OMB No. 1505-0257

Expiration: March 31, 2025

TERRORISM RISK INSURANCE PROGRAM 2023 DATA CALL: CAPTIVE INSURERS

INSURER GROUP AFFILIATIONS

C H

3 Group Code (NAIC or as 

assigned by Aggregator) Insurer Group Name 3 Total 2021 Policyholder Surplus:

4 4 Total 2021 TRIP-Eligible DEP (all lines):

C D E

8

Company Code (NAIC or as 

assigned by Aggregator) Insurance Company Name Type of Insurer Domicile

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

B

B

G

Affiliations

Page 1 of 15
OMB No. 1505-0257

Expiration: March 31, 2025

TERRORISM RISK INSURANCE PROGRAM 2023 DATA CALL: CAPTIVE INSURERS

 DIRECT EARNED PREMIUM (DEP) (JURISDICTION)

2

C D E F G H

5 TRIP-Eligible Line of Coverage

NAIC Line 

(Commercial 

Only)

Total 2022 TRIPEligible DEP (all 

policies)

Total 2022 TRIPEligible DEP 

(Terrorism Risk 

Coverage Declined)

Total 2022 TRIP-Eligible 

DEP (Terrorism Risk 

Coverage Provided for 

Disclosed $0 Charge)

Total 2022 TRIP-Eligible 

DEP (Terrorism Risk 

Coverage Provided with 

a Premium Charged)

Total 2022 DEP Charged 

for Terrorism Risk 

Coverage

6 Fire 1 $ -

7 Fire Deductible Reimbursement 1 $ -

8 Allied Lines 2.1 $ -

9 Allied Lines Deductible Reimbursement 2.1 $ -

10 Commercial Multiple Peril (non-liability portion) 5.1 $ -

11 Commercial Multiple Peril (non-liability portion) 

Deductible Reimbursement 5.1 $ -

12 Commercial Multiple Peril (liability portion) 5.2 $ -

13 Commercial Multiple Peril (liablity portion) Deductible 

Reimbursement 5.2 $ -

14 Ocean Marine 8 $ -

15 Ocean Marine Deductible Reimbursement 8 $ -

16 Inland Marine 9 $ -

17 Inland Marine Deductible Reimbursement 9 $ -

18 Workers' Compensation 16 $ -

19 Workers' Compensation Deductible Reimbursement 16 $ -

20 Excess Workers' Compensation 17.3 $ -

21 Other Liability 17 $ -

22 Other Liablity Deductible Reimbursement 17 $ -

23 Products Liability 18 $ -

24 Products Liablity Deductible Reimbursement 18 $ -

25 Aircraft (all perils) 22 $ -

26 Aircraft (all perils) Deductible Reimbursement 22 $ -

27 Boiler and Machinery 27 $ -

B

 Jurisdiction:

Premium (Juris.)

Page 2 of 15
OMB No. 1505-0257

Expiration: March 31, 2025

TERRORISM RISK INSURANCE PROGRAM 2023 DATA CALL: CAPTIVE INSURERS

 DIRECT EARNED PREMIUM (DEP) (JURISDICTION)

28 Boiler and Machinery Deductible Reimbursement 27 $ -

29 TOTALS $ - $ - $ - $ - $ -

30 Total 2022 Non-TRIP Eligible Lines DEP

Premium (Juris.)

Page 3 of 15
OMB No. 1505-0257

Expiration: March 31, 2025

TERRORISM RISK INSURANCE PROGRAM 2023 DATA CALL: CAPTIVE INSURERS

STANDALONE TERRORISM (NATIONWIDE)

C

2 Element Amount

3 2022 DEP for Standalone Terrorism Policies

4 Portion of 2022 DEP Providing Coverage for Losses for Certified Acts of Terrorism under TRIP

5 Portion of 2022 DEP Providing Coverage for Losses Arising from Other (Non-Certified) Acts of 

Terrorism

6 2022 Number of Standalone Terrorism Policies Issued

7 2022 Number of Standalone Terrorism Policies Issued Providing Coverage for Losses for Certified Acts 

of Terrorism under TRIP

8 2022 Property Insurance Exposure for Standalone Terrorism Policies Providing Coverage for Losses for 

