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Captive Insurers Reinsurance (Nationwide)
ICR 202303-1505-001 · OMB 1505-0257 · Object 129744901.
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| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
|---|---|
| File Title | Captive Insurers Reinsurance (Nationwide) |
| Author | U.S. Department of Treasury |
| Last Modified By | Calc |
| File Modified | 2022-02-04 |
| File Created | 2026-07-14 |
| Conversion State | complete |
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OMB No. 1505-0257 Expiration: XXXX 3 B Group Code (NAIC or as assigned by Aggregator) TERRORISM RISK INSURANCE PROGRAM 2022 DATA CALL: CAPTIVE INSURERS INSURER GROUP AFFILIATIONS C G 3 Total 2020 Policyholder Surplus: Insurer Group Name 4 B Company Code (NAIC or as 8 assigned by Aggregator) 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 4 Total 2020 TRIP-Eligible DEP (all lines): C D E Insurance Company Name Type of Insurer Domicile Affiliations Page 1 of 15 H OMB No. 1505-0257 Expiration: XXXX TERRORISM RISK INSURANCE PROGRAM 2022 DATA CALL: CAPTIVE INSURERS DIRECT EARNED PREMIUM (DEP) (JURISDICTION) Jurisdiction: 2 B 5 TRIP-Eligible Line of Coverage 6 Fire 7 Fire Deductible Reimbursement 8 Allied Lines 9 Allied Lines Deductible Reimbursement 10 Commercial Multiple Peril (non-liability portion) Commercial Multiple Peril (non-liability portion) 11 Deductible Reimbursement 12 Commercial Multiple Peril (liability portion) Commercial Multiple Peril (liablity portion) Deductible 13 Reimbursement 14 Ocean Marine 15 Ocean Marine Deductible Reimbursement 16 Inland Marine 17 Inland Marine Deductible Reimbursement 18 Workers' Compensation 19 Workers' Compensation Deductible Reimbursement 20 Excess Workers' Compensation 21 Other Liability 22 Other Liablity Deductible Reimbursement 23 Products Liability 24 Products Liablity Deductible Reimbursement 25 Aircraft (all perils) 26 Aircraft (all perils) Deductible Reimbursement C NAIC Line (Commercial Only) 1 1 2.1 2.1 5.1 D E Total 2021 TRIPEligible DEP (all policies) $ $ $ $ $ - 5.1 $ - 5.2 $ - 5.2 $ - 8 8 9 9 16 16 17.3 17 17 18 18 22 22 $ - $ - $ $ $ $ $ $ $ $ $ - F G H Total 2021 TRIP- Total 2021 TRIP-Eligible Total 2021 TRIP-Eligible Eligible DEP DEP (Terrorism Risk DEP (Terrorism Risk Total 2021 DEP Charged (Terrorism Risk Coverage Provided for Coverage Provided with for Terrorism Risk Coverage Declined) Disclosed $0 Charge) a Premium Charged) Coverage Premium (Juris.) Page 2 of 15 OMB No. 1505-0257 Expiration: XXXX 27 Boiler and Machinery 28 Boiler and Machinery Deductible Reimbursement 29 TOTALS 30 Total 2021 Non-TRIP Eligible Lines DEP TERRORISM RISK INSURANCE PROGRAM 2022 DATA CALL: CAPTIVE INSURERS DIRECT EARNED PREMIUM (DEP) (JURISDICTION) 27 27 $ $ $ - $ Premium (Juris.) Page 3 of 15 - $ - $ - $ - OMB No. 1505-0257 Expiration: XXXX TERRORISM RISK INSURANCE PROGRAM 2022 DATA CALL: CAPTIVE INSURERS STANDALONE TERRORISM (NATIONWIDE) B Element 2 3 2021 DEP for Standalone Terrorism Policies 4 Portion of 2021 DEP Providing Coverage for Losses for Certified Acts of Terrorism under TRIP Portion of 2021 DEP Providing Coverage for Losses Arising from Other (Non-Certified) Acts of 5 Terrorism 6 2021 Number of Standalone Terrorism Policies Issued 2021 Number of Standalone