I, _______________, certify that I am a Corporate Officer of ___________(Company Name), hereinafter, "Company." I further certify that:
| _____ | The Company will use the Illinois-filed ISO Terrorism Exclusion Endorsements effective ____________(date) and is otherwise in compliance with Bulletin CB#2001-11 issued December 31, 2001 and Bulletin CB#2002-02 issued March 1, 2002. |
| OR | |
| _____ | The Company is filing Terrorism Exclusion Endorsements or policy language effective__________(date) that provides coverage at least as broad as the filed and accepted ISO endorsements listed in CB#2001-11, and that the Company is otherwise in compliance with Bulletin CB#2001-11 issued Decebmer 31, 2001 and Bulletin CB#2002-02 issued March 1, 2002. |
I further certify that:
The Company's current reinsurance agreements do not exclude coverage for the excluded risks of loss due to "Terrorism" as defined by the filed policy or endorsement.
However, on the following dates, the Company's reinsurance agreements with the following Reinsurers will expire, and these Reinsurers have indicated that the new reinsurance contracts will contain terrorism exclusions that apply to the Company's currently in-force direct-written policies, and that as a result, we will have inadequate reinsurance for terrorism coverage on currently in-force direct-written policies.
List Reinsurer Names and Expiration Dates of current contracts:
These reinsurance contracts will exclude terrorism coverage for the following (list all that apply):
Line(s) of insurance (list the applicable lines):
Class(es) of insurance within a line (list applicable class(es):
Specific individual risks (list specific individual risks):
Therefore, the Company requests that the Department accept the Company's filed Terrorism Exclusion language for use on currently in-force policies. The Company understands that such exclusions will be valid on these currently in-force policies only if the Company loses adequate reinsurance for the excluded risk(s).
I hereby certify that the Company also agrees to provide actual proof of loss of adequate reinsurance in compliance with CB#2001-11 when the reinsurance contract(s) renew as of the date(s) listed above, and to highlight all terrorism exclusion language that applies to currently in-force policies.
| _______________________________ | _______________________________ |
| Corporate Office Name (Print) | Corporate Officer Name (Sign) |
| _______________________________ | _______________________________ |
| Corporate Officer Title | Date |