22 A B Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement WC 00 05 03 C Retrospective Rating Plan Premium Endorsement─ One Year Plan WC 00 05 04 C Retrospective Rating Plan Premium Endorsement─ Three Year Plan WC 00 05 05 C Retrospective Rating Plan Premium Endorsement─ Long-term Wrap- Up Construction Project WC 00 05 08 Retrospective Rating Plan Premium Endorsement Aviation Exclusion WC 00 05 09 A Retrospective Rating Plan Premium Endorsement Changes WC 00 05 10 B Retrospective Rating Plan Premium Endorsement Non- Ratable Catastrophe Element or Surcharge WC 00 05 11 Retrospective Rating Plan Premium Endorsement Short Form WC 00 05 12 C Retrospective Rating Plan Premium Endorsement One Year Plan─ Multiple Lines WC 00 05 13 C Retrospective Rating Plan Premium Endorsement Three Year Plan─ Multiple Lines WC 00 05 14 C Retrospective Rating Plan Premium Endorsement Long- Term WrapUp Construction Project ─ Multiple Lines WC 00 05 15 A Retrospective Rating Plan Premium Endorsement Flexibility Options WC 00 05 16 Retrospective Rating Plan Premium Endorsement─ Large Risk Alternative Rating Option (LRARO) WC 00 06 03 Benefits Deductible Endorsement WC 89 06 09 C Policy Termination/ Cancellation/ Reinstatement Notice WC 22 00 00 A Minnesota Amendatory Endorsement WC 22 00 01 Information Page WC 22 03 01 Minnesota Compliance with Applicable Trade Sanction Laws WC 22 03 02 Minnesota Independent Contractors Coverage Endorsement WC 22 03 03 Minnesota Third Degree of Kindred Family Member Exclusion Endt. WC 22 03 04 Minnesota Employee Leasing Endorsement WC 22 03 05 Minnesota Exclusion of Coverage for Leased Employees Endorsement WC 22 03 06 Minnesota Alternate Employer Endorsement [Excluding Employers Liability Coverage] © Minnesota Workers’ Compensation Insurers Association, Inc. Rev 01/2015 Page 2 of 3 EXHIBIT 3A P-1412 WC 22 04 01 Minnesota Contracting Premium Adjustment Program Endorsement WC 22 04 02 Minnesota Anniversary Rating Date Endorsement WC 22 06 00 Minnesota Policy Change Endorsement WC 22 06 01 D Minnesota Cancellation and Nonrenewal Endorsement WC 22 06 02 Minnesota Policy Information Page Endorsement Insured’s Name WC 22 06 03 Minnesota Policy Information Page Endorsement Policy Number WC 22 06 04 Minnesota Policy Information Page Endorsement Effective Date WC 22 06 05 Minnesota Policy Information Page Endorsement Expiration Date WC 22 06 06 Minnesota Policy Information Page Endorsement− Insured’s Mailing Address WC 22 06 07 Minnesota Policy Information Page Endorsement− Experience Modification WC 22 06 08 Minnesota Policy Information Page Endorsement Producer’s Name WC 22 06 09 Minnesota Policy Information Page Endorsement− Change in Workplace Endorsement WC 22 06 10 Minnesota Policy Information Page Endorsement− Insured’s Legal Status WC 22 06 11 Minnesota Policy Information Page Endorsement Add States WC 22 06 12 Minnesota Policy Information Page Endorsement Employer Limits WC 22 06 13 Minnesota Policy Information Page Endorsement Change in State WC 22 06 14 Minnesota Policy information Page Endorsement− Endorsement Numbers WC 22 06 15 A Minnesota Policy information Page Endorsement− Class, Rate, Other Change WC 22 06 16 A Minnesota Policy Information Page Endorsement− Interim Adjustment of Premium WC 22 06 17 Minnesota Policy Information Page Endorsement− Carrier Servicing Office WC 22 06 18 Minnesota Policy Information Page Endorsement− Interstate/ Intrastate Risk ID Number WC 22 06 19 Minnesota Policy Information Page Endorsement Carrier Number WC 22 06 20 Minnesota Entity Address Schedule © Minnesota Workers’ Compensation Insurers Association, Inc. Rev 01/2015 Page 3 of 3 NATIONAL COUNCIL ON COMPENSATION INSURANCE, INC. (Applies in: AK, AL, AR, AZ, CO, CT, DC, FL, GA, HI, IA, ID, IL, KS, KY, LA, MD, ME, MO, MS, MT, NE, NH, NM, NV, OK, OR, RI, SC, SD, TN, TX, UT, VA, VT, WV) P-1412 PAGE 1 FILING MEMORANDUM ITEM P-1412—TERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION ACT OF 2015 ENDORSEMENTS PURPOSE This item revises and withdraws endorsements in NCCI’s Forms Manual of Workers Compensation and Employers Liability Insurance (Forms Manual) as a result of the recent enactment of the Terrorism Risk Insurance Program Reauthorization Act of 2015 (TRIPRA of 2015). BACKGROUND The Terrorism Risk Insurance Act of 2002 (“TRIA” or the “Act”) was implemented as a result of the US Congress recognizing that terrorism is a catastrophe exposure that is real and significant for insurers of workers compensation and other lines of insurance. It initially provided a temporary program under which the Federal government would share in the payment of insured losses caused by certain acts of terrorism. TRIA was scheduled to expire on December 31, 2005. It was renewed as the Terrorism Risk Insurance Extension Act (TRIEA) in 2005, and as the Terrorism Risk Insurance Program Reauthorization Act (TRIPRA) in 2007. NCCI filed several national items that proposed the necessary miscellaneous values, rules, and policy forms to implement the original TRIA and each of its renewals. Recognizing that terrorism is a catastrophe exposure that continues to be significant for insurers of workers compensation and other lines of insurance, the US Congress enacted TRIPRA of 2015. The key provisions are as follows: • The Act was extended for six years and will expire December 31, 2020 • An act of terrorism must be certified by the Secretary of the Treasury, in consultation with the Secretary of Homeland Security, and the Attorney General of the United States Beginning on January 1, 2016: • The current 85% Federal share of compensation under the Terrorism Insurance Program (Program) decreases by one percentage point per calendar year until it is equal to 80% • The current Program trigger for aggregate industry insured losses to exceed $100 million increases by $20 million per calendar year until it is equal to $200 million The current $27.5 billion insurance marketplace aggregate retention amount increases by $2 billion per calendar year, beginning in 2015, until it is equal to $37.5 billion, and is subject to further revision thereafter PROPOSAL To implement the changes as a result of the enactment of TRIPRA of 2015, this item proposes the following revisions to NCCI’s Forms Manual: 1. The Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement (WC 00 04 22 A) must be revised to: • Update the TRIPRA references to TRIPRA of 2015 • Revise the definitions to conform to TRIPRA of 2015 • Revise the Insurer Deductible provisions • Revise the Program trigger amounts and the Federal share of compensation provisions The enclosed materials are copyrighted materials of the National Council on Compensation Insurance, Inc. ("NCCI"). The use of these materials may be governed by a separate contractual agreement between NCCI and its licensees such as an affiliation agreement between you and NCCI. Unless permitted by NCCI, you may not copy, create derivative works (by way of example, create or supplement your own works, databases, software, publications, manuals, or other materials), display, perform, or use the materials, in whole or in part, in any media. Such actions taken by you, or by your direction, may be in violation of federal copyright and other commercial laws. NCCI does not permit or acquiesce such use of its materials. In the event such use is contemplated or desired, please contact NCCI's Legal Department for permission. © Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. NATIONAL COUNCIL ON COMPENSATION INSURANCE, INC. (Applies in: AK, AL, AR, AZ, CO, CT, DC, FL, GA, HI, IA, ID, IL, KS, KY, LA, MD, ME, MO, MS, MT, NE, NH, NM, NV, OK, OR, RI, SC, SD, TN, TX, UT, VA, VT, WV) P-1412 PAGE 2 FILING MEMORANDUM ITEM P-1412—TERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION ACT OF 2015 ENDORSEMENTS 2. The Catastrophe (Other Than Certified Acts of Terrorism) Premium Endorsement (WC 00 04 21 C) must be revised to update the references to the Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement. 3. The Notification Endorsement of Pending Law Change to Terrorism Risk Insurance Program Reauthorization Act of 2007 (WC 00 01 14) must be withdrawn. The purpose of this endorsement was to notify policyholders of the impending expiration of TRIPRA. However, with the enactment of TRIPRA of 2015, this endorsement is no longer needed. 4. The Florida Terrorism Risk Insurance Program Reauthorization Act Endorsement (WC 09 04 03 A) must be revised to: • Update the TRIPRA references to TRIPRA of 2015 • Revise the definitions to conform to TRIPRA of 2015 • Revise the Insurer Deductible provisions • Revise the Program trigger amounts and the Federal share of compensation provisions 5. The Texas Notification Endorsement of Pending Law Change to Terrorism Risk Insurance Program Reauthorization Act of 2007 (WC 42 01 01) must be withdrawn. The purpose of this endorsement was to notify policyholders of the impending expiration of TRIPRA. However, with the enactment of TRIPRA of 2015, this endorsement is no longer needed. IMPACT There will be no statewide premium impact as a result of the changes proposed in this item. EXHIBIT COMMENTS AND IMPLEMENTATION SUMMARY In all states except Hawaii, this item is to become effective for new, renewal, and outstanding policies effective on and after 12:01 a.m. on January 1, 2015. In Hawaii, the effective date is determined upon regulatory approval of the individual carrier's election to adopt this change. Exhibit Current Endorsement Name and Number Proposed Endorsement Name and Number 1 • Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement (WC 00 04 22 A) • Does not apply in Florida; refer to Exhibit 4 for state-specific endorsement for Florida. • Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement (WC 00 04 22 B) • Does not apply in Florida; refer to Exhibit 4 for state-specific endorsement for Florida. 