| B | C | G | H | |||||
| 3 | NAIC Group Code | Insurer Group Name | 3 | Total 2017 Policyholder Surplus | ||||
| 4 | 4 | Total 2017 TRIP-Eligible DEP (all lines) | ||||||
| B | C | D | ||||||
| 8 | NAIC Company Code | Insurance Company Name | Type of Insurer | |||||
| 9 | ||||||||
| 10 | ||||||||
| 11 | ||||||||
| 12 | ||||||||
| 13 | ||||||||
| 14 | ||||||||
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| 27 | ||||||||
| Jurisdiction: | |||||||||||
| 2 | |||||||||||
| B | C | D | E | F | G | H | I | J | K | L | |
| Direct Earned Premium | Number of Policies | ||||||||||
| 6 | TRIP-Eligible Line of Coverage | NAIC Line (Commercial Only) | Total 2018 TRIP-Eligible DEP (all policies) | Total 2018 TRIP-Eligible DEP (Terrorism Risk Coverage Declined) | Total 2018 TRIP-Eligible DEP (Terrorism Risk Coverage Provided for Disclosed $0 Charge) | Total 2018 TRIP-Eligible DEP (Terrorism Risk Coverage Provided with a Premium Charged) | Total 2018 DEP Charged for Terrorism Risk Coverage | Total 2018 Number of Policies (Terrorism Risk Coverage Declined) | Total 2018 Number of Policies (Terrorism Risk Coverage Provided for Disclosed $0 Charge) | Total 2018 Number of Policies by Line (Terrorism Risk Coverage Provided with a Premium Charged) | Total 2018 Number of Policies |
| 7 | Fire | 1 | $- | 0 | |||||||
| 8 | Allied Lines | 2.1 | $- | 0 | |||||||
| 9 | Commercial Multiple Peril (non-liability portion) | 5.1 | $- | 0 | |||||||
| 10 | Commercial Multiple Peril (liability portion) | 5.2 | $- | 0 | |||||||
| 11 | Ocean Marine | 8 | $- | 0 | |||||||
| 12 | Inland Marine | 9 | $- | 0 | |||||||
| 13 | Workers' Compensation | 16 | $- | 0 | |||||||
| 14 | Excess Workers' Compensation | 17.3 | $- | 0 | |||||||
| 15 | Other Liability | 17 | $- | 0 | |||||||
| 16 | Products Liability | 18 | $- | 0 | |||||||
| 17 | Aircraft (all perils) | 22 | $- | 0 | |||||||
| 18 | Boiler and Machinery | 27 | $- | 0 | |||||||
| 19 | TOTALS | $- | $- | $- | $- | $- | 0 | 0 | 0 | 0 | |
| 21 | Total 2018 Number of Policies Containing TRIP-Eligible Coverage | ||||||||||
| B | C | |
| 2 | Element | Amount |
| 3 | 2018 DEP for Standalone Terrorism Policies | |
| 4 | Portion of 2018 DEP Providing Coverage for Losses for Certified Acts of Terrorism under TRIP | |
| 5 | Portion of 2018 DEP Providing Coverage for Losses Arising from Other (Non-Certified) Acts of Terrorism | |
| 6 | 2018 Number of Standalone Terrorism Policies Issued | |
| 7 | 2018 Number of Standalone Terrorism Policies Issued Providing Coverage for Losses for Certified Acts of Terrorism under TRIP | |
| 8 | Total 2018 Property Insurance Exposure for Standalone Terrorism Policies Providing Coverage for Losses for Certified Acts of Terrorism under TRIP | |
| 9 | Total 2018 Limits of Liability for Standalone Terrorism Policies Providing Coverage for Losses for Certified Acts of Terrorism under TRIP | |
| B | C | D | E | |
| 2 | Element | Standalone Cyber | Cyber Coverage Provided as Part of a Package Policy | Totals |
| 3 | Total 2018 TRIP-Eligible DEP (All Cyber Policies) | |||
| 4 | Total 2018 TRIP-Eligible DEP for Cyber Policies (Terrorism Risk Coverage Declined) | $- | ||
| 5 | Total 2018 TRIP-Eligible DEP for Cyber Policies (Terrorism Risk Coverage Provided) | $- | ||
| 6 | Total 2018 DEP Charged for Terrorism Risk Coverage Under Cyber Policies | 0 | ||
| 7 | Total 2018 Number of Cyber Policies Issued | 0 | ||
| 8 | Total 2018 Number of Cyber Policies Issued (Terrorism Risk Coverage Provided) | 0 | ||
| 9 | Total 2018 Limits of Liability for Cyber Policies Providing Coverage for Losses for Certified Acts of Terrorism Under TRIP | $- | ||