Terrorism Policies Issued Providing Coverage for Losses for Certified Acts 7 of Terrorism under TRIP 2021 Property Insurance Exposure for Standalone Terrorism Policies Providing Coverage for Losses 8 for Certified Acts of Terrorism under TRIP Total 2021 Limits of Liability for Standalone Terrorism Policies Providing Coverage for Losses for 9 Certified Acts of Terrorism under TRIP Standalone Terrorism (US) Page 4 of 15 C Amount TERRORISM RISK INSURANCE PROGRAM 2022 DATA CALL: CAPTIVE INSURERS CYBER (NATIONWIDE) OMB No. 1505-0257 Expiration: XXXX B 2 3 Total 2021 TRIP-Eligible DEP (All Cyber Policies) C Element Standalone Cyber D Cyber Coverage provided as part of a Package Policy E Totals $ - 4 Total 2021 Cyber DEP in TRIP-Eligible Lines of Insurance (Terrorism Risk Coverage Declined) $ - 5 Total 2021 Cyber DEP in TRIP-Eligible Lines of Insurance (Terrorism Risk Coverage Provided) $ - 6 Total 2021 TRIP-Eligible DEP Charged for Terrorism Risk Coverage Under Cyber Policies 7 Total 2021 Non-TRIP-Eligible DEP (All Cyber Policies) 8 Total 2021 Number of Cyber Policies Issued in TRIP-Eligible Lines of Insurance 9 Total 2021 Number of Cyber Policies Issued (Terrorism Risk Coverage Provided) 10 Total 2021 Number of Cyber Policies Issued in Non-TRIP-Eligible Lines of Insurance 11 Total 2021 Number of all Cyber Policies Issued 12 Total 2021 Number of all Cyber Policies Issued to Small Policyholders (100 or fewer employees) 13 Total 2021 Number of all Cyber Policies Issued to Medium Policyholders (101-500 employees) $ $ 0 0 0 0 0 0 14 Total 2021 Number of all Cyber Policies Issued to Large Policyholders (501 or more employees) 0 15 Total 2021 DEP of all Cyber Policies Issued to Small Policyholders (100 or fewer employees) $ - 16 Total 2021 DEP of all Cyber Policies Issued to Medium Policyholders (101-500 employees) $ - 17 Total 2021 DEP of all Cyber Policies Issued to Small Policyholders (501 or more employees) $ - 18 Total 2021 Limits of Liability for Cyber Policies Issued in TRIP-Eligible Lines of Insurance $ - Total 2021 Limits of Liability for Cyber Policies Issued in TRIP-Eligible Lines of Insurance Providing Coverage 19 for Losses for Certified Acts of Terrorism Under TRIP $ - 20 Total 2021 Limits of Liability for Cyber Policies Issued in Non-TRIP-Eligible Lines of Insurance Total 2021 Limits of Liability for Cyber Extortion under Cyber Policies Issued in TRIP-Eligible Lines of 21 Insurance $ - $ - Total 2021 Limits of Liability for Ransom Payments for Cyber Extortion under Cyber Policies Issued in TRIP22 Eligible Lines of Insurance Total 2021 Limits of Liability for Cyber Extortion under Cyber Policies Issued in Non-TRIP-Eligible Lines of 23 Insurance $ - $ - Cyber (US) Page 5 of 15 OMB No. 1505-0257 Expiration: XXXX TERRORISM RISK INSURANCE PROGRAM 2022 DATA CALL: CAPTIVE INSURERS CYBER (NATIONWIDE) Total 2021 Limits of Liability for Ransom Payments for Cyber Extortion under Cyber Policies Issued in Non24 TRIP-Eligible Lines of Insurance 25 Total 2021 Direct Losses Paid for Cyber Extortion under all Cyber Policies Issued 26 Total 2021 Direct Losses Incurred for Cyber Extortion under all Cyber Policies Issued Total 2021 Direct Losses Paid for Cyber Extortion (Ransom Payment or Reimbursement Only) under all 27 Cyber Policies Issued 28 Total 2021 Number