2 • Catastrophe (Other Than Certified Acts of Terrorism) Premium Endorsement (WC 00 04 21 C) • Catastrophe (Other Than Certified Acts of Terrorism) Premium Endorsement (WC 00 04 21 D) The enclosed materials are copyrighted materials of the National Council on Compensation Insurance, Inc. ("NCCI"). The use of these materials may be governed by a separate contractual agreement between NCCI and its licensees such as an affiliation agreement between you and NCCI. Unless permitted by NCCI, you may not copy, create derivative works (by way of example, create or supplement your own works, databases, software, publications, manuals, or other materials), display, perform, or use the materials, in whole or in part, in any media. Such actions taken by you, or by your direction, may be in violation of federal copyright and other commercial laws. NCCI does not permit or acquiesce such use of its materials. In the event such use is contemplated or desired, please contact NCCI's Legal Department for permission. © Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. NATIONAL COUNCIL ON COMPENSATION INSURANCE, INC. (Applies in: AK, AL, AR, AZ, CO, CT, DC, FL, GA, HI, IA, ID, IL, KS, KY, LA, MD, ME, MO, MS, MT, NE, NH, NM, NV, OK, OR, RI, SC, SD, TN, TX, UT, VA, VT, WV) P-1412 PAGE 3 FILING MEMORANDUM ITEM P-1412—TERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION ACT OF 2015 ENDORSEMENTS Exhibit Current Endorsement Name and Number Proposed Endorsement Name and Number • Does not apply in AK, FL, MO, NM, TX, and VA • Does not apply in AK, FL, MO, NM, TX, and VA 3 • Notification Endorsement of Pending Law Change to Terrorism Risk Insurance Program Reauthorization Act of 2007 (WC 00 01 14). • Does not apply in Florida. Instead, Form 09-Notice—Florida Notice of Pending Law Change to Terrorism Risk Insurance Program Reauthorization Act of 2007 applies in Florida. This nonfiled form was provided for carriers to use at their underwriting discretion. Since it is a nonfiled form, an exhibit to withdraw the form is not included in this item. However, the form will be removed from NCCI's Forms Manual effective January 1, 2015 upon approval of this item. • Does not apply in Texas; refer to Exhibit 4 for state-specific endorsement for Texas. N/A—Withdrawn 4 • Florida Terrorism Risk Insurance Program Reauthorization Act Endorsement (WC 09 04 03 A) • Applies in Florida only • Florida Terrorism Risk Insurance Program Reauthorization Act Endorsement (WC 09 04 03 B) • Applies in Florida only • Texas Notification Endorsement of Pending Law Change to Terrorism Risk Insurance Program Reauthorization Act of 2007 (WC 42 01 01) • Applies in Texas only N/A—Withdrawn The enclosed materials are copyrighted materials of the National Council on Compensation Insurance, Inc. ("NCCI"). The use of these materials may be governed by a separate contractual agreement between NCCI and its licensees such as an affiliation agreement between you and NCCI. Unless permitted by NCCI, you may not copy, create derivative works (by way of example, create or supplement your own works, databases, software, publications, manuals, or other materials), display, perform, or use the materials, in whole or in part, in any media. Such actions taken by you, or by your direction, may be in violation of federal copyright and other commercial laws. NCCI does not permit or acquiesce such use of its materials. In the event such use is contemplated or desired, please contact NCCI's Legal Department for permission. © Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. NATIONAL COUNCIL ON COMPENSATION INSURANCE, INC. P-1412 PAGE 4 ITEM P-1412—TERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION ACT OF 2015 ENDORSEMENTS EXHIBIT 1 FORMS MANUAL OF WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE TERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION ACT DISCLOSURE (WC 00 04 22 B) TERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION ACT DISCLOSURE ENDORSEMENT (WC 00 04 22 A – B) This endorsement addresses the requirements of the Terrorism Risk Insurance Act of 2002 as amended and extended by the Terrorism Risk Insurance Program Reauthorization Act of 2 –– 0– 0– 7 2015. It serves to notify you of certain limitations under the Act, and that your insurance carrier is charging premium for losses that may occur in the event of an Act of Terrorism. Your policy provides coverage for workers compensation losses caused by Acts of Terrorism, including workers compensation benefit obligations