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Liberty <br /> Healthcare Professional Liability F' ` Its ,, <br /> LIBERTY INSURANCE UNDERWRITERS INC. <br /> (A Stock Insurance Company,hereinafter the"[Insurer/Company]") <br /> ENDORSEMENT NO. <br /> Effective Date: 07/01/2019 <br /> Policy Number: AHY-630201008 <br /> Issued To: Lynn D Shatz <br /> THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. <br /> DISCLOSURE—TERRORISM RISK INSURANCE ACT <br /> THIS ENDORSEMENT IS MADE PART OF YOUR POLICY PURSUANT TO THE TERRORISM RISK <br /> INSURANCE ACT. <br /> In accordance with the Terrorism Risk Insurance Act,including all amendments,("TRIA"or the"Act"),we are required <br /> to provide you with a notice of the portion of your premium attributable to coverage for "certified acts of terrorism," <br /> the federal share of payment of losses from such acts,and the limitation or"cap"on our liability under the Act. <br /> Disclosure of Premium <br /> The Company has made available coverage for "certified acts of terrorism" as defined in the Act. If purchased, the <br /> portion of your premium attributable to coverage for "certified acts of terrorism" is shown in the Declarations, <br /> Declarations Extension Schedule or elsewhere by endorsement in your policy. <br /> Federal Participation In Payment Of Terrorism Losses <br /> If an individual insurer's losses from certified acts of terrorism exceed a deductible amount specified in the Act, the <br /> federal government will reimburse the insurer for the Federal Share of losses paid in excess of the deductible, but only <br /> if aggregate industry losses from such acts exceed the"Program Trigger". <br /> The Federal Share and Program Trigger by calendar year are: <br /> Calendar Year Federal Share Program Trigger <br /> 2015 85% $100,000,000 <br /> 2016 84% $120,000,000 <br /> 2017 83% $140,000,000 <br /> 2018 82% $160,000,000 <br /> 2019 81% $180,000,000 <br /> 2020 80% $200,000,000 <br /> Cap On Insurer Participation In Payment Of Terrorism Losses <br /> If aggregate insured losses attributable to"certified acts of terrorism"exceed$100 billion in a calendar year and we have <br /> met our deductible under the Act,we shall not be liable for the payment of any portion of the amount of such losses <br /> that exceeds $100 billion. Nor shall Treasury make any payment for any portion of the amount of such losses that <br /> I 2 <br /> TRIA-N004-0315 <br />