of Claims Associated with Payments reported in Line 27 Total 2021 Direct Defense and Loss Containment Amounts Paid for Cyber Extortion under all Cyber Policies 29 Issued Total 2021 Direct Defense and Loss Containment Amounts Incurred for Cyber Extortion under all Cyber 30 Policies Issued Cyber (US) Page 6 of 15 $ - $ $ - $ 0 $ - $ - OMB No. 1505-0257 Expiration: XXXX TERRORISM RISK INSURANCE PROGRAM 2022 DATA CALL: CAPTIVE INSURERS EXPOSURE BASES BY JURISDICTION Jurisdiction: 2 B 5 TRIP-Eligible Line of Coverage 6 Fire 7 Fire Deductible Reimbursement 8 Allied Lines 9 Allied Lines Deductible Reimbursement 10 Commercial Multiple Peril (non-liability portion) Commercial Multiple Peril (non-liability portion) 11 Deductible Reimbursement 12 Commercial Multiple Peril (liability portion) Commercial Multiple Peril (liability portion) 13 Deductible Reimbursement 14 Ocean Marine 15 Ocean Marine Deductible Reimbursement 16 Inland Marine 17 Inland Marine Deductible Reimbursement 18 Workers' Compensation 19 Workers' Compensation Deductible Reimbursement 20 Excess Workers' Compensation 21 Other Liability 22 Other Liability Deductible Reimbursement 23 Products Liability 24 Products Liability Deductible Reimbursement 25 Aircraft (all perils) 26 Aircraft (all perils) Deductible Reimbursement 27 Boiler and Machinery 28 Boiler and Machinery Deductible Reimbursement 29 TOTALS C D E F G H I J Total 2021 TRIP-Eligible Total 2021 Total 2021 Property Exposure Total 2021 TRIP-Eligible Policyholder Policyholder Total 2021 TRIP-Eligible (Terrorism Risk Property Exposures Deductibles for TRIP- Total 2021 TRIP-Eligible Deductibles for TRIPNAIC Line Property Exposure Coverage Provided and (Terrorism Risk Eligible Property Property Exposure Eligible Property (Commercial (Terrorism Risk NBCR Risks Not Coverage Provided Policies (Terrorism Risk (Terrorism Risk Policies (Terrorism Risk Only) Coverage Provided) Excluded) Only for NBCR Risks) Coverage Provided) Coverage Declined) Coverage Declined) 1 1 2.1 2.1 5.1 K L M N O P Q Total 2021 TRIP-Eligible Total 2021 Total 2021 Total 2021 Limits of Limits of Liability Total 2021 TRIP-Eligible Policyholder Total 2021 Limits of Policyholder Liability for TRIP(Terrorism Risk Limits of Liability Deductibles for TRIPLiability for TRIPDeductibles for TRIP- Total 2021 Payroll for Eligible Policies Coverage Provided and (Terrorism Risk Eligible Liability Eligible Liability Eligible Liability TRIP-Eligible Policies (Terrorism Risk NBCR Risks Not Coverage Provided Policies (Terrorism Risk Policies (Terrorism Risk Policies (Terrorism Risk (Terrorism Risk Coverage Provided) Excluded) Only for NBCR Risks) Coverage Provided) Coverage Declined) Coverage Declined) Coverage Provided) Total 2021 Payroll Not Subject to Terrorism Risk Coverage 5.1 5.2 5.2 8 8 9 9 16 16 17.3 17 17 18 18 22 22 27 27 $ - $ - $ - $ - $ - $ Exposure Bases (Juris.) Page 7 of 15 - $ - $ - $ - $ - $ - $ - OMB No. 1505-0257 Expiration: XXXX TERRORISM RISK INSURANCE PROGRAM 2022 DATA CALL: CAPTIVE INSURERS POLICYHOLDER INDUSTRY CODE (NATIONWIDE) A 2 B NAICS Code Number Most Applicable to the Business(es) Insured by the Captive Insurer: Industry Code (US) Page 8 of 15 TERRORISM RISK INSURANCE PROGRAM 2022 DATA CALL: CAPTIVE INSURERS PLACES OF WORSHIP (NATIONWIDE) (NAICS, SIC, ISO, or