dictated by state law. Coverage for such losses is still subject to all terms, definitions, exclusions, and conditions in your policy, and any applicable federal and/or state laws, rules, or regulations. Definitions The definitions provided in this endorsement are based on and have the same meaning as the definitions in the Act. If words or phrases not defined in this endorsement are defined in the Act, the definitions in the Act will apply. “Act” means the Terrorism Risk Insurance Act of 2002, which took effect on November 26, 2002, and any amendments thereto, including any amendments resulting from the Terrorism Risk Insurance Program Reauthorization Act of 2 –– 0– 0– 7 2015. “Act of Terrorism” means any act that is certified by the Secretary of the Treasury, in – co –– n– cu ––r r–e –– n– ce –w ––t i–h – –h t–– e S –e –– c–e r––a t––y r– o ––f S ––a t––e t––, consultation with the Secretary of Homeland Security, and the Attorney General of the United States as meeting all of the following requirements: a. The act is an act of terrorism. b. The act is violent or dangerous to human life, property or infrastructure. c. The act resulted in damage within the United States, or outside of the United States in the case of the premises of United States missions or certain air carriers or vessels. d. The act has 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. “Insured Loss” means any loss resulting from an act of terrorism (and, except for Pennsylvania, including an act of war, in the case of workers compensation) that is covered by primary or excess property and casualty insurance issued by an insurer if the loss occurs in the United States or at the premises of United States missions or to certain air carriers or vessels. “Insurer Deductible” means, for the period beginning on January 1, 2 –– 0– 0– 8 2015, and ending on December 31, 2 –– 0– 1– 4 2020, an amount equal to 20% of our direct earned premiums, o –– ve ––r –h t–– e– ca ––e l–– n– d– a–r – ye –– a–r during the immediately preceding calendar year. –h t–– ea –– p– p–il–c –a –– b–e l– P ––o r–– g–a r–m – Y –e –– a–. r– –P “ ––o r–– g–a r–m –Y –e –– a–” r––e r––e f––s r– –o t– e –– a– ch –– ca ––e l–– n– d– a–r – ye –– a–r b –– e–w t–e –– e– n– Ja –– n– u– a–y r– 1 ––, 2 –– 0– 0– 8a –– n– dD –e –– ce –m –b –– e–r 3 –– 1–, 2 –– 0– 1– 4–, a –– sa –– p– p–il–c –a –– b–e l––. © Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. NATIONAL COUNCIL ON COMPENSATION INSURANCE, INC. P-1412 PAGE 5 ITEM P-1412—TERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION ACT OF 2015 ENDORSEMENTS EXHIBIT 1 (CONT'D) FORMS MANUAL OF WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE TERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION ACT DISCLOSURE (WC 00 04 22 B) Limitation of Liability The Act limits our liability to you under this policy. If aggregate Insured Losses exceed $100,000,000,000 in a P ––o r–– g–a r–m – Y –e –– a–r calendar year and if we have met our Insurer Deductible, we are not liable for the payment of any portion of the amount of Insured Losses that exceeds $100,000,000,000; and for aggregate Insured Losses up to $100,000,000,000, we will pay only a pro rata share of such Insured Losses as determined by the Secretary of the Treasury. Policyholder Disclosure Notice 1. Insured Losses would be partially reimbursed by the United States Government. If the aggregate industry Insured Losses exceed: a. $100,000,000, with respect to such Insured Losses occurring in calendar year 2015, the United States Government would pay 85% of our Insured Losses that exceed our Insurer Deductible. b. $120,000,000, with respect to such Insured Losses occurring in calendar year 2016, the United States Government would pay 84% of our Insured Losses that exceed our Insurer Deductible. c. $140,000,000, with respect to such Insured Losses occurring in calendar year 2017, the United States Government would pay 83% of our Insured Losses that exceed our Insurer Deductible. d. $160,000,000, with respect to such Insured Losses occurring in calendar year 2018, the United States Government would pay 82% of our Insured Losses that exceed our Insurer Deductible. e. $180,000,000, with respect to such Insured Losses occurring in calendar year 2019, the United States Government would pay 81% of our Insured Losses that exceed our Insurer Deductible. f. $200,000,000, with respect to such Insured Losses occurring in calendar year 2020, the United States Government would pay 80% of our Insured Losses that exceed our Insurer Deductible. –– $ 1– 0– 0–0 ,–– 0– 0–0 ,–– 0– 0 –n i– a –P ––o r–– g–a r–m – Y –e –– a–, r––h t–– eU –n ––t i–e –– dS ––a t––e t–– sG –o –– ve ––n r–m –e –– n–t w –o –– u–d l– p –– a– y8 –– 5% – o ––f o –– u–r –n I–– su ––e r–– dL –– o– s– se –– s –h t–– a–t e –– x– ce –– e– do –– u–r –n I–– su ––e r––r D –e –– d– u– c–it–b ––e l––. 