**POLICY NO.: 60703940**

**DECLARATIONS, cont’d**

**Item 7. Notice to: (Conditions 3 and 5)**

a) All Notices of Occurrence, Claim or Loss:
   - To:
     - Via Email: highexcessclaims@aig.com
     - Via Easy-Link Fax: 877-839-9721
     - Via mail to:
       AIG Claims, Inc.
       Cat Excess Casualty Claims
       P.O. Box 305904
       Nashville, TN 37230-5904

b) All other Notices:
   - To:
     American International Reinsurance Company, Ltd.
     27 Richmond Road
     Pembroke, HM08
     Bermuda
     Attn: Cat Excess Liability Underwriting

**Item 8.**
a) Premium: USD $95,000 (for 100% Flat Annual)
b) Minimum Earned Premium: USD $33,250
c) Commission: 0%

**Item 9. The Company:**
American International Reinsurance Company, Ltd.
At the address stated at the top of the Declarations Page

**Item 10. Policy Form: Endorsements**
The Bermuda Shorts Form – 03 (Ed. 03/14)
1 – 6 at Policy Issuance

**Date of Issuance:** September 1, 2017

**Authorized Representative**

117111(4/14)
Page 2 of 9
©AIG, Inc. All rights reserved.
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This text is a declaration page from an insurance policy, detailing the notice requirements, premium information, company details, and policy form.