# IRON-STARR

## THE BERMUDA SHORTS FORM - 03 (cont'd)

### DECLARATIONS - attaching to and forming part of Policy No: IS0002927

#### Item 6. Underlying Limits:
- (Insuring Agreement 2):
  - USD 450,000,000 Each Occurrence, Claim or Loss
  - USD 450,000,000 Aggregate
  - Which in turn is excess of various insurances and/or retentions as more fully set forth in the Followed Policy

#### Item 7. Notice to:
- (Conditions 3 and 5)
  - a) All Notices of Occurrence, Claim or Loss:
    - To: Iron-Starr Excess Agency Ltd.
      - Attention: Claims Manager
      - 141 Front Street
      - Hamilton HM19, Bermuda
      - claims@ironstarrecess.com
  - b) All other Notices:
    - To: Iron-Starr Excess Agency Ltd.
      - Attention: Underwriting Dept.
      - 141 Front Street
      - Hamilton HM 19, Bermuda

#### Item 8.
- a) Premium: USD 107,160
- b) Minimum Earned Premium: 35%
- c) Commission: 0%

#### Item 9. The Company:
- Iron-Starr Excess Agency Ltd. For and on behalf of subscribing insurers as follows:
  - 30% Ironshore Insurance Ltd.
  - 30% Starr Insurance & Reinsurance Limited
  - 30% Hamilton Re, Ltd.
  - 10% Antares Syndicate 1274 (Binding Authority UMR: B6081B001211C)
- at the address stated at the top of the Declarations Page

**Date of Issuance:** July 18, 2016
ISEABSF Declarations [04/16]