OTHER) OMB No. 1505-0257 Expiration: XXXX C D E F G H I J Property 3 4 5 Code NAICS SIC 6 ISO 7 8 Other Total 2021 DEP Charged for Terrorism Risk Coverage Description 813110 Religious Organizations 8661 Religious Organizations Total 2021 TRIPEligible DEP Total 2021 TRIP(Terrorism Risk Eligible DEP Coverage (Terrorism Risk Provided) Coverage Declined) 0900 (Property) Religious Organizations 41650 (Liablity) Places of Worship TOTALS: $ - $ - $ K L M Liability - Total 2021 TRIPEligible DEP $ $ $ - $ $ - N Total 2021 DEP Total 2021 TRIPTotal 2021 TRIPTotal 2021 DEP Charged for Eligible DEP Eligible DEP Charged for Terrorism Risk (Terrorism Risk (Terrorism Risk Total 2021 TRIP- Terrorism Risk Coverage Coverage Declined) Coverage Provided) Eligible DEP Coverage $ $ - $ Places of Worship (US) Page 9 of 15 - $ - $ O Workers' Compensation - $ - $ $ - $ - All Categories Total 2021 TRIPEligible DEP $ - Total 2021 TRIPEligible DEP $ $ $ - $ $ - OMB No. 1505-0257 Expiration: XXXX TERRORISM RISK INSURANCE PROGRAM 2022 DATA CALL: CAPTIVE INSURERS GEOGRAPHIC EXPOSURES (NATIONWIDE) B 2 Region 3 Atlanta, GA C Description 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 8 Cleveland, OH 9 Dallas/Ft. Worth, TX 10 Denver, CO 11 Detroit, MI 12 Houston, TX 13 Las Vegas, NV 14 Los Angeles, CA 15 Miami, FL D E F G Total 2021 Payroll for Total 2021 Payroll for TRIP-Eligible Primary WC TRIP-Eligible Primary WC Total 2021 TRIP-Eligible Total 2021 TRIP-Eligible and Excess WC Policies and Excess WC Policies Property Exposure Property Exposure (Terrorism Risk Coverage (Terrorism Risk Coverage (Terrorism Risk Coverage (Terrorism Risk Coverage Provided) Not Provided) Provided) Declined) All zip codes within the four counties of Cook, DuPage, Lake, and Will. All zip codes in the counties of Cuyahoga and Lake. All zip codes in the two counties of Dallas and Tarrant (Fort Worth). All zip codes in the three counties of Adams, Arapahoe, and Denver. All zip codes in the three counties of Macomb, Oakland, and Wayne. All zip codes in Harris County. All zip codes in Clark County. All zip codes within the two counties of Los Angeles and Orange. All zip codes in Miami-Dade County. Geographic (US) Page 10 of 15 OMB No. 1505-0257 Expiration: XXXX 16 Minneapolis/St. Paul, MN 17 New York, NY 18 Newark, NJ TERRORISM RISK INSURANCE PROGRAM 2022 DATA CALL: CAPTIVE INSURERS GEOGRAPHIC EXPOSURES (NATIONWIDE) All zip codes in the two counties of Hennepin and Ramsey. All zip codes within the five counties of Kings (Brooklyn), Queens, New York (Manhattan), Bronx, and Richmond (Staten Island). 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). All zip codes in the two counties of Orange and Seminole. 19 Orlando, FL All zip codes in Philadelphia County. 20 Philadelphia, PA All zip codes in Maricopa County. 21 Phoenix, AZ All zip codes in San Diego County 22 San Diego, CA All zip codes within the two counties of San Francisco and San Mateo. 23 San Francisco, CA All zip codes in Santa Clara County. 24 San Jose, CA All zip codes in King County. 25 Seattle, WA All zip codes in the two counties of St. Louis City and St. Louis. 26 St. Louis, MO Tampa/St. Petersburg, All zip codes in the two counties of Hillsborough and Pinellas. 