Certified Acts of Terrorism under TRIP

9 Total 2022 Limits of Liability for Standalone Terrorism Policies Providing Coverage for Losses for 

Certified Acts of Terrorism under TRIP

B

Standalone Terrorism (US)

Page 4 of 15
OMB No. 1505-0257

Expiration: March 31, 2025

TERRORISM RISK INSURANCE PROGRAM 2023 DATA CALL: CAPTIVE INSURERS

CYBER (NATIONWIDE)

C D E

2 Element Standalone Cyber

Cyber Coverage 

provided as part of a 

Package Policy Totals

3 Total 2022 TRIP-Eligible DEP (All Cyber Policies) $ -

4 Total 2022 Cyber DEP in TRIP-Eligible Lines of Insurance (Terrorism Risk Coverage Declined) $ -

5 Total 2022 Cyber DEP in TRIP-Eligible Lines of Insurance (Terrorism Risk Coverage Provided) $ -

6 Total 2022 TRIP-Eligible DEP Charged for Terrorism Risk Coverage Under Cyber Policies $ -

7 Total 2022 Non-TRIP-Eligible DEP (All Cyber Policies) $ -

8 Total 2022 Number of Cyber Policies Issued in TRIP-Eligible Lines of Insurance 0

9 Total 2022 Number of Cyber Policies Issued (Terrorism Risk Coverage Provided) 0

10 Total 2022 Number of Cyber Policies Issued in Non-TRIP-Eligible Lines of Insurance 0

11 Total 2022 Number of all Cyber Policies Issued 0

12 Total 2022 Number of all Cyber Policies Issued to Small Policyholders (100 or fewer employees or less then 

$10 million in revenue) 0

13 Total 2022 Number of all Cyber Policies Issued to Medium Policyholders (101-500 employees or $10-$100 

million in revenue) 0

14 Total 2022 Number of all Cyber Policies Issued to Large Policyholders (501 or more employees or more than 

$100 million in revenue) 0

15 Total 2022 DEP of all Cyber Policies Issued to Small Policyholders (100 or fewer employees or less than $10 

million in revenue) $ -

16 Total 2022 DEP of all Cyber Policies Issued to Medium Policyholders (101-500 employees or $10-$100 

million in revenue) $ -

17 Total 2022 DEP of all Cyber Policies Issued to Large Policyholders (501 or more employees or more than 

$100 million in revenue) $ -

18 Total 2022 Policy Limits for Cyber Policies Issued in TRIP-Eligible Lines of Insurance $ -

19

Total 2022 Policy Limits for Cyber Policies Issued in TRIP-Eligible Lines of Insurance Providing Coverage for 

Losses for Certified Acts of Terrorism Under TRIP $ -

20 Total 2022 Policy Limits for Cyber Policies Issued in Non-TRIP-Eligible Lines of Insurance $ -

21 Total 2022 Policy Limits for Cyber Extortion under Cyber Policies Issued in TRIP-Eligible Lines of Insurance $ -

22

Total 2022 Policy Limits for Ransom Payments for Cyber Extortion under Cyber Policies Issued in TRIPEligible Lines of Insurance $ -

B

Cyber (US)

Page 5 of 15
OMB No. 1505-0257

Expiration: March 31, 2025

TERRORISM RISK INSURANCE PROGRAM 2023 DATA CALL: CAPTIVE INSURERS

CYBER (NATIONWIDE)

23

Total 2022 Policy Limits for Cyber Extortion under Cyber Policies Issued in Non-TRIP-Eligible Lines of 

Insurance $ -

24

Total 2022 Policy Limits for Ransom Payments for Cyber Extortion under Cyber Policies Issued in Non-TRIPEligible Lines of Insurance $ -

25 Total 2022 Direct Losses Paid for Cyber Extortion under all Cyber Policies Issued $ -

26 Total 2022 Direct Losses Incurred for Cyber Extortion under all Cyber Policies Issued $ -

27

Total 2022 Direct Losses Paid for Cyber Extortion (Ransom Payment or Reimbursement Only) under all Cyber 

Policies Issued $ -

28 Total 2022 Number of Claims Associated with Payments reported in Line 27 $ -

29

Total 2022 Direct Defense and Loss Containment Amounts Paid for Cyber Extortion under all Cyber Policies 

Issued $ -

30

Total 2022 Direct Defense and Loss Containment Amounts Incurred for Cyber Extortion under all Cyber 

