B C G H 3 NAIC Group Code Insurer Group Name 3 Total 2016 Policyholder Surplus 4 4 Total 2016 TRIP-Eligible DEP (all lines) Affiliations Page 1 of 19
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1 OMB No Expiration: TERRORISM RISK INSURANCE PROGRAM 218 DATA CALL: INSURER (NONSMALL) GROUPS OR COMPANIES INSURER GROUP AFFILIATIONS B C G H 3 NAIC Group Code Insurer Group Name 3 Total 216 Policyholder Surplus 4 4 Total 216 TRIP (all lines) B C D 8 NAIC Company Code Insurance Company Name Type of Insurer Affiliations Page 1 of 19
2 OMB No Expiration: TERRORISM RISK INSURANCE PROGRAM 218 DATA CALL: INSURER (NONSMALL) GROUPS OR COMPANIES POLICIES AND DIRECT EARNED PREMIUM BY JURISDICTION Jurisdiction: 2 B C D E F G H Direct Earned Premium Total 217 TRIP Total 217 TRIP when Total 217 TRIPEligible DEP when Total 217 TRIPEligible DEP when Terrorism Total 217 Disclosed NAIC Line (all Not Provided for Risk Premium 6 TRIPEligible Line of (Commercial Only) policies) Purchased Disclosed Charge Charged DEP Charged 7 Fire 1 8 Allied Lines Commercial Multiple Peril (nonliability portion) Commercial Multiple Peril (liability portion) Ocean Marine 8 12 Inland Marine 9 13 Workers' Compensation Excess Workers' Compensation Other Liability Products Liability Aircraft (all perils) Boiler and Machinery TOTALS 21 Total 217 Number of Policies Containing TRIP Eligible Policies and DEP (Juris.) Page 2 of 19
3 OMB No Expiration: TERRORISM RISK INSURANCE PROGRAM 218 DATA CALL: INSURER (NONSMALL) GROUPS OR COMPANIES POLICIES AND DIRECT EARNED PREMIUM BY JURISDICTION I J K L Number of Policies Total 217 Number of Policies by Line ( Not Purchased) Total 217 Number of Policies by Line ( Provided for Disclosed Charge) Total 217 Number of Policies by Line ( Premium Charged) Total 217 Number of Policies by Line Policies and DEP (Juris.) Page 3 of 19
4 OMB No Expiration: TERRORISM RISK INSURANCE PROGRAM 218 DATA CALL: INSURER (NON SMALL) GROUPS OR COMPANIES STANDALONE TERRORISM (NATIONWIDE) B C 2 Element Amount DEP for Standalone Terrorism Policies 4 Portion of 217 DEP for TRIP Certified Terrorism Loss 5 Portion of 217 DEP for NonCertified Terrorism Loss Number of Standalone Terrorism Policies Issued Number of Standalone Terrorism Policies Covering TRIP Loss Issued Total Property Insurance Exposure for Standalone Terrorism Policies Covering TRIP Loss Total Limits of Liability for Standalone Terrorism Policies Covering TRIP Loss Standalone Terrorism (US) Page 4 of 19
5 OMB No Expiration: TERRORISM RISK INSURANCE PROGRAM 218 DATA CALL: INSURER (NONSMALL) GROUPS OR COMPANIES CYBER (NATIONWIDE) B C D E 2 Element Standalone Cyber Cyber Provided as Part of a Package Policy Totals TRIP for Cyber Policies 217 TRIP for Cyber Policies Not Providing for Certified Acts of Terrorism 4 Under TRIP 217 TRIP for Cyber Policies Providing for Certified Acts of Terrorism 5 Under TRIP Total Disclosed DEP Charged Under Cyber Policies Number of Cyber Policies Issued Number of Cyber Policies Covering TRIP Loss Issued Total Liability Policy Limits for Cyber Policies Covering TRIP Loss
6 OMB No Expiration: TERRORISM RISK INSURANCE PROGRAM 218 DATA CALL: INSURER (NONSMALL) GROUPS OR COMPANIES EXPOSURE BASES BY JURISDICTION Jurisdiction: 2 B C D E F G Total 217 H 5 TRIPEligible Line of NAIC Line (Commercial Only) Total 217 Property Insurance Exposure Subject to Terrorism Risk Total 217 Policyholder Deductibles under 217 Property Insurance Exposure Subject to Terrorism Risk Total 217 Property Insurance Exposure Not Subject to Policyholder Deductibles under 217 Property Insurance Exposure Not Subject to Total 217 Limits of Liability Subject to 6 Fire 1 7 Allied Lines Commercial Multiple Peril (nonliability portion) Commercial Multiple Peril (liability portion) Ocean Marine 8 11 Inland Marine 9 12 Workers' Compensation Excess Workers' Compensation Other Liability Products Liability Aircraft (all perils) Boiler and Machinery TOTALS Exposure Bases (Juris.) Page 6 of 19
