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HISCOX <br />Policy Number: UDC -1655192 -CGL -15/ <br />Named Insured: AHG Architectural Services/ <br />Endorsement Number: 23 <br />Endorsement Effective: November 10, 2015 <br />Hiscox Insurance Company Inc. <br />THIS ENDORSEMENT IS ATTACHED TO AND MADE PART OF YOUR POLICY IN <br />RESPONSE TO THE DISCLOSURE REQUIREMENTS OF THE TERRORISM RISK <br />INSURANCE ACT. THIS ENDORSEMENT DOES NOT GRANT ANY COVERAGE OR <br />CHANGE THE TERMS AND CONDITIONS OF ANY COVERAGE UNDER THE POLICY. <br />DISCLOSURE PURSUANT TO TERRORISM RISK <br />INSURANCE ACT <br />SCHEDULE <br />SCHEDULE — PART I <br />Terrorism Premium (Certified Acts) $ 4.01 <br />This premium is the total Certfied Acts premium attributable to the following Coverage Part(s), Cover- <br />age Form(s) and/or Policy(ies): <br />Additional information, if any, concerning the terrorism premium: <br />SCHEDULE — PART 11 <br />Federal share of terrorism losses 85% year 2015; 84% year 2016; 83% year 2017; 82% year 2018; 81 % <br />year 2019 and 80% year 2020. <br />Information required to complete this Schedule, if not shown above, will be shown in the Declarations. <br />A. Disclosure Of Premium <br />In accordance with the federal Terrorism Risk In- <br />surance Act, we are required to provide you with a <br />nofice disclosing the portion of your premium, if <br />any, attributable to coverage for terrorist acts certi- <br />fied under the Terrorism Risk Insurance Act. The <br />portion of your premium attributable to such cov- <br />erage is shown in the Schedule of this endorse- <br />ment or in the policy Declarations. <br />IL 09 85 01 15 0 Insurance Services Office, Inc., 2015 Page 1 of 2 <br />