Policies Issued $ -

Cyber (US)

Page 6 of 15
OMB No. 1505-0257

Expiration: March 31, 2025

TERRORISM RISK INSURANCE PROGRAM 2023 DATA CALL: CAPTIVE INSURERS

EXPOSURE BASES BY JURISDICTION

2

C D E F G H I J K L M N O P Q

5 TRIP-Eligible Line of Coverage

NAIC Line 

(Commercial 

Only)

Total 2022 TRIPEligible Property 

Exposure (Terrorism 

Risk Coverage 

Provided)

Total 2022 TRIPEligible Property 

Exposure (Terrorism 

Risk Coverage 

Provided and NBCR 

Risks Not Excluded)

Total 2022 TRIPEligible Property 

Exposures (Terrorism 

Risk Coverage 

Provided Only for 

NBCR Risks) 

Total 2022 

Policyholder 

Deductibles for TRIPEligible Property 

Policies (Terrorism 

Risk Coverage 

Provided)

Total 2022 TRIPEligible Property 

Exposure (Terrorism 

Risk Coverage 

Declined)

Total 2022 

Policyholder 

Deductibles for TRIPEligible Property 

Policies (Terrorism 

Risk Coverage 

Declined)

Total 2022 Limits of 

Liability for TRIPEligible Policies 

(Terrorism Risk 

Coverage Provided)

Total 2022 TRIPEligible Limits of 

Liability (Terrorism 

Risk Coverage 

Provided and NBCR 

Risks Not Excluded)

Total 2022 TRIPEligible Limits of 

Liability (Terrorism 

Risk Coverage 

Provided Only for 

NBCR Risks) 

Total 2022 

Policyholder 

Deductibles for TRIPEligible Liability 

Policies (Terrorism 

Risk Coverage 

Provided)

Total 2022 Limits of 

Liability for TRIPEligible Liability 

Policies (Terrorism 

Risk Coverage 

Declined)

Total 2022 

Policyholder 

Deductibles for TRIPEligible Liability 

Policies (Terrorism 

Risk Coverage 

Declined)

Total 2022 Payroll for 

TRIP-Eligible Policies 

(Terrorism Risk 

Coverage Provided)

Total 2022 Payroll Not 

Subject to Terrorism 

Risk Coverage

6 Fire 1

7 Fire Deductible Reimbursement 1

8 Allied Lines 2.1

9 Allied Lines Deductible Reimbursement 2.1

10 Commercial Multiple Peril (non-liability portion) 5.1

11

Commercial Multiple Peril (non-liability portion) 

Deductible Reimbursement 5.1

12 Commercial Multiple Peril (liability portion) 5.2

13

Commercial Multiple Peril (liability portion) 

Deductible Reimbursement 5.2

14 Ocean Marine 8

15 Ocean Marine Deductible Reimbursement 8

16 Inland Marine 9

17 Inland Marine Deductible Reimbursement 9

18 Workers' Compensation 16

19 Workers' Compensation Deductible Reimbursement 16

20 Excess Workers' Compensation 17.3

21 Other Liability 17

22 Other Liability Deductible Reimbursement 17

23 Products Liability 18

24 Products Liability Deductible Reimbursement 18

25 Aircraft (all perils) 22

26 Aircraft (all perils) Deductible Reimbursement 22

27 Boiler and Machinery 27

28 Boiler and Machinery Deductible Reimbursement 27

29 TOTALS $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ -

 Jurisdiction:

B

Exposure Bases (Juris.)

Page 7 of 15
OMB No. 1505-0257

Expiration: March 31, 2025

TERRORISM RISK INSURANCE PROGRAM 2023 DATA CALL: CAPTIVE INSURERS

POLICYHOLDER INDUSTRY CODE (NATIONWIDE)

B

2 NAICS Code Number Most Applicable to the 

Business(es) Insured by the Captive Insurer:

A

Industry Code (US)

Page 8 of 15
OMB No. 1505-0257

Expiration: March 31, 20225

TERRORISM RISK INSURANCE PROGRAM 2023 DATA CALL: CAPTIVE INSURERS

PLACES OF WORSHIP (NATIONWIDE)

(NAICS, SIC, ISO, or OTHER)

