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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 04 21 E <br /> ( Ed . 01 -21 ) <br /> CATASTROPHE (OTHER THAN CERTIFIED ACTS OF TERRORISM) PREMIUM ENDORSEMENT <br /> This endorsement is notification that your insurance carrier is charging premium to cover the losses that may occur in <br /> the event of a Catastrophe ( Other Than Certified Acts of Terrorism ) as that term is defined below . Your policy <br /> provides coverage for workers compensation losses caused by a Catastrophe ( Other Than Certified Acts of <br /> Terrorism ) . This premium charge does not provide funding for Certified Acts of Terrorism contemplated under the <br /> Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement (WC 00 04 22 C) , attached to this <br /> policy <br /> For purposes of this endorsement, the following definitions apply : <br /> • Catastrophe ( Other Than Certified Acts of Terrorism ) : Any single event , resulting from an Earthquake , <br /> Noncertified Act of Terrorism , or Catastrophic Industrial Accident , which results in aggregate workers <br /> compensation losses in excess of $50 million <br /> • Earthquake : The shaking and vibration at the surface of the earth resulting from underground movement along <br /> a fault plane or from volcanic activity . <br /> • Noncertified Act of Terrorism : An event that is not certified as an Act of Terrorism by the Secretary of the <br /> Treasury pursuant to the Terrorism Risk Insurance Act of 2002 (as amended ) but that meets all of the following <br /> criteria : <br /> a . It is an act that is violent or dangerous to human life , property , or infrastructure ; <br /> b . The act results in damage within the United States , or outside of the United States in the case of the <br /> premises of United States missions or air carriers or vessels as those terms are defined in the Terrorism <br /> Risk Insurance Act of 2002 (as amended ) ; and <br /> c . It is an act that has been committed by an individual or individuals as part of an effort to coerce the civilian <br /> population of the United States or to influence the policy or affect the conduct of the United States <br /> Government by coercion . <br /> • Catastrophic Industrial Accident : A chemical release , large explosion , or small blast that is localized in nature <br /> and affects workers in a small perimeter the size of a building . <br /> The premium charge for the coverage your policy provides for workers compensation losses caused by a Catastrophe <br /> (Other Than Certified Acts of Terrorism ) is shown in Item 4 of the Information Page or in the Schedule below . <br /> Schedule <br /> State Rate Premium <br /> CA 0 . 010 $ 18 . 00 <br /> This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated . <br /> (The information below is required only when this endorsement is issued subsequent to preparation of the policy . ) <br /> Endorsement Effective 12/11 /2021 Policy No . WWC3560056 Endorsement No . 0 <br /> Insured Tank-Tight Systems Inc Premium $ 10 , 588 <br /> Insurance Company Wesco Insurance Company <br /> Countersigned by <br /> WC 00 04 21 E <br /> (Ed . 01 -21 ) <br /> © Copyright 2020 National Council on Compensation Insurance , Inc . All rights reserved . <br />