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BK : 1959 PG : 1890 * * Old Republic Surety Company * OLD REPLBLIC 1025 South Semoran Blvd . , Suite 1085 , Winter Park , FL 32792 * * ( 800 )-277-2663 ) DATE : 10/ 13/ 05 011.,t Re , ; . bloc 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 : OCN558287 PRINCIPAL Underground Utilities , Inc . ORUGFF Indian River .oun� y Board of county commissioners RIDER - POLICYHOLDER DISCLOSURE NOTICE OF TERRORISM INSURANCE COVERAGE Rider has been provided to Principal and Obligee . Corerag : for acts of terroris r s included in the cautioned bond . You snould know that, effective Novemb• r 1' 6 . 2002 . under that bond , any losses caused by certified acts of . terrorism would be partially reimbursed by the Jr11ed States under a formula established by federal law Under this formula , the United States pays 901/- ` , Fred terrorism losses exceeding the statutorily established deductible paid by Old Republic . The estabt & lied 3r - ual deductibie is eaual to 7 ^/, of the prior years direct earned premium written by Old Republic for losses n : r ed n : ? OC :, t0 "/ kr log: , e > ncurred � n 2004 , and 151X for losses incurred in 2005 . Payment for a loss will not r :: eed the Emit 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 . %, s Definer; ! n Sectior ? 02 ( 1 ) of the Terrorism Risk Insurance Act of 2002 , a certified " act of terrorism " mean s any a . t that ic cert , fied ov the Secretary of the Treasury in concurrence with the Secretary of State and the Atte ,ney ener�, , ` ! rip linite ;i ^ t ; , fes In be an act of terrr) nsm To be certified , the act of terrorism must be . 1 ) a violent 3c � or ae. ac ' I .lat is ri .3ngeroi : s tc human life , property or infrastructure , 2 ) have resulted in damage within the Jr. ted Slatrs r: : rias de the IJnited,States in the case of an air carrier or vessel , or the premises of a United Mates 7i ssion . end 31 have ., een 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 refect the purchase SELECTION OR REJECTION OF TERRORISM INSURANCE COVERAGE The premum you have been charged for this bond includes terrorism coverage , for a premium of $ T , 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 UNOEr2 THE ACT . Note : If you reject the coverage , you must check the box below, sign this form and return it to the address shown above . The premium will be credited . 1 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 bond . James E . Lee Bond bligee ' s Signature Vice President - Ofd Republic Insurance Company Lam^ .C, Regeol � — � .. President - Old Republic Surety Company Print Name Vice President - Bituminous Casualty Corporation Vice President - International Business & Mercantile _ 1d /3 ' a � REassurance Co . Date ORSC 22836 ( 1 /2003 ) Attach to all contract bonds as a cover page . A TRUE COPY CERTIFICATION ON LAST PAGE J. K. BARTON, CLERK