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BK : 1959 PG : 1890 * * Old Republic Surety Company * OLD REPUBLIC 1025 South Semoran Blvd . , Suite 1085 , Winter Park , FL 32792 * * (800 )-277 -2663 ) DATE : 10/ 13/ 05 O ! �_ Rel_, bhc Insurance Company ( Old Republic ; as anent 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 . ORI- IGFF Indian River (,oun� y Board of County Commissioners RIDER - POLICYHOLDER DISCLOSURE NOTICE OF TERRORISM INSURANCE COVERAGE Rider has been provided to Principal and Obligee . , t:) ,rera9 = for acts of terror -r s s included in the capticmed bond . You snould knout that, effective Novemb•_ r 6 . 21`D ^ 2 . under that bond . any ! osses caused by certified acts of . terrorism would be partially reimbursed by the Jr � ted Slates under a formula established by federal law Under this formula , the United States pays 9011/- ; ed terrorism losses exceeding the statutorily established deductible paid by Old Republic . The established ar tAa d eductibie is eaual to of the prior years direct earned premium written by Old Republic for losses Heil n , .'_ OC .; t0 % for loc. se •; ncurred in 2004 , and 15 % for losses incurred in 2005 . Payment for a loss will not d the " mit of ! iatbihtV 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 1042 ( 1 ) of the Terrorism Risk Insurance Act of 2002 , a certified "act of terrorism " means any a ,:. ' that is cert , tied by the Secre- tary of the Treasury in concurrence with the Secretary of State and the A.ttr ,Hey ; ' i ! ec to be an act of Perron . m To he certified , the act of terrorism must be : 1 ) a vroient 3C ' or a ^ act that ; s rr :3ng _ rolis tc human life , property or infrastructure ; 2 ) have resulted in damage within tha r. ' ted Status oWs! de the 0nited,States in the case of an air carver or vessel , or the premises of a Uniteu States -n rsioe ? nd 31 have teen 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 premum 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 UNDEt2 THE ACT . Note : If You refect 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 bond, James E . Lee Bond bligee ' s Signature Vice President - Old Republic Insurance Company zi 4! President - Old Republic Surety Company Print Name fl Vice President - Bituminous Casualty Corporation Vice President - International Business & Mercantile /d /rJ? — dS REassurance Co . Date ORSC 22836 ( 112003 ) Attach to all contract bonds as a cover page . A TRUE COPY CERTIFICATION ON LAST PAGE J. K. BARTON, CLERK