7 OMB No Expiration: TERRORISM RISK INSURANCE PROGRAM 218 DATA CALL: INSURER (NONSMALL) GROUPS OR COMPANIES EXPOSURE BASES BY JURISDICTION I J K L Total 217 Policyholder Deductibles under 217 Limits of Liablity Subject to Terrorism Risk Total 217 Limits of Liability Not Subject to Total 217 Policyholder Deductibles under 217 Limits of Liability Not Subject to Total 217 Payroll Subject to Terrorism Risk Exposure Bases (Juris.) Page 7 of 19
8 OMB No Expiration: TERRORISM RISK INSURANCE PROGRAM 218 DATA CALL: INSURER (NONSMALL) GROUPS OR COMPANIES POLICYHOLDER INDUSTRY CODE (NATIONWIDE) (NAICS, SIC, or OTHER) B C D E F G H 3 Code Description Total 217 Disclosed DEP Charged Total 217 TRIP When Not Purchased Total 217 TRIP When Terrorism Risk Purchased Total 217 TRIP 4 11 Agriculture, Forestry, Fishing & Hunting 5 21 Mining, Quarrying, and Oil & Gas Extraction 6 22 Utilities 7 23 Construction Manufacturing 9 42 Wholesale Trade Retail Trade Transportation & Warehousing Information Finance & Insurance Real Estate and Rental and Leasing Professional, Scientific & Technical Service Management of Companies and Enterprises 17 Administrative & Support & Waste Management 56 & Remediation Services Educational Services Health Care & Social Assistance 2 71 Arts, Entertainment & Recreation Accommodation & Food Services NAICS Code Property Other Services (except Public Administration) Public Administration 24 N/A Unavailable Industry (NAICS, SIC, or OTHER) Page 8 of 19
9 OMB No Expiration: TERRORISM RISK INSURANCE PROGRAM 218 DATA CALL: INSURER (NONSMALL) GROUPS OR COMPANIES POLICYHOLDER INDUSTRY CODE (NATIONWIDE) (NAICS, SIC, or OTHER) B C D E F G H 3 Code Description Total 217 Disclosed DEP Charged Property Total 217 TRIP When Not Purchased Total 217 TRIP When Terrorism Risk Purchased Total 217 TRIP Agriculture, Forestry & Fishing Mining Construction Manufacturing 29 Transportation, Communications, Electric, Gas & 449 Sanitary Services Wholesale Trade Retail Trade Finance, Insurance & Real Estate Services Public Administration 35 N/A Unavailable SIC Code N/A Unavailable Other 44 TOTALS: Industry (NAICS, SIC, or OTHER) Page 9 of 19
10 OMB No Expiration: TERRORISM RISK INSURANCE PROGRAM 218 DATA CALL: INSURER (NONSMALL) GROUPS OR COMPANIES POLICYHOLDER INDUSTRY CODE (NATIONWIDE) (NAICS, SIC, or OTHER) B C D 3 Code Description 4 11 Agriculture, Forestry, Fishing & Hunting 5 21 Mining, Quarrying, and Oil & Gas Extraction 6 22 Utilities 7 23 Construction Manufacturing 9 42 Wholesale Trade Retail Trade Transportation & Warehousing Information Finance & Insurance Real Estate and Rental and Leasing Professional, Scientific & Technical Service Management of Companies and Enterprises Administrative & Support & Waste Management & Remediation Services Educational Services Health Care & Social Assistance 2 71 Arts, Entertainment & Recreation Accommodation & Food Services NAICS Code I J K L M N Total 217 Disclosed DEP Charged Total 217 TRIP When Not Purchased Liability Total 217 TRIP When Purchased Total 217 TRIP Workers' Compensation Total 217 Disclosed DEP Charged Total 217 TRIP Other Services (except Public Administration) Public Administration 24 N/A Unavailable Industry (NAICS, SIC, or OTHER) Page 1 of 19
11 OMB No Expiration: TERRORISM RISK INSURANCE PROGRAM 218 DATA CALL: INSURER (NONSMALL) GROUPS OR COMPANIES POLICYHOLDER INDUSTRY CODE (NATIONWIDE) (NAICS, SIC, or OTHER) B C D 3 Code Description Agriculture, Forestry & Fishing Mining Construction Manufacturing Transportation, Communications, Electric, Gas & Sanitary Services Wholesale Trade Retail Trade Finance, Insurance & Real Estate Services Public Administration 35 N/A Unavailable SIC Code N/A Unavailable Other 44 TOTALS: I J K L M N Total 217 Disclosed DEP Charged Total 217 TRIP When Not Purchased Liability Total 217 TRIP When Purchased Total 217 TRIP Workers' Compensation Total 217 Disclosed DEP Charged Total 217 TRIP Industry (NAICS, SIC, or OTHER) Page 11 of 19
