Form 1 2016 TRIP Data Collection Form

Collection of Data from Property and Casualty Insurers for a Report on the Effectiveness of the Terrorism Risk Insurance Program

2016 Data Call Template Revised.xlsx

Collection of Data from Property and Casualty Insurers for a Report on the Effectiveness of the Terrorism Risk Insurance Program - Small Insurers

OMB: 1505-0253

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Overview

Affiliations
Premium (Juris.)
Number of Policies (Juris.)
Package Policies (US)
Standalone Terrorism (US)
Exposure Bases (Juris.)
Industry Code (NAICS or SIC)
Geographic (US)
Reinsurance (US)


Sheet 1: Affiliations

A B C D E F G H I J
2 NAIC Group Code Insurer Group Name NAIC Company Code Insurance Company Name Type of Insurer (Admitted (A), Domestic Surplus Lines (DSL), Alien Surplus Lines (ASL), Captive (C), Risk Retention Group (RRG), Residual Market Entity (RM), State Workers' Compensation Fund (WCF)) Total 2015 Net Admitted Assets Total 2015 Policyholder Surplus Total 2014 TRIP-Eligible DEP (all lines) (Cell E19 of Premium by Jurisdiction Worksheet, all Jurisdictions Combined) Total 2015 TRIP-Eligible DEP (all lines) (Cell E16 of Premium by Jurisdiction Worksheet, all Jurisdictions Combined)
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22 TOTALS:




































































General Instructions: Please provide the requested information for each company within an affiliated group of insurers (expanding the fields as necessary if your insurer group includes more companies for which space is provided that write TRIA-eligible lines insurance). The subsequent charts, however, seek information only on a consolidated insurer group basis. If not part of a group, please report information for your single company only. Premium information should be provided on a direct earned premium (DEP) basis. Financial data in all Worksheets should be provided in US Dollars, rounded whole numbers using a 1000 separator (,), and without any currency symbol (e.g., $). Refer to the Data Dictionary for further instructions. All information provided as part of this submission shall be certified by the responding insurer as a full and true statement of the information provided to the best of its knowledge, information, and belief.





































Notice Under the Paperwork Reduction Act














We estimate that it will take you about 50 hours to complete this form (all worksheets combined), assuming you have information to provide in connection with all of the identified questions, and only about 25 hours if you have more limited information. However, you are not required to provide information requested unless a valid OMB control number is displayed on the form. Any comments or suggestions regarding this form should be sent to the Federal Insurance Office, 1500 Pennsylvania Avenue, NW, Room 1410, Washington, DC 20220. Do not send completed forms to this address. Submit forms according to instructions provided at [http://www._____________]













Sheet 2: Premium (Juris.)

A B C D E F G H I
2 TRIP-Eligible Line of Coverage NAIC Line (Commercial Only) Jurisdiction Total 2015 TRIP-Eligible DEP (all policies) Total 2015 TRIP-Eligible DEP when Terrorism Risk Coverage Not Purchased Total 2015 TRIP-Eligible DEP when Terrorism Risk Coverage Provided for Disclosed $0 Charge Total 2015 TRIP-Eligible DEP when Terrorism Risk Coverage Premium Charged Total 2015 Disclosed Terrorism Risk Coverage DEP Charged
3 Fire 1





4 Allied Lines 2.1





5 Commercial Multiple Peril (non-liability portion) 5.1





6 Commercial Multiple Peril (liability portion) 5.2





7 Ocean Marine 8





8 Inland Marine 9





9 Workers' Compensation 16





10 Excess Workers' Compensation 16.0003





11 Other Liability 17





12 Umbrella and Excess (Commercial) 17.0020





13 Products Liability 18





14 Aircraft (all perils) 22





15 Boiler and Machinery 27





16 TOTALS






17 ALL DISCLOSED TERRORISM RISK PREMIUM COLLECTED IN ALL TRIA-ELIGIBLE LINES, 2003-2015






18 YEARS COVERED BY CELL I17 IF NOT 2003-2015






19 TOTAL 2014 TRIP-ELIGIBLE DEP (ALL LINES)
















General Instructions: See instructions in the Data Dictionary for this Worksheet.
