D E F G H I J K L M N O

All Categories

3 Description

Total 2022 DEP 

Charged for 

Terrorism Risk 

Coverage

Total 2022 TRIPEligible DEP 

(Terrorism Risk 

Coverage 

Declined)

Total 2022 TRIPEligible DEP 

(Terrorism Risk 

Coverage 

Provided)

Total 2022 TRIPEligible DEP

Total 2022 DEP 

Charged for 

Terrorism Risk 

Coverage

Total 2022 TRIPEligible DEP 

(Terrorism Risk 

Coverage Declined)

Total 2022 TRIPEligible DEP 

(Terrorism Risk 

Coverage 

Provided)

Total 2022 TRIPEligible DEP

Total 2022 DEP 

Charged for 

Terrorism Risk 

Coverage

Total 2022 TRIPEligible DEPTotal 2022 TRIPEligible DEP

4 NAICS 813110 Religious Organizations $ - $ - $ -

5 SIC 8661 Religious Organizations $ - $ - $ -

6 ISO 0900 (Property)

41650 (Liablity) Religious Organizations $ - $ - $ -

7 Other Places of Worship $ - $ - $ -

8 TOTALS: $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ -

Workers' Compensation

Code

C

Property Liability

Places of Worship (US)

Page 9 of 15
OMB No. 1505-0257

Expiration: March 31, 2025

TERRORISM RISK INSURANCE PROGRAM 2023 DATA CALL: CAPTIVE INSURERS

GEOGRAPHIC EXPOSURES (NATIONWIDE)

C D E F G

2 Region Description

Total 2022 Payroll for 

TRIP-Eligible Primary WC 

and Excess WC Policies 

(Terrorism Risk Coverage 

Provided)

Total 2022 Payroll for 

TRIP-Eligible Primary WC 

and Excess WC Policies 

(Terrorism Risk Coverage 

Not Provided)

Total 2022 TRIP-Eligible 

Property Exposure 

(Terrorism Risk Coverage 

Provided)

Total 2022 TRIP-Eligible 

Property Exposure 

(Terrorism Risk Coverage 

Declined)

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 21013, 

21020,21023,21030, 21031, 21051, 21053, 21057, 21065, 21071, 21074, 21082, 

21087, 21092, 21102, 21105, 21111, 21120, 21131, 21136, 21152, 21155, 21161; 

include the following zip codes from Anne Arundel County – 21060, 21061, 21062, 

21076, 21077, 21090, 21098, 21122, 21123, 21144, 21225, 21226, 21240.

5 Boston, MA

All zip codes from Suffolk county; for Essex County only include zip codes 01901 

through 01908, 01910, 01945, 01960, 01961, 01970, 01971; for Norfolk County only 

include zip codes 02026, 02027, 02030, 02062, 02090, 02169, 02170, 02171, 02184 

through 02191, 02269, 02445, 02446, 02447, 02457, 02467, 02481, 02482, 02492, 

02494; for Middlesex County only include zip codes 01701 through 01705, 01760, 

01770, 01776, 01778, 01801, 01803, 01805 through 01808, 01813, 01815, 01866, 

01867, 01880, 01888, 01890, 02138 through 02145, 02148, 02149, 02153, 02155, 

02156, 02176, 02180, 02212, 02238, 02239, 02420, 02421, 02451 through 02456, 

02458 through 02462, 02464 through 02468, 02471, 02472, 02474 through 02479, 

02493, 02495.

6 Buffalo, NY

All zip codes for Buffalo NY (14201 through 14228, 14231, 14233, 14240, 14241, 

14260, 14261, 14263, 14264, 14265, 14267, 14269, 14270, 14272, 14273, 14276, 

14280); Niagara Falls in Niagara county (14109, 14301, 14302, 14303, 14304, 14305); 

and include the nearby suburbs in Erie and Niagara counties (14010, 14026, 14031, 

14032, 14037, 14043, 14051, 14059, 14068, 14075, 14086, 14120, 14127, 14140, 

14150, 14151).