27 FL 28 Washington, DC All other Locations in the U.S. 30 Unknown 31 Subtotal 32 Total 29 All zip codes within Washington D.C. and all zip codes within the two counties of Arlington, VA and Alexandria City, VA. All areas in the US other than those specified in Cells C3-C28 If locations are unknown for a policy, enter the requested information here. All metro regions specified in Cells C3-C28 All metro regions and other locations specified in Cells C3-C30 $ $ - $ - $ Geographic (US) Page 11 of 15 - $ - $ - $ - $ - OMB No. 1505-0257 Expiration: XXXX TERRORISM RISK INSURANCE PROGRAM 2022 DATA CALL: CAPTIVE INSURERS GEOGRAPHIC EXPOSURES (NATIONWIDE) Payroll Exposure Property Exposure ZIP Code of Top 5 Largest Amount of Top 5 Largest Accumulated Exposure Accumulated Exposure Locations by Property Locations by Property Insurance Exposure Insurance Exposure Amount of Top 5 Largest (Terrorism Risk Coverage (Terrorism Risk Coverage ZIP Code of Top 5 Largest Accumulated Exposure Locations Accumulated Exposure Provided) (Metropolitan Provided) (Metropolitan by Payroll Locations by Payroll Areas) Areas) Top 5 Largest Accumulated Exposure Locations (Metro Areas, (Rows C3 to C28) 35 36 37 38 39 1 2 3 4 5 Payroll Exposure Top 5 Largest Accumulated Exposure Locations (All Other Non-Metro Areas, (Rows C29-C30) 43 44 45 46 47 Property Exposure ZIP Code of Top 5 Largest Amount of Top 5 Largest Accumulated Exposure Accumulated Exposure Locations by Property Locations by Property Insurance Exposure Insurance Exposure Amount of Top 5 Largest (Terrorism Risk Coverage (Terrorism Risk Coverage ZIP Code of Top 5 Largest Accumulated Exposure Locations Accumulated Exposure Provided) (NonProvided)(Nonby Payroll Locations by Payroll Metropolitan Areas) Metropolitan Areas) 1 2 3 4 5 49 ZIP Code Associated with Largest Probable Maximum Loss (PML) 50 Largest PML at a Single Location (Amount) Geographic (US) Page 12 of 15 OMB No. 1505-0257 Expiration: XXXX TERRORISM RISK INSURANCE PROGRAM 2022 DATA CALL: CAPTIVE INSURERS REINSURANCE (NATIONWIDE) B 2 Element 3 Size of TRIP 2021 Deductible (Cell H4 of Insurer Group Affiliations Chart x 20%) 4 Total 2021 Limits Any One Loss of Purchased Treaty Reinsurance Covering TRIP Loss 5 Total 2021 Aggregate Limits of Purchased Treaty Reinsurance Covering TRIP Loss 6 2021 Attachment Point Any One Loss of Purchased Treaty Reinsurance Covering TRIP Loss 7 2021 Co-Participation Share Any One Loss of Purchased Treaty Reinsurance Covering TRIP Loss 8 Total 2021 Limits Any One Loss of Purchased Treaty Reinsurance Covering Natural Catastrophic Loss 9 Total 2021 Aggregate Limits of Purchased Treaty Reinsurance Covering Natural Catastrophic Loss 10 2021 Attachment Point Any One Loss of Purchased Treaty Reinsurance Covering Natural Catastrophic Loss 11 2021 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, 2021 Limits Any One Loss of NBCR Reinsurance for Certified Acts of Terrorism involving WC Loss If Yes, 2021 Attachment Point Any One Loss of NBCR Reinsurance for Certified Acts of Terrorism involving WC Loss 16 If Yes, 2021 Co-Participation Share (if any) Any One Loss of NBCR Reinsurance For Certified Acts of Terrorism involving WC Loss 17 18 Reinsurance for NBCR Property Loss Resulting from Certified Acts of Terrorism? If Yes, 2021 Limits Any One Loss of NBCR Reinsurance for Certified Acts of Terrorism involving