Sheet 3: Number of Policies (Juris.)

A B C D E F G H
2 TRIP-Eligible Line of Coverage NAIC Line (Commercial Only) Jurisdiction Total 2015 Number of Policies by line Total 2015 Number of Policies by line when Terrorism Risk Coverage Not Purchased Total 2015 Number of Policies by line when Terrorism Risk Coverage Provided for Disclosed $0 Charge Total 2015 Number of Policies by line when Terrorism Risk Coverage Premium Charged
3 Fire 1




4 Allied Lines 2.1




5 Commercial Multiple Peril (non-liability portion) 5.1




6 Commercial Multiple Peril (liability portion) 5.2




7 Ocean Marine 8




8 Inland Marine 9




9 Workers' Compensation 16




10 Excess Workers' Compensation 16.0003




11 Other Liability 17




12 Umbrella and Excess (Commercial) 17.0020




13 Products Liability 18




14 Aircraft (all perils) 22




15 Boiler and Machinery 27




16 TOTAL





17 TOTAL NUMBER OF POLICIES CONTAINING TRIP-ELIGIBLE COVERAGE






















General Instructions: See instructions in the Data Dictionary for this Worksheet.






















Sheet 4: Package Policies (US)

A B C D E F G H I J K L
2 Jurisdiction Total 2015 Number of Package/Multi-line Policies containing at least one TRIP-Eligible Line Total 2015 DEP associated with Package/Multi-line Policies containing at least one TRIP-Eligible Line Total 2015 TRIP-Eligible DEP associated with Package/Multi-line Policies containing at least one TRIP-Eligible Line Total 2015 Number of Package/Multi-line Policies containing at least one TRIP-Eligible Line, but where No Terrorism Risk Coverage was Purchased Total 2015 TRIP-Eligible DEP associated with Package/Multi-line Policies containing at least one TRIP-Eligible Line, but where No Terrorism Risk Coverage was Purchased Total 2015 Number of Package/Multi-line Policies containing at least one TRIP-Eligible Line where Terrorism Risk Coverage was provided for a Disclosed $0 Premium Total 2015 TRIP-Eligible DEP associated with Package/Multi-line Policies containing at least one TRIP-Eligible Line where Terrorism Risk Coverage was provided for a Disclosed $0 Premium Total 2015 Number of Package/Multi-line Policies containing at least one TRIP-Eligible Line where Terrorism Risk Coverage provided for a Disclosed non-$0 Premium Total 2015 TRIP-Eligible DEP associated with Package/Multi-line Policies containing at least one TRIP-Eligible Line where Terrorism Risk Coverage provided for a Disclosed non-$0 Premium Total 2015 Disclosed Terrorism Coverage DEP Charged under Package/Multi-line Policies containing at least one TRIP-Eligible Line
3 Alabama









4 Alaska









5 American Samoa









6 Arizona









7 Arkansas









8 California









9 Colorado









10 Connecticut









11 Delaware









12 District of Columbia









13 Florida









14 Georgia









15 Guam









16 Hawaii









17 Idaho









18 Illinois









19 Indiana









20 Iowa









21 Kansas









22 Kentucky









23 Louisiana









24 Maine









25 Maryland









26 Massachusetts









27 Michigan









28 Minnesota









29 Mississippi









30 Missouri









31 Montana









32 Nebraska









33 Nevada









34 New Hampshire









35 New Jersey









36 New Mexico









37 New York









38 North Carolina









39 North Dakota









40 Northern Marianas









41 Ohio









42 Oklahoma









43 Oregon









44 Pennsylvania









45 Puerto Rico









46 Rhode Island









47 South Carolina









48 South Dakota









49 Tennessee









50 Texas









51 Utah









52 Vermont









53 Virginia









54 Virgin Islands









55 Washington









56 West Virginia









57 Wisconsin









58 Wyoming









59 TOTALS
































General Instructions: See instructions in the Data Dictionary for this Worksheet.