12 OMB No Expiration: B C D TERRORISM RISK INSURANCE PROGRAM 218 DATA CALL: INSURER (NONSMALL) GROUPS OR COMPANIES POLICYHOLDER INDUSTRY CODE (NATIONWIDE) (NAICS, SIC, or OTHER) O All Categories 3 Code Description 4 11 Agriculture, Forestry, Fishing & Hunting 5 21 Mining, Quarrying, and Oil & Gas Extraction 6 22 Utilities 7 23 Construction Manufacturing 9 42 Wholesale Trade Retail Trade Transportation & Warehousing Information Finance & Insurance Real Estate and Rental and Leasing Professional, Scientific & Technical Service Management of Companies and Enterprises Administrative & Support & Waste Management & Remediation Services Educational Services Health Care & Social Assistance 2 71 Arts, Entertainment & Recreation Accommodation & Food Services NAICS Code Total 217 TRIP Other Services (except Public Administration) Public Administration 24 N/A Unavailable Industry (NAICS, SIC, or OTHER) Page 12 of 19
13 OMB No Expiration: B C D TERRORISM RISK INSURANCE PROGRAM 218 DATA CALL: INSURER (NONSMALL) GROUPS OR COMPANIES POLICYHOLDER INDUSTRY CODE (NATIONWIDE) (NAICS, SIC, or OTHER) O All Categories 3 Code Description Agriculture, Forestry & Fishing Mining Construction Manufacturing Transportation, Communications, Electric, Gas & Sanitary Services Wholesale Trade Retail Trade Finance, Insurance & Real Estate Services Public Administration 35 N/A Unavailable SIC Code N/A Unavailable Other 44 TOTALS: Total 217 TRIP Industry (NAICS, SIC, or OTHER) Page 13 of 19
14 OMB No Expiration: TERRORISM RISK INSURANCE PROGRAM 218 DATA CALL: INSURER (NONSMALL) GROUPS OR COMPANIES GEOGRAPHIC EXPOSURES (NATIONWIDE) B C D E F G 2 Region Description Total 217 Payroll Subject to TRIP under Primary WC Total 217 Payroll Subject to TRIP under Excess WC Total 217 Property Insurance Exposure Subject to TRIP Property Total 217 Property Insurance Exposure Not Subject to TRIP Property 3 Atlanta. GA 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 2113, 212,2123,213, 2131, 2151, 2153, 2157, 2165, 2171, 2174, 2182, 2187, 2192, 2112, 2115, 21111, 2112, 21131, 21136, 21152, 21155, 21161; include the following zip codes from Anne Arundel County 216, 2161, 2162, 2176, 2177, 219, 2198, 21122, 21123, 21144, 21225, 21226, Boston. MA 6 Buffalo, NY All zip codes from Suffolk County; for Essex County only include zip codes 191 through 198, 191, 1945, 196, 1961, 197, 1971; for Norfolk County only include zip codes 226, 227, 23, 262, 29, 2169, 217, 2171, 2184 through 2191, 2269, 2445, 2446, 2447, 2457, 2467, 2481, 2482, 2492, 2494; for Middlesex County only include zip codes 171 through 175, 176, 177, 1776, 1778, 181, 183, 185 through 188, 1813, 1815, 1866, 1867, 188, 1888, 189, 2138 through 2145, 2148, 2149, 2153, 2155, 2156, 2176, 218, 2212, 2238, 2239, 242, 2421, 2451 through 2456, 2458 through 2462, 2464 through 2468, 2471, 2472, 2474 through 2479, 2493, All zip codes for Buffalo NY (1421 through 14228, 14231, 14233, 1424, 14241, 1426, 14261, 14263, 14264, 14265, 14267, 14269, 1427, 14272, 14273, 14276, 1428); Niagara Falls in Niagara county (1419, 1431, 1432, 1433, 1434, 1435); and include the nearby suburbs in Erie and Niagara counties (141, 1426, 1431, 1432, 1437, 1443, 1451, 1459, 1468, 1475, 1486, 1412, 14127, 1414, 1415, 14151). 7 Chicago, IL All zip codes within the four counties of Cook, DuPage, Lake, and Will. 8 Cleveland, OH All zip codes within the two counties of Cuyahoga and Lake. 9 Dallas/Ft. Worth, TX All zip codes in the two counties of Dallas and Tarrant (Fort Worth). Geographic (US) Page 14 of 19