2. Notwithstanding item 1 above, the United States Government will not make any payment under the Act for any portion of Insured Losses that exceed $100,000,000,000. 3. The premium charge for the coverage your policy provides for Insured Losses is included in the amount shown in Item 4 of the Information Page or in the Schedule below. Schedule State Rate © Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. Premium NATIONAL COUNCIL ON COMPENSATION INSURANCE, INC. P-1412 PAGE 6 ITEM P-1412—TERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION ACT OF 2015 ENDORSEMENTS EXHIBIT 2 FORMS MANUAL OF WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE CATASTROPHE (OTHER THAN CERTIFIED ACTS OF TERRORISM) PREMIUM ENDORSEMENT (WC 00 04 21 D) CATASTROPHE (OTHER THAN CERTIFIED ACTS OF TERRORISM) PREMIUM ENDORSEMENT (WC 00 04 21 C – D) This endorsement is notification that your insurance carrier is charging premium to cover the losses that may occur in the event of a Catastrophe (other than Certified Acts of Terrorism) as that term is defined below. Your policy provides coverage for workers compensation losses caused by a Catastrophe (other than Certified Acts of Terrorism). This premium charge does not provide funding for Certified Acts of Terrorism contemplated under the Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement –W (–C – –– 0 00 –– 42 –– 2A ––) (WC 00 04 22 B), attached to this policy. For purposes of this endorsement, the following definitions apply: • Catastrophe (other than Certified Acts of Terrorism): Any single event, resulting from an Earthquake, Noncertified Act of Terrorism, or Catastrophic Industrial Accident, which results in aggregate workers compensation losses in excess of $50 million. • Earthquake: The shaking and vibration at the surface of the earth resulting from underground movement along a fault plane or from volcanic activity. • Noncertified Act of Terrorism: An event that is not certified as an Act of Terrorism by the Secretary of Treasury pursuant to the Terrorism Risk Insurance Act of 2002 (as amended) but that meets all of the following criteria: a. It is an act that is violent or dangerous to human life, property, or infrastructure; b. The act results in damage within the United States, or outside of the United States in the case of the premises of United States missions or air carriers or vessels as those terms are defined in the Terrorism Risk Insurance Act of 2002 (as amended); and c. It is an act that has 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. • Catastrophic Industrial Accident: A chemical release, large explosion, or small blast that is localized in nature and affects workers in a small perimeter the size of a building. The premium charge for the coverage your policy provides for workers compensation losses caused by a Catastrophe (other than Certified Acts of Terrorism) is shown in Item 4 of the Information Page or in the Schedule below. Schedule State Rate © Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. Premium NATIONAL COUNCIL ON COMPENSATION INSURANCE, INC. P-1412 PAGE 7 ITEM P-1412—TERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION ACT OF 2015 ENDORSEMENTS EXHIBIT 3 FORMS MANUAL OF WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE NOTIFICATION ENDORSEMENT OF PENDING LAW CHANGE TO TERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION ACT OF 2007 (WC 00 01 14) N –O –T ––F I––C I–A –T ––O I–N –E –N –D –O –R –S –E –M –E –N –T –O –F –P –E –N –D ––N I–G – L –A –W – C –H –A –N –G –E –T –O – T –E –R –R –O –R ––S I–M – R ––S I–K – –N I–S –U –R –A –N –C –E – P –R –O –G –R –A –M – R –E –A –U –T –H –O –R ––Z I–A –T ––O I–N –A –C –T –O –F –2 –– 0– 0– 7 –W (–C –0 –– 00 –– 11 –– 4–) T –h ––s i– e –– n– d– o–s r–e –m –e –– n–t –s i– b –– e–n i–– g– se –– n–t –o t– – yo –– uw ––t i–h – –e r–– sp –– e– c–t –o t– – yo –– u–r w –o ––k r–e ––s r– – co –m –p –– e– n– sa ––it–o –– na –– n– de –m –p ––o l–– ye ––s r– –il–a –– b–li–i–t–y – –n i–– su ––a r–– n– ce –p –– o–il–c –– y–. T –h ––s i– e –– n– d– o–s r–e –m –e –– n–t d –– o– e– sn –– o–t –e r–– p–a l–– ce – –h t–– e– se –– p– a–a r––e t– T –e ––r r–o ––i r–s –m – R ––s i–– k –n I–– su ––a r–– n– ce –P ––o r–– g–a r–m – R –e –– a– u–h t–– o–i r–z –a ––it–o –– nA –– c–t D ––s i–– c–o l–– su ––e r– E –n –– d– o–s r–e –m –e –– n–t –W (–C –0 –– 00 –– 42 –– 2A ––) –h t–– a–t –s i– a ––t t–a –– ch –– e– d –o t– – yo –– u–r – cu ––r r–e –– n–t p –– o–il–c –– ya –– n– d w –h ––c i–h – –e r–m –a ––n i–– s –n i– e ––f f–e –– c–t a –– sa –– p– p–il–c –a –– b–e l––. T –h –– eT –e ––r r–o ––i r–s –m – R ––s i–– k –n I–– su ––a r–– n– ce –A –– c–t o ––f 2 –– 0– 0– 2 –T (–R ––A I ––) a –– sp ––e r–– v–o i–– u– s–y l– a –m –e –– n– d– e– da –– n– de –– x–e t–– n– d– e– db –– y –h t–– eT –e ––r r–o ––i r–s –m – R ––s i–– k –n I–– su ––a r–– n– ce –P ––o r–– g–a r–m – R –e –– a– u–h t–– o–i r–z –a ––it–o –– nA –– c–t o ––f 2 –– 0– 0– 7 –T (–R ––P I–R –A ––, )– p ––o r–– v–d i–– e– s –o f––r a –p ––o r–– g–a r–m – u –– n– d– e–r w –h ––c i–h – –h t–– e –e f–– d– e–a r––l –– g o– ve ––n r–m –e –– n–t w ––li–l– – sh –– a–e r– –n i– –h t–– ep –– a– ym –e –– n–t o ––f –n i–– su ––e r–– d –o l–– s– se –– s– ca –– u– se –– db –– y– ce ––t r–a ––n i– a –– c–s t– o ––f –e t––r r–o ––i r–s –m ––. –n I– –h t–– ea –– b– se –– n– ce –o ––f ––fi a f–r–m –a ––it–v –e –U –S –C –o –– n– g–e r–– s– s–o i–– n– a–l a –– c–it–o –– n –o t– e –– x–e t–– n– d–, u –– p– d– a–e t––, o ––r o ––h t–– e–w r ––s i–e – –e r–– a– u–h t–– o–i r–z –e –T –R ––P I–R –A ––, –n i– w –h –– o–e l– o ––r –n i– p –– a–t r–,– T –R ––P I–R –A – –s i– – s– ch –– e– d– u–e l–– d –o t– e –– xp ––r i–e –D –e –– ce –m –b –– e–r 3 –– 1–, 2 –– 0– 1– 4–. S ––n i–– ce – –h t–– e –it–m –e ––a t–– b–e l– –o f––r a –– n– y –u f––t r–h –– e–r C –o –– n– g–e r–– s– s–o i–– n– a–l a –– c–it–o –– n –e r–– sp –– e– c–it–n –– gT –R ––P I–R –A – –s i– u –– n– kn –– ow –n –a ––t –h t––s i– –it–m –e ––, a –– n– d e– – xp –– o– su ––e r– –o t– a –– c–s t– o ––f –e t––r r–o ––i r–s –m – –e r–m –a ––n i–– s–, w –e –a ––e r– p ––o r–– v–d i––n i–– go –– u–r p –– o–il–c –– yh –– o–d l–– e–s r– w ––t i–h – –e r––e l–– va –– n–t –n i––o f––m r–a ––it–o –– n– co –– n– ce ––n r––n i–– g –h t–– e–r i– w –o ––k r–e ––s r– – co –m –p –– e– n– sa ––it–o –– np –– o–il–c ––e i–– s –n i– e ––f f–e –– c–t o –– no ––r a ––t f–e ––r – Ja –– n– u– a–y r– 1 ––, 2 –– 0– 1– 4 –n i– –h t–– ee –– ve –– n–t o ––f T –R ––P I–R –A ––s ’– e –– xp ––r i–a ––it–o –– n–. Y –o –– u–r p –– o–il–c –– yp ––o r–– v–d i–– e– s– co –– ve ––a r–– g– e –o f––r w –o ––k r–e ––s r– – co –m –p –– e– n– sa ––it–o –– n –o l–– s– se –– s– ca –– u– se –– db –– ya –– c–s t– o ––f –e t––r r–o ––i r–s –m – o ––r w –a ––, r––n i–– c–u l–– d–n i–– g w –o ––k r–e ––s r– – co –m –p –– e– n– sa ––it–o –– nb –– e– n– e–t fi– o –– b–il–g –– a–it–o –– n– sd ––c i––a t––e t–– db –– y– s–a t––e t– –a l–w ––, e –– x– ce –– p–t –n i– P –e –– n– n– s– y–v l–a –– n–a i– w –h –– e–e r– –n i––u j––i r–e –– so ––r –– d e– a–h t–– s –e r–– su ––t l–i–n –– g –r f–o –m – – ce ––t r–a ––n i– w –a ––r–r–e ––a l––e t–– da –– c–it–v ––t i–i–e –– sa ––e r– e –– x– c–u l–– d– e– d –r f–o –m – w –o ––k r–e ––s r– – co –m –p –– e– n– sa ––it–o –– n– co –– ve ––a r–– g– e–. C –o –– ve ––a r–– g– e –o f––r – su –– ch – –o l–– s– se –– s –s i– – s–it–l–l– – su –– b–e j–– c–t –o t– a ––ll––e t––m r–– s–, d –– e–n fi––t i–i–o –– n– s–, e –– x– c–u l–– s–o i–– n– s–, a –– n– d– co –– n– d–t i–i–o –– n– s –n i– – yo –– u–r p –– o–il–c –– y–. T –h –e –p ––re –m ––u i–m – c –h –a ––rg –e – –o f––r –h t–e –c –o –v –– e–ra –g –e –y –o –u ––r p –o ––i l–c –– yp ––ro –v ––d i–e –– s –o f––r –e t––r–ro ––r–s i–m – o ––r w –a ––r –o l–s –– s– e– s –s i– s –h –o –w –n – –n i– –t I–e –m – 4o – ––f –h t–e – –n I––o f––rm –a ––i t–o –n –P –a –g –e –o ––r –h t–e –S –c –h –e –d –u ––e l– –n i– –h t–e –T –e ––r–ro ––r–s i–m – R ––s i–– k –n I–s –u ––ra –n –c –– eP ––ro –g ––ra –m – R –e –– au ––h t–o ––r–z i–a ––i t–o –n – A –c ––t D ––s i–– c–o l–s –u ––re –E –n –d –o ––rs –– em –e –n ––t –W (–C –0 –– 00 –– 42 –– 2A ––) –h t–a ––t –s i– a ––t t–a –– ch –e –d – –o t– y –o –u ––r p –o ––i l–c –– y–, a –n –d – –h t––s i– a –m –o –u –n ––t m –a –– y –o c –n ––i t–n –u –e –o ––r c –h –a –n –g –e – –o f––r n –e –w –,– –re –n –e –w –a ––, l– a –n –d – –n i––f -–o ––rc –– ep –o ––i l–c ––e i–– s –n i– e ––f f–e –– c–t o –n –o ––r a ––t f–e ––r D –e –– c– em –b –e ––r 3 –– 1–, 2 –– 0– 1– 4 –n i– –h t–e –e –– v– en ––t o ––f T –R ––P I–R –A ––s ’– e –– xp ––r i–a ––i t–o –n ––, s –u –b ––e j–– c–t –o t– –re –g –u ––a l––o t––ry – –re –– v–e i–w – –n i– a –– c– co ––rd –a –n –c –– ew ––t i–h –a –p –p ––i l–c –– ab ––e l– s ––a t––e t– –a l–w –. Y –o –– un –– e– e– dn –– o–t d –– oa –– n– y–h t––n i–– g –u f––t r–h –– e–r a ––t –h t––s i– –it–m –e ––. © Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. NATIONAL COUNCIL ON COMPENSATION INSURANCE, INC. P-1412 PAGE 8 ITEM P-1412—TERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION ACT OF 2015 ENDORSEMENTS EXHIBIT 4 FORMS MANUAL OF WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE FLORIDA TERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION ACT ENDORSEMENT (WC 09 04 03 B) FLORIDA TERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION ACT ENDORSEMENT (WC 09 04 03 A – B) This endorsement addresses requirements of the Terrorism Risk Insurance Act of 2002 as amended by the Terrorism Risk Insurance Program Reauthorization Act of 2 –– 0– 0– 7 2015. Definitions The definitions provided in this endorsement are based on and have the same meaning as the definitions in the Act . If words or phrases not defined in this endorsement are defined in the Act, the definitions in the Act will apply. 