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* * Old Republic Surety Company * • 1025 South Semoran Blvd . , Suite 1085 , Winter Park , FL 32792 OLD REPUBLIC * * (800)-277-2663 ) DATE : 04 /08 /04 Old Republic Insurance Company ( Old Republic) as agent for: Old Republic Surety Company , Bituminous Casualty Corporation , and International Business & Mercantile REassurance Co. TO BE ATTACHED TO AND FORM PART OF CONTRACT BOND NUMBER : 02N540927 PRINCIPAL: Underground Utilities , Inc . OBLIGEE : Indian River County Board of County Commissioners RIDER - POLICYHOLDER DISCLOSURE NOTICE OF TERRORISM INSURANCE COVERAGE Rider has been provided to Principal and Obligee . Coverage for acts of terrorism is included in the captioned bond . You should know that, effective November 26 , 2002 , under that bond , any losses caused by certified acts of terrorism would be partially reimbursed by the United States under a formula established by federal law. Under this formula , the United States pays 90 % of covered terrorism losses exceeding the statutorily established deductible paid by Old Republic. The established annual deductible is equal to 7 % of the prior years direct earned premium written by Old Republic for losses incurred in 2003 , 10% for losses incurred in 2004 , and 15 % for losses incurred in 2005 . Payment for a loss will not exceed the limit of liability under this bond . This bond will not pay for any portion of certified terrorism loss beyond any applicable annual liability cap set forth in the Act. The terms of this rider do not provide coverage for any loss that would otherwise be excluded by the terms of this bond . As defined in Section 102( 1 ) of the Terrorism - Risk Insurance Act of 2002 , a certified "act of terrorism" means any act that is certified by the Secretary of the Treasury , in concurrence with the Secretary of State and the Attorney General of the United States , to be an act of terrorism . To be certified , the act of terrorism must be : 1 ) a violent act or an act that is dangerous to human life , property , or infrastructure; 2 ) have resulted in damage within the United States , or outside the United States in the case of an air carrier or vessel , or the premises of a United States mission ; and 3) have been committed by an individual or individuals acting on behalf of any foreign person or foreign interest, as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion . You have a right to purchase insurance coverage for losses arising from terrorism , or you may choose to reject the purchase . SELECTION OR REJECTION OF TERRORISM INSURANCE COVERAGE The premium you have been charged for this bond includes terrorism coverage , for a premium of $ 7 . 00 which you must pay within 30 days of this offer. THE PREMIUM CHARGED FOR THIS COVERAGE DOES NOT INCLUDE ANY CHARGES FOR THE PORTION OF LOSS COVERED BY THE FEDERAL GOVERNMENT UNDER THE ACT . Note : If you reiect the coverage, you must check the box below, sign this form and return it to the address shown above . The premium will be credited ❑ I hereby elect to have the exclusion of terrorism coverage apply to this bond . I understand that I will have no . ' . coverage for losses arising from acts of terrorism . +" ' The undersigned agrees that this election will apply only to this bon l 's James E . Lee BonO gee ' s Signature 0 , , Vice President - Old Republic Insurance Company ,.� c war \. President - Old Republic Surety Company Print Name , a Vice President - Bituminous Casualty Corporation Vice President - International Business & Mercantile REassurance Co . Date ORSC 22836 ( 1 /2003) Attach to all contract bonds as a cover page.