15 OMB No Expiration: TERRORISM RISK INSURANCE PROGRAM 218 DATA CALL: INSURER (NONSMALL) GROUPS OR COMPANIES GEOGRAPHIC EXPOSURES (NATIONWIDE) 1 Denver, CO All zip codes within the counties of Adams, Arapahoe, and Denver. 11 Detroit, MI All zip codes within the counties of Macomb, Oakland, and Wayne. 12 Houston, TX All zip codes in Harris County. 13 Las Vegas, NV All zip codes in Clark County. 14 Los Angeles, CA All zip codes within the two counties of Los Angeles and Orange. 15 Miami, FL All zip codes in MiamiDade County. Minneapolis/St. Paul, 16 MN All zip codes in the two counties of Hennepin and Ramsey. 17 New York, NY 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 (711 through 718, 7112, 7114, 7175, 7182, 7184, 7188, 7189, 7191, 7192, 7193, 7194, 7195, 7198, 7199) and Elizabeth (721, 722, 726, 727, 728). 18 Newark, NJ 19 Orlando, FL All zip codes in the two counties of Orange and Seminole. 2 Philadelphia, PA All zip codes in Philadelphia County. 21 Phoenix, AZ All zip codes in Maricopa County. 22 San Diego, CA All zip codes in San Diego County 23 San Francisco, CA All zip codes within the two counties of San Francisco and San Mateo. 24 San Jose, CA All zip codes in Santa Clara County. 25 Seattle, WA All zip codes in King County. 26 St. Louis, MO All zip codes in the two counties of St. Louis City and St. Louis. Tampa/St. Petersburg, 27 FL All zip codes in the two counties of Hillsborough and Pinellas. 28 Washington, DC All other Locations in 29 the U.S. 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 C3C28 3 Unknown If locations are unknown for a policy, enter the requested information here. 31 Subtotal All metro regions specified in Cells C3C28 32 Total All metro regions and other locations specified in Cells C3C3. Geographic (US) Page 15 of 19
16 OMB No Expiration: TERRORISM RISK INSURANCE PROGRAM 218 DATA CALL: INSURER (NONSMALL) GROUPS OR COMPANIES GEOGRAPHIC EXPOSURES (NATIONWIDE) Top 5 Largest Accumulated Exposure Locations (Metro Areas, (Rows C3 to C28) Payroll Exposure ZIP Code of Top 5 Largest Accumulated Exposure Locations by Payroll Amount of Top 5 Largest Accumulated Exposure Locations by Payroll ZIP Code of Top 5 Largest Accumulated Exposure Locations by Property Insurance Exposure subject to TRIP Property Property Exposure Amount of Top 5 Largest Accumulated Exposure Locations by Property Insurance Exposure subject to TRIP Property Top 5 Largest Accumulated Exposure Locations (All Other NonMetro Areas, (Rows C29C3) Payroll Exposure ZIP Code of Top 5 Largest Accumulated Exposure Locations by Payroll Amount of Top 5 Largest Accumulated Exposure Locations by Payroll ZIP Code of Top 5 Largest Accumulated Exposure Locations by Property Insurance Exposure subject to TRIP Property Property Exposure Amount of Top 5 Largest Accumulated Exposure Locations by Property Insurance Exposure subject to TRIP Property 49 ZIP Code Associated with Largest Probable Maximum Loss (PML) 5 Largest PML at a Single Location (Amount) Geographic (US) Page 16 of 19
17 OMB No Expiration: TERRORISM RISK INSURANCE PROGRAM 218 DATA CALL: INSURER (NONSMALL) GROUPS OR COMPANIES REINSURANCE (NATIONWIDE) B C D 2 Element Response Description or Explanation (if any) 3 Size of TRIP 217 Deductible (Cell H4 of Insurer Group Affiliations Chart x 2%) 4 Total 217 Limits Any One Loss of Purchased Reinsurance Covering TRIP Loss 5 Total 217 Aggregate Limits of Purchased Reinsurance Covering TRIP Loss Attachment Point of Purchased Treaty Reinsurance Covering TRIP Loss CoParticipation Share of Purchased Treaty Reinsurance Covering TRIP Loss 8 Total 217 Limits Any One Loss of Purchased Reinsurance Covering Natural Catastrophic Loss 9 Total 217 Aggregate Limits of Purchased Reinsurance Covering Natural Catastrophic Loss Attachment Point of Purchased Treaty Reinsurance Covering Natural Catastrophic Loss CoParticipation Share 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, Total 217 Limits of NBCR Reinsurance for Certified Acts of Terrorism involving WC Loss 16 If Yes, 217 Attachment Point of NBCR Reinsurance for Certified Acts of Terrorism involving WC Loss If Yes, 217 CoParticipation Share (if any) of NBCR Reinsurance For Certified Acts of Terrorism 17 involving WC Loss 18 Reinsurance for NBCR Property Loss Resulting from Certified Acts of Terrorism? 