7 Chicago, IL All zip codes within the four counties of Cook, DuPage, Lake, and Will.

8 Cleveland, OH All zip codes in the counties of Cuyahoga and Lake.

9 Dallas/Ft. Worth, TX All zip codes in the two counties of Dallas and Tarrant (Fort Worth).

10 Denver, CO All zip codes in the three counties of Adams, Arapahoe, and Denver.

11 Detroit, MI All zip codes in the three 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 Miami-Dade County.

B

Geographic (US)

Page 10 of 15
OMB No. 1505-0257

Expiration: March 31, 2025

TERRORISM RISK INSURANCE PROGRAM 2023 DATA CALL: CAPTIVE INSURERS

GEOGRAPHIC EXPOSURES (NATIONWIDE)

16 Minneapolis/St. Paul, 

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).

18 Newark, NJ

All zip codes for the cities of Newark (07101 through 07108, 07112, 07114, 07175, 

07182, 07184, 07188, 07189, 07191, 07192, 07193, 07194, 07195, 07198, 07199) 

and Elizabeth (07201, 07202, 07206, 07207, 07208).

19 Orlando, FL All zip codes in the two counties of Orange and Seminole.

20 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.

27 Tampa/St. Petersburg, 

FL All zip codes in the two counties of Hillsborough and Pinellas.

28 Washington, DC All zip codes within Washington D.C. and all zip codes within the two counties of 

Arlington, VA and Alexandria City, VA.

29

All other Locations in 

the U.S. All areas in the US other than those specified in Cells C3-C28

30 Unknown If locations are unknown for a policy, enter the requested information here.

31 Subtotal All metro regions specified in Cells C3-C28 $ - $ - $ - $ -

32 Total All metro regions and other locations specified in Cells C3-C30 $ - $ - $ - $ -

Geographic (US)

Page 11 of 15
OMB No. 1505-0257

Expiration: March 31, 2025

TERRORISM RISK INSURANCE PROGRAM 2023 DATA CALL: CAPTIVE INSURERS

GEOGRAPHIC EXPOSURES (NATIONWIDE)

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 

(Terrorism Risk Coverage 

Provided) (Metropolitan 

Areas)

Amount of Top 5 Largest 

Accumulated Exposure 

Locations by Property 

Insurance Exposure 

(Terrorism Risk Coverage 

Provided) (Metropolitan 

Areas)

35 1.

36 2.

37 3.

38 4.

39 5.

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 

(Terrorism Risk Coverage 

Provided) (NonMetropolitan Areas)

Amount of Top 5 Largest 

Accumulated Exposure 

Locations by Property 

Insurance Exposure 

(Terrorism Risk Coverage 

Provided)(NonMetropolitan Areas)

43 1.

44 2.

45 3.

46 4.

47 5.

49

50

ZIP Code Associated with Largest Probable Maximum Loss (PML)

Largest PML at a Single Location (Amount)

Payroll Exposure Property Exposure

Payroll Exposure Property Exposure

Top 5 Largest 

Accumulated Exposure 

Locations

(Metro Areas, 

(Rows C3 to C28)

Top 5 Largest 

Accumulated Exposure 

Locations

(All Other Non-Metro 

Areas, 

(Rows C29-C30)

Geographic (US)

Page 12 of 15
OMB No. 1505-0257

Expiration: March 31, 2025

TERRORISM RISK INSURANCE PROGRAM 2023 DATA CALL: CAPTIVE INSURERS

REINSURANCE (NATIONWIDE)

C

2 Element Response

3 Size of TRIP 2022 Deductible (Cell H4 of Insurer Group Affiliations Chart x 20%)

4 Total 2022 Limits Any One Loss of Purchased Treaty Reinsurance Covering TRIP Loss

5 Total 2022 Aggregate Limits of Purchased Treaty Reinsurance Covering TRIP Loss

6 2022 Attachment Point Any One Loss of Purchased Treaty Reinsurance Covering TRIP Loss

7 2022 Co-Participation Share Any One Loss of Purchased Treaty Reinsurance Covering TRIP Loss

8 Total 2022 Limits Any One Loss of Purchased Treaty Reinsurance Covering Natural Catastrophic Loss

9 Total 2022 Aggregate Limits of Purchased Treaty Reinsurance Covering Natural Catastrophic Loss

10 2022 Attachment Point Any One Loss of Purchased Treaty Reinsurance Covering Natural Catastrophic Loss

11 2022 Co-Participation Share Any One Loss 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, 2022 Limits Any One Loss of NBCR Reinsurance for Certified Acts of Terrorism involving WC Loss