| Jurisdiction: | |||||||||||||
| 2 | |||||||||||||
| B | C | D | E | F | G | H | I | J | K | L | M | N | |
| 5 | TRIP-Eligible Line of Coverage | NAIC Line (Commercial Only) | Total 2018 TRIP-Eligible Property Exposure (Terrorism Risk Coverage Provided) | Total 2018 TRIP-Eligible Property Exposure (Terrorism Risk Coverage Provided and NBCR Risks Not Excluded) | Total 2018 Policyholder Deductibles for TRIP-Eligible Property Policies (Terrorism Risk Coverage Provided) | Total 2018 TRIP-Eligible Property Exposure (Terrorism Risk Coverage Declined) | Total 2018 Policyholder Deductibles for TRIP-Eligible Property Policies (Terrorism Risk Coverage Declined) | Total 2018 Limits of Liability for TRIP-Eligible Policies (Terrorism Risk Coverage Provided) | Total 2018 TRIP-Eligible Limits of Liability (Terrorism Risk Coverage Provided and NBCR Risks Not Excluded) | Total 2018 Policyholder Deductibles for TRIP-Eligible Liability Policies (Terrorism Risk Coverage Provided) | Total 2018 Limits of Liability for TRIP-Eligible Policies (Terrorism Risk Coverage Declined) | Total 2018 Policyholder Deductibles for TRIP-Eligible Liability Policies (Terrorism Risk Coverage Declined) | Total 2018 Payroll for TRIP-Eligible Policies (Terrorism Risk Coverage Provided) |
| 6 | Fire | 1 | |||||||||||
| 7 | Allied Lines | 2.1 | |||||||||||
| 8 | Commercial Multiple Peril (non-liability portion) | 5.1 | |||||||||||
| 9 | Commercial Multiple Peril (liability portion) | 5.2 | |||||||||||
| 10 | Ocean Marine | 8 | |||||||||||
| 11 | Inland Marine | 9 | |||||||||||
| 12 | Workers' Compensation | 16 | |||||||||||
| 13 | Excess Workers' Compensation | 17.3 | |||||||||||
| 14 | Other Liability | 17 | |||||||||||
| 15 | Products Liability | 18 | |||||||||||
| 16 | Aircraft (all perils) | 22 | |||||||||||
| 17 | Boiler and Machinery | 27 | |||||||||||
| 18 | TOTALS | $- | $- | $- | $- | $- | $- | $- | $- | $- | $- | $- | |
| B | C | D | E | F | G | H | I | J | K | L | M | N | O | ||
| Property | Liability | Workers' Compensation | All Categories | ||||||||||||
| 3 | Code | Description | Total 2018 DEP Charged for Terrorism Risk Coverage | Total 2018 TRIP-Eligible DEP (Terrorism Risk Coverage Declined) | Total 2018 TRIP-Eligible DEP (Terrorism Risk Coverage Provided) | Total 2018 TRIP-Eligible DEP | Total 2018 DEP Charged for Terrorism Risk Coverage | Total 2018 TRIP-Eligible DEP (Terrorism Risk Coverage Declined) | Total 2018 TRIP-Eligible DEP (Terrorism Risk Coverage Provided) | Total 2018 TRIP-Eligible DEP | Total 2018 DEP Charged for Terrorism Risk Coverage | Total 2018 TRIP-Eligible DEP | Total 2018 TRIP-Eligible DEP | ||
| 4 | NAICS Code | 11 | Agriculture, Forestry, Fishing & Hunting | $- | $- | $- | |||||||||
| 5 | 21 | Mining, Quarrying, and Oil & Gas Extraction | $- | $- | $- | ||||||||||
| 6 | 22 | Utilities | $- | $- | $- | ||||||||||
| 7 | 23 | Construction | $- | $- | $- | ||||||||||
| 8 | 31-33 | Manufacturing | $- | $- | $- | ||||||||||
| 9 | 42 | Wholesale Trade | $- | $- | $- | ||||||||||
| 10 | 44-45 | Retail Trade | $- | $- | $- | ||||||||||
| 11 | 48-49 | Transportation & Warehousing | $- | $- | $- | ||||||||||
| 12 | 51 | Information | $- | $- | $- | ||||||||||
| 13 | 52 | Finance & Insurance | $- | $- | $- | ||||||||||
| 14 | 53 | Real Estate and Rental and Leasing | $- | $- | $- | ||||||||||
| 15 | 54 | Professional, Scientific & Technical Service | $- | $- | $- | ||||||||||
| 16 | 55 | Management of Companies and Enterprises | $- | $- | $- | ||||||||||
| 17 | 56 | Administrative & Support & Waste Management & Remediation Services | $- | $- | $- | ||||||||||
