HomeMy Public PortalAbout2015 McCall Urban Renewal Terrorism Insurance WaiverIF YOU WISH TO REJECT COVERAGE UNDER THE TERRORISM RISK
INSURANCE ACT, AS EXTENDED ON DECEMBER 26, 2007, THE NAMED
INSURED MUST APPROVE AND SIGN THE FOLLOWING STATEMENTS:
TERRORISM RISK INSURANCE ACT REJECTION OF FULL COVERAGE
We, as a Member of ICRMP, acknowledge that we have been notified as
required under the Terrorism Risk Insurance Act, as extended on December 26,
2007, that as respects to the above referenced policy of insurance policy
referenced above:
1. We have been offered coverage for acts of terrorism as defined in the Act;
2. We have been advised that if we accept coverage for acts of terrorism as
defined in the Act, the United States Government will participate in the payment
of terrorism losses insured under the Act, subject to the provisions of the Act;
3. We have been told that if we reject coverage under the Act by signing this
notice, to the extent allowed by law, we will have only our respective share of the
alternative coverage for any act of terrorism under the policy issued by ICRMP.
4. We have been notified of the annual premium for coverage for acts of
terrorism as defined in the Act.
5. We hereby reject coverage for acts of terrorism as defined in the Act and
understand my policy will contain an exclusion for acts of terrorism as defined by
TRIPRA, but will otherwise provide limited coverage concerning acts of terrorism
as addressed by the ICRMP policy issued annually to Members.
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Print name Pri
McCall Urban Renewal
Public Entity Name
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RETURN THIS FORM TO YOUR AGENT OR ICRMP. A COPY OF THIS DOCUMENT IS AS
BINDING AS THE ORIGINAL.
ATTENTION AGENT: THIS FORM MUST BE SIGNED PERSONALLY BY AN AUTHORIZED
OFFICER OF THE INSURED AND RETURNED TO ICRMP.
For Policy Year Effective July 1, 2015