16

If Yes, 2022 Attachment Point Any One Loss of NBCR Reinsurance for Certified Acts of Terrorism 

involving WC Loss

17

If Yes, 2022 Co-Participation Share (if any) Any One Loss of NBCR Reinsurance For Certified Acts of 

Terrorism involving WC Loss

18 Reinsurance for NBCR Property Loss Resulting from Certified Acts of Terrorism?

19

If Yes, 2022 Limits Any One Loss of NBCR Reinsurance for Certified Acts of Terrorism involving Property 

Loss

20

If Yes, 2022 Attachment Point Any One Loss of NBCR Reinsurance for Certified Acts of Terrorism 

involving Property Loss

21

If Yes, 2022 Co-Participation Share (if any) Any One Loss of NBCR Reinsurance for Certified Acts of 

Terrorism involving Property Loss

22 Reinsurance for NBCR Liability Loss Resulting from Certified Acts of Terrorism?

23

If Yes, 2022 Limits Any One Loss of NBCR Reinsurance for Certified Acts of Terrorism involving Liability 

Loss

24

If Yes, 2022 Attachment Point Any One Loss of NBCR Reinsurance for Certified Acts of Terrorism 

involving Liability Loss

25

If Yes, 2022 Co-Participation Share (if any) Any One Loss of NBCR Reinsurance for Certified Acts of 

Terrorism involving Liability Loss

26 Any Other Reinsurance Exclusions Specifically Applicable to Certified Acts of Terrorism Under TRIP?

D

Description or Explanation (if any)

B

Reinsurance (US)

Page 13 of 15
OMB No. 1505-0257

Expiration: March 31, 2025

TERRORISM RISK INSURANCE PROGRAM 2023 DATA CALL: CAPTIVE INSURERS

REINSURANCE (NATIONWIDE)

30 Total Projected Loss $ -

31 Deductible/Retention of Insureds under Policies issued by Group or Company

32 Net Loss to Group or Company within TRIP Deductible

33 Private Reinsurance Recovery within Deductible Layer

34 Claim under TRIP

35 Net Loss to Group or Company within Co-Pay Layer

36 Private Reinsurance Recovery within Co-Pay Layer

Using the following defined terrorism event, calculate and report the total projected loss under property, workers' compensation, and liability 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 co-pay obligation under TRIP; and 

(6) any private reinsurance recovery available to the group or company within the Co-Pay Layer. 

On September 3, 2022 (a Saturday), at 9:00 p.m. (Pacific Time), a 5 to 6 ton truck bomb is detonated in downtown Las Vegas, Nevada, on West Flamengo Road between Las Vegas Boulevard and U.S. 15 (Las Vegas 

Freeway). The precise GPS coordinates are 36° 06’ 53.6” N, 115° 10’ 34.5” W. Assume 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). In addition, for purposes of estimating any workers’ compensation impacts, do not modify your 

estimates based upon any projections or assumptions as to a reduced number of employees in the affected area based upon the impacts of the COVID-19 pandemic. Rather, assume the area contains the number of 

employees (consistent with the estimates provided below) that would be expected to be in the area without accounting for any potential reductions on account of COVID-19. 

-Zone 1 (less than 100 meters from site): Collapse and fire following, 100% property damage, 10% fire loss

-Zone 2 (100-200 meters from site): Massive structural damage to surrounding properties, 50% property damage, 5% fire loss

-Zone 3 (200-400 meters from site): Heavy debris damage to surrounding properties, 25% property damage, 2.5% fire loss

-Zone 4 (400-500 meters from site): Light debris damage to surrounding properties, 10% property damage, 1% fire loss

Radius of potential damage: Up to 1600 meters. Between 500-1600 meters you may assume 1% property damage and 0% fire loss. 

-Worker Injuries: 1,500 blue/white collar deaths in total and 3,000 injuries in total. The following further assumptions can be applied as to the level of injuries incurred among workers: 20 percent permanent total 

disability; 30 percent permanent partial disability; and 50 percent temporary disability.

27

Reinsurance (US)

Page 14 of 15
Notice under the Paperwork Reduction Act

We estimate it will take you about 52 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 Terrorism Risk 

Insurance Program Office, Department of the Treasury, 1500 Pennsylvania 

Avenue NW, Room 1410 MT, Washington, DC 20220. Do not send 

completed forms to this address. Submit forms according to instructions 

provided at www.tripsection111data.com