| 18 | 61 | Educational Services | $- | $- | $- | ||||||||||
| 19 | 62 | Health Care & Social Assistance | $- | $- | $- | ||||||||||
| 20 | 71 | Arts, Entertainment & Recreation | $- | $- | $- | ||||||||||
| 21 | 72 | Accommodation & Food Services | $- | $- | $- | ||||||||||
| 22 | 81 | Other Services (except Public Administration) | $- | $- | $- | ||||||||||
| 23 | 92 | Public Administration | $- | $- | $- | ||||||||||
| 24 | N/A | Unavailable | $- | $- | $- | ||||||||||
| 25 | SIC Code | 01-09 | Agriculture, Forestry & Fishing | $- | $- | $- | |||||||||
| 26 | 10-14 | Mining | $- | $- | $- | ||||||||||
| 27 | 15-17 | Construction | $- | $- | $- | ||||||||||
| 28 | 20-39 | Manufacturing | $- | $- | $- | ||||||||||
| 29 | 40-49 | Transportation, Communications, Electric, Gas & Sanitary Services | $- | $- | $- | ||||||||||
| 30 | 50-51 | Wholesale Trade | $- | $- | $- | ||||||||||
| 31 | 52-59 | Retail Trade | $- | $- | $- | ||||||||||
| 32 | 60-67 | Finance, Insurance & Real Estate | $- | $- | $- | ||||||||||
| 33 | 70-89 | Services | $- | $- | $- | ||||||||||
| 34 | 91-99 | Public Administration | $- | $- | $- | ||||||||||
| 35 | N/A | Unavailable | $- | $- | $- | ||||||||||
| 36 | Other | $- | $- | $- | |||||||||||
| 37 | $- | $- | $- | ||||||||||||
| 38 | $- | $- | $- | ||||||||||||
| 39 | $- | $- | $- | ||||||||||||
| 40 | $- | $- | $- | ||||||||||||
| 41 | $- | $- | $- | ||||||||||||
| 42 | $- | $- | $- | ||||||||||||
| 43 | N/A | Unavailable | $- | $- | $- | ||||||||||
| 44 | TOTALS: | $- | $- | $- | $- | $- | $- | $- | $- | $- | $- | $- | |||
| B | C | D | E | F | G | |
| 2 | Region | Description | Total 2018 Payroll for TRIP-Eligible Primary WC Policies (Terrorism Risk Coverage Provided) | Total 2018 Payroll for TRIP-Eligible Excess WC WC Policies (Terrorism Risk Coverage Provided) | Total 2018 TRIP-Eligible Property Exposure (Terrorism Risk Coverage Provided) | Total 2018 TRIP-Eligible Property Exposure (Terrorism Risk Coverage Declined) |
| 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 through 01908, 01910, 01945, 01960, 01961, 01970, 01971; for Norfolk County only include zip codes 02026, 02027, 02030, 02062, 02090, 02169, 02170, 02171, 02184 through 02191, 02269, 02445, 02446, 02447, 02457, 02467, 02481, 02482, 02492, 02494; for Middlesex County only include zip codes 01701 through 01705, 01760, 01770, 01776, 01778, 01801, 01803, 01805 through 01808, 01813, 01815, 01866, 01867, 01880, 01888, 01890, 02138 through 02145, 02148, 02149, 02153, 02155, 02156, 02176, 02180, 02212, 02238, 02239, 02420, 02421, 02451 through 02456, 02458 through 02462, 02464 through 02468, 02471, 02472, 02474 through 02479, 02493, 02495. | ||||
| 6 | Buffalo, NY | All zip codes for Buffalo NY (14201 through 14228, 14231, 14233, 14240, 14241, 14260, 14261, 14263, 14264, 14265, 14267, 14269, 14270, 14272, 14273, 14276, 14280); Niagara Falls in Niagara county (14109, 14301, 14302, 14303, 14304, 14305); and include the nearby suburbs in Erie and Niagara counties (14010, 14026, 14031, 14032, 14037, 14043, 14051, 14059, 14068, 14075, 14086, 14120, 14127, 14140, 14150, 14151). | ||||
| 7 | Chicago, IL | All zip codes within the four counties of Cook, DuPage, Lake, and Will. | ||||
| 8 | Cleveland, OH | All zip codes within the two counties of Cuyahoga and Lake. | ||||
| 9 | Dallas/Ft. Worth, TX | All zip codes in the two counties of Dallas and Tarrant (Fort Worth). | ||||
| 10 | Denver, CO | All zip codes within the counties of Adams, Arapahoe, and Denver. | ||||