Sheet 5: Standalone Terrorism (US)

A B C
2 Element Amount
3 2015 DEP for Standalone Terrorism Policies
4 Portion of 2015 DEP for TRIP Certified Terrorism Loss Coverage
5 Portion of 2015 DEP for Non-Certified Terrorism Loss Coverage
6 2015 Number of Standalone Terrorism Policies Issued
7 2015 Number of Standalone Terrorism Policies Covering TRIP Loss Issued
8 2015 Total Insured Values (TIVs) for Standalone Terrorism Policies Covering TRIP Loss (Property)
9 2015 Total Limits of Liability for Standalone Terrorism Policies Covering TRIP Loss (Liability)




General Instructions: See instructions in the Data Dictionary for this Worksheet.

Sheet 6: Exposure Bases (Juris.)

A B C D E F G H I
2 TRIP-Eligible Line of Coverage NAIC Line (Commercial Only) Jurisdiction 2015 Total Insured Values (TIVs) Subject to Terrorism Risk Coverage 2015 TIVs Not Subject to Terrorism Risk Coverage Total 2015 Limits of Liability Subject to Terrorism Risk Coverage Total 2015 Limits of Liability Not Subject to Terrorism Risk Coverage Total 2015 Payroll Subject to Terrorism Risk Coverage
3 Fire 1





4 Allied Lines 2.1





5 Commercial Multiple Peril (non-liability portion) 5.1





6 Commercial Multiple Peril (liability portion) 5.2





7 Ocean Marine 8





8 Inland Marine 9





9 Workers' Compensation 16





10 Excess Workers' Compensation 16.0003





11 Other Liability 17





12 Umbrella and Excess (Commercial) 17.0020





13 Products Liability 18





14 Aircraft (all perils) 22





15 Boiler and Machinery 27





16 TOTALS
















General Instructions: See instructions in the Data Dictionary for this Worksheet.
















Sheet 7: Industry Code (NAICS or SIC)

A B C D E F G H I J K L M N O P Q R S T
2 NAICS Code NAICS Code Description Applicable to Policyholder SIC Code SIC Code Description Jurisdiction Total TRIP-Eligible DEP (all categories)
Total 2015 TRIP-Eligible DEP Property Total 2015 TRIP-Eligible DEP Property When Terrorism Risk Coverage Not Purchased Total 2015 TRIP-Eligible DEP Property When Terrorism Risk Coverage Purchased Total 2015 Disclosed Terrorism Risk Coverage DEP Charged for Property
Total 2015 TRIP-Eligible DEP Other Commercial Total 2015 TRIP-Eligible DEP Other Commercial When Terrorism Risk Coverage Not Purchased Total 2015 TRIP-Eligible DEP Other Commercial When Terrorism Risk Coverage Purchased Total 2015 Disclosed Terrorism Risk Coverage DEP Charged for Other Commercial
Total 2015 TRIP-Eligible DEP WC Total 2015 Disclosed Terrorism Risk Coverage DEP Charged for WC
3 11 Agriculture, Forestry, Fishing & Hunting
















4 21 Mining, quarrying and oil and gas extraction
















5 22 Utilities
















6 23 Construction
















7 31-33 Manufacturing
















8 42 Wholesale Trade
















9 44-45 Retail Trade
















10 48-49 Transportation & Warehousing
















11 51 Information
















12 52 Finance & Insurance
















13 53 Real Estate and Rental and Leasing
















14 54 Professional, Scientific & Technical Service
















15 55 Management of Companies and Enterprises
















16 56 Administrative & Support & Waste Management & Remediation Services
















17 61 Educational Services
















18 62 Health Care & Social Assistance
















19 71 Arts, Entertainment & Recreation
















20 72 Accommodation & Food Services
















21 81 Other Services (except Public Administration)
















22 92 Public Administration
















23

01-09 Agriculture, Forestry & Fishing














24

10-14 Mining














25

15-17 Construction














26

20-39 Manufacturing














27

40-49 Transportation, Communications, Electric, Gas & Sanitary Services














28

50-51 Wholesale Trade














29

52-59 Retail Trade














30

60-67 Finance, Insurance & Real Estate














31

70-89 Services














32

91-99 Public Administration














33
TOTALS:

























































General Instructions: Report direct earned premium information (DEP) as divided by the industry classification of your policyholders. Use NAICS Codes for purposes of allocation unless you still use SIC Codes; report in the appropriate fields for one or the other, but not both. Unlike other worksheets, this Worksheet does not seek information segregated by coverage subject to TRIA provided for a $0 disclosed premium charge. "Other Commercial" references liability coverages; see the Exposure Bases by Jurisdiction Worksheet to identify lines as divided between property and liability exposures. Refer to the data dictionary for further instructions.















Sheet 8: Geographic (US)

A B C D E F G H I J K
2 Jurisdiction Description Total 2015 Payroll Subject to TRIP Coverage under Primary WC Coverage Total 2015 Payroll Subject to TRIP Coverage under Excess WC Coverage Total 2015 TIVs Subject to TRIP Property Coverage Total 2015 TIVs Not Subject to TRIP Property Coverage ZIP Code of Top 5 Largest Accumulated Exposure Locations by Payroll Amount of Top 5 Largest Accumulated Exposure Locations by Payroll ZIP Code of Top 5 Largest Accumulated Exposure Locations by TIVs subject to TRIP Property Coverage Amount of Top 5 Largest Accumulated Exposure Locations by TIVs subject to TRIP Property Coverage
3 Atlanta. GA All zip codes within the four counties of Fulton, DeKalb, Clayton, and Cobb.







4 Baltimore, MD All zip codes in Baltimore City, all zip codes in Baltimore County excluding 21013, 21020,21023,21030, 21031, 21051, 21053, 21057, 21065, 21071, 21074, 21082, 21087, 21092, 21102, 21105, 21111, 21120, 21131, 21136, 21152, 21155, 21161; include the following zip codes from Anne Arundel County – 21060, 21061, 21062, 21076, 21077, 21090, 21098, 21122, 21123, 21144, 21225, 21226, 21240.







5 Boston. MA All zip codes from Suffolk county; for Essex County only include zip codes 01901 thru 01908, 01910, 01945, 01960, 01961, 01970, 01971; for Norfolk County only include zip codes 02026, 02027, 02030, 02062, 02090, 02169, 02170, 02171, 02184 thru 02191, 02269, 02445, 02446, 02447, 02457, 02467, 02481, 02482, 02492, 02494; for Middlesex County only include zip codes 01701 thru 01705, 01760, 01770, 01776, 01778, 01801, 01803, 01805 thru 01808, 01813, 01815, 01866, 01867, 01880, 01888, 01890, 02138 thru 02145, 02148, 02149, 02153, 02155, 02156, 02176, 02180, 02212, 02238, 02239, 02420, 02421, 02451 thru 02456, 02458 thru 02462, 02464 thru 02468, 02471, 02472, 02474 thru 02479, 02493, 02495.