1. “Act” means the Terrorism Risk Insurance Act of 2002, which took effect on November 26, 2002, and any amendments, including any amendments resulting from the Terrorism Risk Insurance Program Reauthorization Act of 2 –– 0– 0– 7 2015. 2. “Act of Terrorism” means any act that is certified by the Secretary of the Treasury, in – co –– n– cu ––r r–e –– n– ce –w ––t i–h – –h t–– eS –e –– c–e r––a t––y r– o ––f S ––a t––e t––, consultation with the Secretary of Homeland Security, and the Attorney General of the United States as meeting all of the following requirements: a. The act is an act of terrorism. b. The act is violent or dangerous to human life, property or infrastructure. c. The act resulted in damage within the United States, or outside of the United States in the case of the premises of United States missions or certain air carriers or vessels. d. The act has 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. 3. “Insured Loss” means any loss resulting from an act of terrorism (including an act of war, in the case of workers compensation) that is covered by primary or excess property and casualty insurance issued by an insurer if the loss occurs in the United States or at the premises of United States missions or to certain air carriers or vessels. 4. “Insurer Deductible” means, for the period beginning on January 1, 2 –– 0– 0– 8 2015, and ending on December 31, 2 –– 0– 1– 4 2020, an amount equal to 20% of our direct earned premiums, o –– ve ––r –h t–– e– ca ––e l–– n– d– a–r – ye –– a–r during the immediately preceding calendar year. –h t–– ea –– p– p–il–c –a –– b–e l– P ––o r–– g–a r–m – Y –e –– a–r –. 5. –P “ ––o r–– g–a r–m – Y –e –– a–” r– –e r––e f––s r– –o t– e –– a– ch –– ca ––e l–– n– d– a–r – ye –– a–r b –– e–w t–e –– e– n– Ja –– n– u– a–y r– 1 ––, 2 –– 0– 0– 8a –– n– dD –e –– ce –m –b –– e–r 3 –– 1–, 2 –– 0– 1– 4–, a –– s –– a p– p–il–c –a –– b–e l––. Limitation of Liability The Act may limit our liability to you under this policy. If aggregate Insured Losses exceed $100,000,000,000 in a P ––o r–– g–a r–m – Y –e –– a–r calendar year and if we have met our Insurer Deductible, we may not be liable for the payment of any portion of the amount of Insured Losses that exceeds $100,000,000,000; and for aggregate Insured Losses up to $100,000,000,000, we may only have to pay a pro rata share of such Insured Losses as determined by the Secretary of the Treasury. Policyholder Disclosure Notice 1. Insured Losses would be partially reimbursed by the United States Government. If the aggregate industry Insured Losses exceed: © Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. NATIONAL COUNCIL ON COMPENSATION INSURANCE, INC. P-1412 PAGE 9 ITEM P-1412—TERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION ACT OF 2015 ENDORSEMENTS EXHIBIT 4 (CONT'D) FORMS MANUAL OF WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE FLORIDA TERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION ACT ENDORSEMENT (WC 09 04 03 B) a. $100,000,000, with respect to such Insured Losses occurring in calendar year 2015, the United States Government would pay 85% of our Insured Losses that exceed our Insurer Deductible. b. $120,000,000, with respect to such Insured Losses occurring in calendar year 2016, the United States Government would pay 84% of our Insured Losses that exceed our Insurer Deductible. c. $140,000,000, with respect to such Insured Losses occurring in calendar year 2017, the United States Government would pay 83% of our Insured Losses that exceed our Insurer Deductible. d. $160,000,000, with respect to such Insured Losses occurring in calendar year 2018, the United States Government would pay 82% of our Insured Losses that exceed our Insurer Deductible. e. $180,000,000, with respect to such Insured Losses occurring in calendar year 2019, the United States Government would pay 81% of our Insured Losses that exceed our Insurer Deductible. f. $200,000,000, with respect to such Insured Losses occurring in calendar year 2020, the United States Government would pay 80% of our Insured Losses that exceed our Insurer Deductible. – s$ –– 1– 0– 0–0 ,–– 0– 0–0 ,–– 0– 0 –n i– a –P ––o r–– g–a r–m – Y –e –– a–, r––h t–– eU –n ––t i–e –– dS ––a t––e t–– sG –o –– ve ––n r–m –e –– n–t w –o –– u–d l– p –– a– y8 –– 5% – o ––f o –– u–r –n I–– su ––e r–– dL –– o– s– se –– s –h t–– a–t e –– x– ce –– e– do –– u–r –n I–– su ––e r––r D –e –– d– u– c–it–b ––e l––. 2. Notwithstanding item 1 above, the United States Government may not have to make any payment under the Act for any portion of Insured Losses that exceeds – $100,000,000,000. 