Property 19 Loss If Yes, 2021 Attachment Point Any One Loss of NBCR Reinsurance for Certified Acts of Terrorism 20 involving Property Loss If Yes, 2021 Co-Participation Share (if any) Any One Loss of NBCR Reinsurance for Certified Acts of 21 Terrorism involving Property Loss 22 Reinsurance for NBCR Liability Loss Resulting from Certified Acts of Terrorism? If Yes, 2021 Limits Any One Loss of NBCR Reinsurance for Certified Acts of Terrorism involving Liability Loss 23 If Yes, 2021 Attachment Point Any One Loss of NBCR Reinsurance for Certified Acts of Terrorism involving Liability Loss 24 If Yes, 2021 Co-Participation Share (if any) Any One Loss of NBCR Reinsurance for Certified Acts of Terrorism involving Liability Loss 25 26 Any Other Reinsurance Exclusions Specifically Applicable to Certified Acts of Terrorism Under TRIP? Reinsurance (US) Page 13 of 15 C Response D Description or Explanation (if any) OMB No. 1505-0257 Expiration: XXXX TERRORISM RISK INSURANCE PROGRAM 2022 DATA CALL: CAPTIVE INSURERS REINSURANCE (NATIONWIDE) Using the following defined terrorism event, calculate and report the total projected loss under property, workers' compensation, and liability policies containing terrorism risk insurance subject to TRIP issued by the Group or Company, and then within that figure report the following: (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. On October 13, 2021 (a Wednesday), at 11:00 a.m. (Eastern Time), a 5 to 6 ton truck bomb is detonated in downtown Miami, Florida, on Biscayne Boulevard Way, between Brickell Avenue and SE Third Avenue. The 27 precise GPS coordinates are 25° 46’ 15” N, 80° 11’ 22” W. Assume that 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). In addition, for purposes of estimating any workers’ compensation impacts, do not modify your estimates based upon any projections or assumptions as to a reduced number of employees in the affected area based upon the impacts of the COVID-19 pandemic. Rather, assume the area contains the number of employees (consistent with the estimates provided below) that would be expected to be in the area without accounting for any potential reductions on account of COVID-19. -Zone 1 (less than 100 meters from site): Collapse and fire following, 100% property damage, 10% fire loss -Zone 2 (100-200 meters from site): Massive structural damage to surrounding properties, 50% property damage, 5% fire loss -Zone 3 (200-400 meters from site): Heavy debris damage to surrounding properties, 25% property damage, 2.5% fire loss -Zone 4 (400-500 meters from site): Light debris damage to surrounding properties, 10% property damage, 1% fire loss Radius of potential damage: Up to 1600 meters. Between 500-1600 meters you may assume 1% property damage and 0% fire loss. -Worker Injuries: 1,500 blue/white collar deaths in total and 3,000 injuries in total. The following further assumptions can be applied as to the level of injuries incurred among workers: 20 percent permanent total disability; 30 percent permanent partial disability; and 50 percent temporary disability. 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 $ Reinsurance (US) Page 14 of 15 - Notice under the Paperwork Reduction Act We estimate it will take you about 52 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