6 Charlotte, NC All zip codes within the five counties of Mecklenburg, Gaston, York, Union and Cabarrus.







7 Chicago, IL All zip codes within the four counties of Cook, DuPage, Lake, and Will.







8 Dallas/Ft. Worth, TX All zip codes in the two counties of Dallas and Tarrant (Fort Worth).







9 Denver, CO All zip codes in the counties of Denver, Adams, and Arapahoe.







10 Detroit, MI All zip codes in the counties of Wayne, Oakland, and Macomb.







11 Houston, TX All zip codes in Harris County.







12 Las Vegas, NV All zip codes in Clark County.







13 Los Angeles, CA All zip codes within the two counties of Los Angeles and Orange.







14 Miami, FL All zip codes in Miami-Dade County.







15 Minneapolis/St. Paul, MN All zip codes in the two counties of Hennepin and Ramsey.







16 New York, NY All zip codes within the five counties of Kings (Brooklyn), Queens, New York (Manhattan), Bronx, and Richmond (Staten Island).







17 Newark, NJ All zip codes for the cities of Newark (07101 thru 07108, 07112, 07114, 07175, 07182, 07184, 07188, 07189, 07191, 07192, 07193, 07194, 07195, 07198, 07199) and Elizabeth (07201, 07202, 07206, 07207, 07208).







18 Philadelphia, PA All zip codes in Philadelphia County.







19 Phoenix, AZ All zip codes in Maricopa County.







20 Pittsburgh, PA All zip codes in Allegheny County.







21 Portland, OR All zip codes in Multnomah County, OR and Clark County, WA.







22 Providence, RI All zip codes in Providence County.







23 Riverside/San Bernardino, CA All zip codes in the counties of Riverside and San Bernardino.







24 San Diego, CA All zip codes in San Diego County







25 San Francisco, CA All zip codes with the two counties of San Francisco and San Mateo.







26 Seattle, WA All zip codes in King County.







27 St. Louis, MO All zip codes in the two counties of St. Louis City and St. Louis.







28 Tampa/St. Petersburg, FL All zip codes in the two counties of Hillsborough and Pinellas.







29 Washington, DC All zip codes within Washington D.C. and all zip codes within the two counties of Arlington VA and Alexandria City VA.







30 TOTALS:








31









32 Jurisdiction Description Total 2015 Payroll Subject to TRIA Coverage under Primary WC Coverage Total 2015 Payroll Subject to TRIA Coverage under Excess WC Coverage Total 2015 TIVs Subject to TRIA Property Coverage Total 2015 TIVs Not Subject to TRIA Property Coverage ZIP Code of Top 5 Largest Accumulated Exposure Locations by Payroll Amount of Top 5 Largest Accumulated Exposure Locations by Payroll ZIP Code of Top 5 Largest Accumulated Exposure Locations by TIVs subject to TRIA Property Coverage Amount of Top 5 Largest Accumulated Exposure Locations by TIVs subject to TRIA Property Coverage
33 All other Locations in the US All areas in the US other than those specified in Cells C3-C29







34 All other Locations in the US








35 All other Locations in the US








36 All other Locations in the US








37 All other Locations in the US








38 GRAND TOTALS (Individual Jurisdictions plus all other locations in the US)








39









40 Largest Probable Maximum Loss (PML) at a Single Location







41 ZIP Code Associated with Largest PML







42


Payroll Coded by Employee Location (Y/N) Payroll Coded by Headquarters Location (Y/N) Payroll Coded based upon Other Method (Y/N)



43 Indicate in the adjoining cells if reported payroll is geocoded by separate locations where employees are located or if it is allocated by assignment to a single headquarters location, or otherwise assigned





























General Instructions: This template seeks exposure information by various metropolitan areas, then for the remainder of the US as a whole. Refer to the Data Dictionary for further instructions. The final questions (Lines 40 and 41) seek information concerning the insurer group or reporting company's largest Probable Maximum Loss at a single street level address location, assuming the detonation of a 5 ton truck bomb at that location.