| 11 | Detroit, MI | All zip codes within the counties of Macomb, Oakland, and Wayne. | ||||
| 12 | Houston, TX | All zip codes in Harris County. | ||||
| 13 | Las Vegas, NV | All zip codes in Clark County. | ||||
| 14 | Los Angeles, CA | All zip codes within the two counties of Los Angeles and Orange. | ||||
| 15 | Miami, FL | All zip codes in Miami-Dade County. | ||||
| 16 | Minneapolis/St. Paul, MN | All zip codes in the two counties of Hennepin and Ramsey. | ||||
| 17 | New York, NY | All zip codes within the five counties of Kings (Brooklyn), Queens, New York (Manhattan), Bronx, and Richmond (Staten Island). | ||||
| 18 | Newark, NJ | All zip codes for the cities of Newark (07101 through 07108, 07112, 07114, 07175, 07182, 07184, 07188, 07189, 07191, 07192, 07193, 07194, 07195, 07198, 07199) and Elizabeth (07201, 07202, 07206, 07207, 07208). | ||||
| 19 | Orlando, FL | All zip codes in the two counties of Orange and Seminole. | ||||
| 20 | Philadelphia, PA | All zip codes in Philadelphia County. | ||||
| 21 | Phoenix, AZ | All zip codes in Maricopa County. | ||||
| 22 | San Diego, CA | All zip codes in San Diego County. | ||||
| 23 | San Francisco, CA | All zip codes within the two counties of San Francisco and San Mateo. | ||||
| 24 | San Jose, CA | All zip codes in Santa Clara County. | ||||
| 25 | Seattle, WA | All zip codes in King County. | ||||
| 26 | St. Louis, MO | All zip codes in the two counties of St. Louis City and St. Louis. | ||||
| 27 | Tampa/St. Petersburg, FL | All zip codes in the two counties of Hillsborough and Pinellas. | ||||
| 28 | Washington, DC | All zip codes within Washington D.C. and all zip codes within the two counties of Arlington, VA and Alexandria City, VA. | ||||
| 29 | All other Locations in the U.S. | All areas in the US other than those specified in Cells C3-C28. | ||||
| 30 | Unknown | If locations are unknown for a policy, enter the requested information here. | ||||
| 31 | Subtotal | All metro regions specified in Cells C3-C28. | $- | $- | $- | $- |
| 32 | Total | All metro regions and other locations specified in Cells C3-C30. | $- | $- | $- | $- |
| Top 5 Largest Accumulated Exposure Locations (Metro Areas, (Rows C3 to C28) |
Payroll Exposure | Property Exposure | ||||
| 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 Property Insurance Exposure (Terrorism Risk Coverage Provided) | Amount of Top 5 Largest Accumulated Exposure Locations by Property Insurance Exposure(Terrorism Risk Coverage Provided) | |||
| 35 | 1 | |||||
| 36 | 2 | |||||
| 37 | 3 | |||||
| 38 | 4 | |||||
| 39 | 5 | |||||
| Top 5 Largest Accumulated Exposure Locations (All Other Non-Metro Areas, (Rows C29-C30) |
Payroll Exposure | Property Exposure | ||||
| 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 Property Insurance Exposure (Terrorism Risk Coverage Provided) | Amount of Top 5 Largest Accumulated Exposure Locations by Property Insurance Exposure (Terrorism Risk Coverage Provided) | |||
| 43 | 1 | |||||
| 44 | 2 | |||||
| 45 | 3 | |||||
| 46 | 4 | |||||
| 47 | 5 | |||||
| 49 | ZIP Code Associated with Largest Probable Maximum Loss (PML) | |||||
| 50 | Largest PML at a Single Location (Amount) | |||||
| B | C | D | ||
| 2 | Element | Response | Description or Explanation (if any) | |
| 3 | Size of TRIP 2018 Deductible (Cell H4 of Insurer Group Affiliations Chart x 20%) | |||
| 4 | Total 2018 Limits Any One Loss of Purchased Reinsurance Covering TRIP Loss | |||
| 5 | Total 2018 Aggregate Limits of Purchased Treaty Reinsurance Covering TRIP Loss | |||
| 6 | 2018 Attachment Point Any One Loss of Purchased Treaty Reinsurance Covering TRIP Loss | |||