3. The premium charged for the coverage for Insured Losses under this policy is included in the amount shown in Item 4 of the Information Page or the Schedule below. Schedule Rate per $100 of Remuneration © Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. NATIONAL COUNCIL ON COMPENSATION INSURANCE, INC. P-1412 PAGE 10 ITEM P-1412—TERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION ACT OF 2015 ENDORSEMENTS EXHIBIT 4 FORMS MANUAL OF WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE TEXAS NOTIFICATION ENDORSEMENT OF PENDING LAW CHANGE TO TERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION ACT OF 2007 (WC 42 01 01) T –E –X –A –S –N –O –T ––F I––C I–A –T ––O I–N – E –N –D –O –R –S –E –M –E –N –T –O –F –P –E –N –D ––N I–G – L –A –W – C –H –A –N –G –E –T –O – T –E –R –R –O –R ––S I–M – R ––S I–K – –N I–S –U –R –A –N –C –E –P –R –O –G –R –A –M – R –E –A –U –T –H –O –R ––Z I–A –T ––O I–N –A –C –T –O –F –2 –– 0– 0– 7 –W (–C –4 –– 20 –– 10 –– 1–) T –h ––s i– e –– n– d– o–s r–e –m –e –– n–t –s i– b –– e–n i–– g– se –– n–t –o t– – yo –– uw ––t i–h – –e r–– sp –– e– c–t –o t– – yo –– u–r w –o ––k r–e ––s r– – co –m –p –– e– n– sa ––it–o –– na –– n– de –m –p ––o l–– ye ––s r– –il–a –– b–li–i–t–y – –n i–– su ––a r–– n– ce –p –– o–il–c –– y–. T –h –– eT –e ––r r–o ––i r–s –m – R ––s i–– k –n I–– su ––a r–– n– ce –A –– c–t o ––f 2 –– 0– 0– 2 –T (–R ––A I ––) a –– sp ––e r–– v–o i–– u– s–y l– a –m –e –– n– d– e– da –– n– de –– x–e t–– n– d– e– db –– y –h t–– eT –e ––r r–o ––i r–s –m – R ––s i–– k –n I–– su ––a r–– n– ce –P ––o r–– g–a r–m – R –e –– a– u–h t–– o–i r–z –a ––it–o –– nA –– c–t o ––f 2 –– 0– 0– 7 –T (–R ––P I–R –A ––, )– p ––o r–– v–d i–– e– s –o f––r a –p ––o r–– g–a r–m – u –– n– d– e–r w –h ––c i–h – –h t–– e –e f–– d– e–a r––l –– g o– ve ––n r–m –e –– n–t w ––li–l– – sh –– a–e r– –n i– –h t–– ep –– a– ym –e –– n–t o ––f –n i–– su ––e r–– d –o l–– s– se –– s– ca –– u– se –– db –– y– ce ––t r–a ––n i– a –– c–s t– o ––f –e t––r r–o ––i r–s –m ––. –n I– –h t–– ea –– b– se –– n– ce –o ––f ––fi a f–r–m –a ––it–v –e –U –S –C –o –– n– g–e r–– s– s–o i–– n– a–l a –– c–it–o –– n –o t– e –– x–e t–– n– d–, u –– p– d– a–e t––, o ––r o ––h t–– e–w r ––s i–e – –e r–– a– u–h t–– o–i r–z –e –T –R ––P I–R –A ––, –n i– w –h –– o–e l– o ––r –n i– p –– a–t r–,– T –R ––P I–R –A – –s i– – s– ch –– e– d– u–e l–– d –o t– e –– xp ––r i–e –D –e –– ce –m –b –– e–r 3 –– 1–, 2 –– 0– 1– 4–. S ––n i–– ce – –h t–– e –it–m –e ––a t–– b–e l– –o f––r a –– n– y –u f––t r–h –– e–r C –o –– n– g–e r–– s– s–o i–– n– a–l a –– c–it–o –– n –e r–– sp –– e– c–it–n –– gT –R ––P I–R –A – –s i– u –– n– kn –– ow –n –a ––t –h t––s i– –it–m –e ––, a –– n– d e– – xp –– o– su ––e r– –o t– a –– c–s t– o ––f –e t––r r–o ––i r–s –m – –e r–m –a ––n i–– s–, w –e –a ––e r– p ––o r–– v–d i––n i–– go –– u–r p –– o–il–c –– yh –– o–d l–– e–s r– w ––t i–h – –e r––e l–– va –– n–t –n i––o f––m r–a ––it–o –– n– co –– n– ce ––n r––n i–– g –h t–– e–r i– w –o ––k r–e ––s r– – co –m –p –– e– n– sa ––it–o –– np –– o–il–c ––e i–– s –n i– e ––f f–e –– c–t o –– no ––r a ––t f–e ––r – Ja –– n– u– a–y r– 1 ––, 2 –– 0– 1– 4 –n i– –h t–– ee –– ve –– n–t o ––f T –R ––P I–R –A ––s ’– e –– xp ––r i–a ––it–o –– n–. Y –o –– u–r p –– o–il–c –– yp ––o r–– v–d i–– e– s– co –– ve ––a r–– g– e –o f––r w –o ––k r–e ––s r– – co –m –p –– e– n– sa ––it–o –– n –o l–– s– se –– s– ca –– u– se –– db –– ya –– c–s t– o ––f –e t––r r–o ––i r–s –m – o ––r w –a ––, r––n i–– c–u l–– d–n i–– g w –o ––k r–e ––s r– – co –m –p –– e– n– sa ––it–o –– nb –– e– n– e–t fi– o –– b–il–g –– a–it–o –– n– sd ––c i––a t––e t–– db –– y– s–a t––e t– –a l–w ––. C –o –– ve ––a r–– g– e –o f––r – su –– ch – –o l–– s– se –– s –s i– – s–it–l–l– – su –– b–e j–– c–t –o t– a ––ll– –e t––m r–– s–, d –– e–n fi––t i–i–o –– n– s–, e –– x– c–u l–– s–o i–– n– s–, a –– n– d– co –– n– d–t i–i–o –– n– s –n i– – yo –– u–r p –– o–il–c –– y–. T –h –e –p ––re –m ––u i–m – c –h –a ––rg –e – –o f––r –h t–e –c –o –v –– e–ra –g –e –y –o –u ––r p –o ––i l–c –– yp ––ro –v ––d i–e –– s –o f––r –e t––r–ro ––r–s i–m – o ––r w –a ––r –o l–s –– s– e– sm –a –– yc –o –n ––i t–n –u –e – o ––r c –h –a –n –g –e – –o f––r n –e –w –,– –re –n –e –w –a ––, l– a –n –d – –n i––f -–o ––rc –– ep –o ––i l–c ––e i–– s –n i– e ––f f–e –– c–t o –n –o ––r a ––t f–e ––r D –e –– c– em –b –e ––r 3 –– 1–, 2 –– 0– 1– 4 –n i– –h t–e –e –– v– en ––t o ––f T –R ––P I–R –A ––s ’– e –– xp ––r i–a ––i t–o –n ––, s –u –b ––e j–– c–t –o t– –re –g –u ––a l––o t––ry – –re –– v–e i–w – –n i– a –– c– co ––rd –a –n –c –– ew ––t i–h –a –p –p ––i l–c –– ab ––e l– s ––a t––e t– –a l–w –.– Y –o –– un –– e– e– dn –– o–t d –– oa –– n– y–h t––n i–– g –u f––t r–h –– e–r a ––t –h t––s i– –it–m –e ––. © Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.