19 If Yes, Total 217 Limits of NBCR Reinsurance for Certified Acts of Terrorism involving Property Loss If Yes, 217 Attachment Point of NBCR Reinsurance for Certified Acts of Terrorism involving Property 2 Loss If Yes, 217 CoParticipation Share (if any) of NBCR Reinsurance for Certified Acts of Terrorism involving 21 Property Loss 22 Reinsurance for NBCR Liability Loss Resulting from Certified Acts of Terrorism? 23 If Yes, Total 217 Limits of NBCR Reinsurance for Certified Acts of Terrorism involving Liability Loss If Yes, 217 Attachment Point of NBCR Reinsurance for Certified Acts of Terrorism involving Liability 24 Loss If Yes, 217 CoParticipation Share (if any) of NBCR Reinsurance for Certified Acts of Terrorism involving 25 Liability Loss 26 Any other reinsurance exclusions specifically applicable to TRIP Certified Acts of Terrorism? Reinsurance (US) Page 17 of 19
18 OMB No Expiration: TERRORISM RISK INSURANCE PROGRAM 218 DATA CALL: INSURER (NONSMALL) GROUPS OR COMPANIES REINSURANCE (NATIONWIDE) Using the following defined terrorism event, calculate and report the total projected loss under 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 copay obligation under TRIP; and (6) any private reinsurance recovery available to the group or company within the CoPay Layer. The scenario involves two separate, but related, attacks placing place on October 13, 217 (a Friday). 1. At 11: a.m., a group of five terrorists detonate five suitcase bombs carried in luggage carts in the main departure area of Terminal 3 at O'Hare International Airport. Use the following estimates in calculating damages: The departure area sustains massive debris damage (5% property damage, 1% fire loss) Injuries: 25 blue/white collar worker deaths in total, and 1 injuries in total Assume that all of O'Hare Airport is closed for 7 days, and Terminal 3 is closed for 6 days. 2. At 11:3 a.m., a 56 ton truck bomb detonates at Willis Tower (233 S. Wacker Drive, Chicago, IL 666). Assume that the loss does not involve any NBCR exposures. Assume also 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: Zone 1 (1 meters from site): Collapse and fire following, 1% property damage, 1% fire loss Zone 2 (2 meters from site): Massive structural damage to surrounding properties, 5% property damage, 5% fire loss Zone 3 (4 meters from site): Heavy debris damage to surrounding properties, 25% property damage, 2.5% fire loss Zone 4 (5 meters from site): Light debris damage to surrounding properties, 1% property damage, 1% fire loss Injuries: 2, blue/white collar worker deaths in total, and 4, injuries in total Total Projected Loss under Policies Issued by Group or Company 29 Deductible/Retention of Insureds under Policies issued by Group or Company 3 Net Loss to Group or Company within TRIP Deductible 31 Private Reinsurance Recovery within Deductible Layer 32 Claim under TRIP 33 Net Loss to Group or Company within CoPay Layer 34 Private Reinsurance Recovery within CoPay Layer Reinsurance (US) Page 18 of 19
19 Notice under the Paperwork Reduction Act We estimate it will take you about 75 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 Insurance Program Office, Department of the Treasury, 15 Pennsylvania Avenue NW, Room 141 MT, Washington, DC 222. Do not send completed forms to this address. Submit forms according to instructions provided at
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