| 7 | 2018 Co-Participation Share Any One Loss of Purchased Treaty Reinsurance Covering TRIP Loss | |||
| 8 | Total 2018 Limits Any One Loss of Purchased Treaty Reinsurance Covering Natural Catastrophic Loss | |||
| 9 | Total 2018 Aggregate Limits of Purchased Treaty Reinsurance Covering Natural Catastrophic Loss | |||
| 10 | 2018 Attachment Point Any One Loss of Purchased Treaty Reinsurance Covering Natural Catastrophic Loss | |||
| 11 | 2018 Co-Participation Share Any One Loss of Purchased Treaty Reinsurance Covering Natural Catastrophic Loss | |||
| 12 | Any Reinsurance Exclusions for TRIP Certified Foreign Acts of Terrorism? | |||
| 13 | Any Reinsurance Exclusions for TRIP Certified Domestic Acts of Terrorism? | |||
| 14 | Reinsurance for NBCR WC Exposures Resulting from Certified Acts of Terrorism? | |||
| 15 | If Yes, 2018 Limits Any One Loss of NBCR Reinsurance for Certified Acts of Terrorism involving WC Loss | |||
| 16 | If Yes, 2018 Attachment Point Any One Loss of NBCR Reinsurance for Certified Acts of Terrorism involving WC Loss | |||
| 17 | If Yes, 2018 Co-Participation Share (if any) Any One Loss 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, 2018 Limits Any One Loss of NBCR Reinsurance for Certified Acts of Terrorism involving Property Loss | |||
| 20 | If Yes, 2018 Attachment Point Any One Loss of NBCR Reinsurance for Certified Acts of Terrorism involving Property Loss | |||
| 21 | If Yes, 2018 Co-Participation Share (if any) Any One Loss of NBCR Reinsurance for Certified Acts of Terrorism involving Property Loss | |||
| 22 | Reinsurance for NBCR Liability Loss Resulting from Certified Acts of Terrorism? | |||
| 23 | If Yes, 2018 Limits Any One Loss of NBCR Reinsurance for Certified Acts of Terrorism involving Liability Loss | |||
| 24 | If Yes, 2018 Attachment Point Any One Loss of NBCR Reinsurance for Certified Acts of Terrorism involving Liability Loss | |||
| 25 | If Yes, 2018 Co-Participation Share (if any) Any One Loss of NBCR Reinsurance for Certified Acts of Terrorism involving Liability Loss | |||
| 26 | Any Other Reinsurance Exclusions Specifically Applicable to TRIP Certified Acts of Terrorism Under TRIP? | |||
| 27 | Using the following defined terrorism event (which should be considered to be a single event, loss, or occurrence for purpose of calculating applicable deductibles and policy limits), calculate and report the total projected loss (dividing the loss associated with the two identified explosions as indicated) under property and workers' compensation policies containing terrorism risk insurance subject to TRIP issued by the Group or Company, and then within that figure report the following (Note: To the extent a figure is subject to a single limit between Location A and Location B, such as the TRIP Deductible, allocate as appropriate between Location A and Location B depending upon where the loss figures fall). (1) the deductible or retention obligations of insureds under triggered policies for the insurer group (or single company that is not part of a group); (2) the projected amount of net loss the insurer group (or single company that is not part of a group) will sustain within its TRIP deductible, net of policyholder obligations or private reinsurance; (3) any private reinsurance recovery available to the group or company within the TRIP deductible; (4) the amount of the group or company's claim under TRIP; (5) the amount of the group or company's continuing net co-pay obligation under TRIP; and (6) any private reinsurance recovery available to the group or company within the