Sheet 9: Reinsurance (US)

A B C D E
2 Element Amount Yes/No Description or Explanation (if any)
3 Size of TRIP 2015 Deductible (Cell I22 of Insurer Group Affiliations Chart x 20%)


4 Total 2015 Limits Any One Loss of Purchased Reinsurance Covering TRIA Loss


5 Total 2015 Aggregate Limits of Purchased Reinsurance Covering TRIA Loss


6 2015 Attachment Point of Purchased Treaty Reinsurance Covering TRIA Loss


7 2015 Co-Participation Share of Purchased Treaty Reinsurance Covering TRIA Loss


8 Total 2015 Limits Any One Loss of Purchased Reinsurance Covering Natural Catastrophic Loss


9 Total 2015 Aggregate Limits of Purchased Reinsurance Covering Natural Catastrophic Loss


10 2015 Attachment Point of Purchased Treaty Reinsurance Covering Natural Catastrophic Loss


11 2015 Co-Participation Share of Purchased Treaty Reinsurance Covering Natural Catastrophic Loss


12 Any reinsurance exclusions for TRIA Certified Foreign Acts of Terrorism?


13 Any reinsurance exclusions for TRIA Certified Domestic Acts of Terrorism?


14 Reinsurance for NBCR WC Exposures Resulting from Certified Acts of Terrorism?


15 If Yes, Total 2015 Limits of NBCR Reinsurance for Certified Acts of Terrorism involving WC Loss


16 If Yes, 2015 Attachment Point of NBCR Reinsurance for Certified Acts of Terrorism involving WC Loss


17 If Yes, 2015 Co-Participation Share (if any) of NBCR Reinsurance For Certified Acts of Terrorism involving WC Loss


18 Reinsurance for NBCR Property Loss Resulting from Certified Acts of Terrorism?


19 If Yes, Total 2015 Limits of NBCR Reinsurance for Certified Acts of Terrorism involving Property Loss


20 If Yes, 2015 Attachment Point of NBCR Reinsurance for Certified Acts of Terrorism involving Property Loss


21 If Yes, 2015 Co-Participation Share (if any) of NBCR Reinsurance for Certified Acts of Terrorism involving Property Loss


22 Reinsurance for NBCR Other Commercial Loss Resulting from Certified Acts of Terrorism?


23 If Yes, Total 2015 Limits of NBCR Reinsurance for Certified Acts of Terrorism involving Other Commercial Loss


24 If Yes, 2015 Attachment Point of NBCR Reinsurance for Certified Acts of Terrorism involving Other Commercial Loss


25 If Yes, 2015 Co-Participation Share (if any) of NBCR Reinsurance for Certified Acts of Terrorism involving Other Commercial Loss


26 Any other reinsurance exclusions specifically applicable to TRIP Certified Acts of Terrorism?


27



28 * Using the following defined terrorism event, calculate and report (1) the projected amount of loss the insurer group (or single company that is not part of a group) will sustain net within its TRIA deductible; (2) any private reinsurance recovery available to the group or company; (3) the amount of the group or company's claim under TRIP; and (4) the amount of the group or company's continuing co-pay obligation under TRIP. The scenario is a 5 ton truck bomb detonates at Rockefeller Center (45 Rockefeller Plaza, New York, NY 10111) on June 9, 2015 (a Tuesday) at 11:00 AM. Further assume that the loss does not involve any NBCR exposures, and that damage emanating from the blast site is characterized by the following:
29



30 Zone 1 (200 meters from site): Collapse and fire following, 100% property damage and 10% fire loss
31 Zone 2 (400 meters from site): Massive debris damage to surrounding properties (25% property damage, 2.5% fire loss)
32 Zone 3 (500 meters from site): Light debris damage to surrounding properties (10% property damage, 1% fire loss)
33 Injuries: 2,000 blue/white-collar worker deaths in total and 4,000 injuries in total
34



35 Loss Element Amount

36 Loss to Group or Company within TRIP Deductible


37 Private Reinsurance Recovery


38 Claim under TRIP


39 Co-Pay Obligation


40 TOTAL (sum of C36-C39)












General Instructions: See instructions in the Data Dictionary for this Worksheet.


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