Co-Pay Layer. Location A: On May 20, 2018 (a Monday), at 11:30 a.m., a 5-6 ton truck bomb detonates at Embarcadero Center (at the corner of Sacramento and Front Streets) in San Francisco, California 94111. The loss resulting from the explosion is characterized by the estimates below; however, if your group or company typically utilizes different damage assumptions for an explosion of this magnitude, please use those alternative assumptions: -Zone 1 (100 meters from site): Collapse and fire following, 100% property damage, 10% fire loss -Zone 2 (200 meters from site): Massive structural damage to surrounding properties, 50% property damage, 5% fire loss -Zone 3 (400 meters from site): Heavy debris damage to surrounding properties, 25% property damage, 2.5% fire loss -Zone 4 (500 meters from site): Light debris damage to surrounding properties, 10% property damage, 1% fire loss -Casualties: 2,000 total worker deaths plus 4,000 total worker injuries. Location B: Also on May 20, 2018, at 12:30 PM, a car bomb explodes at Union Square (at the corner of Geary and Powell Streets) in San Francisco, California 94108. The car contains 2-3 pounds of Cesium-137, which is dispersed into the atmosphere by the blast. Again, the loss resulting from the explosion is characterized by the estimates below; however, if your group or company typically utilizes different damage assumptions for an explosion of this magnitude, please use those alternative assumptions. The dispersal of radiological material is identified shortly after the blast by fixed radiation monitoring devices in the city. The zone of actual and threatened dispersal of the Cesium-137 is an area bounded by Broadway, Highway 101, and Interstate 80 ("dispersal zone"). 50 percent of all workers in the dispersal zone (not including any killed by the blast at Location A) request or are provided medical monitoring. 500 workers in total (not including any of those injured by the blast at Location A) develop short and long-term injuries associated with radiation exposure (your exposure should be based upon your estimate of your market share of this total number of employees). The blast itself (apart from the dispersal of radiological material) causes no injuries, deaths, or physical property damage, apart from damage to the vehicle. Responsible governmental authorities prohibit access to the dispersal area for a period of 90 days while recovery operations are conducted, debris is cleared, clean-up crews conduct decontamination operations, and utilities, services, and access is restored. |
|||
| Location A | Location B | Total (Locations A and B) | ||
| 30 | Total Projected Loss | $- | $- | $- |
| 31 | Deductible/Retention of Insureds under Policies issued by Group or Company | $- | ||
| 32 | Net Loss to Group or Company within TRIP Deductible | $- | ||
| 33 | Private Reinsurance Recovery within Deductible Layer | $- | ||
| 34 | Claim under TRIP | $- | ||
| 35 | Net Loss to Group or Company within Co-Pay Layer | $- | ||
| 36 | Private Reinsurance Recovery within Co-Pay Layer | $- | ||
| Notice under the Paperwork Reduction Act We estimate it will take you about 75 hours to complete this form. However, you are not required to provide the 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 Terrorism Risk Insurance Program Office, Department of the Treasury, 1500 Pennsylvania Avenue NW, Room 1410 MT, Washington, DC 20220. Do not send completed forms to this address. Submit forms according to instructions provided at www.tripsection111data.com. |
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |