# IRON·STARR

## THE BERMUDA SHORTS FORM (cont'd)

**DECLARATIONS - attaching to and forming part of Policy No:** IS0000881

**Item 10. Declaration:**
The subscribing Insurer's obligations under this Policy are several and not joint and are limited solely to the extent of their individual subscriptions. No subscribing Insurer is responsible for the subscription of any co-subscribing Insurer that for any reason does not satisfy all, or part, of its obligations.

**Item 11. Policy Form: Endorsements:**
The Bermuda Shorts Form – ISEABSF (07/09)
1 – 9 at Policy Issuance

**Item 12. a) Representative of Named Insured: b) Address:**
Aon (Bermuda) Ltd.
30 Woodbourne Avenue
Pembroke, HM 08
Bermuda

**Authorized Representative**

Date of Issuance: June 14, 2012
ISEABSF Declarations [01/12]
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This document appears to be a declaration form attached to a policy issued by Iron Starr, specifically using the Bermuda Shorts Form. It outlines the obligations of the subscribing insurers, the policy form used, and the address of the authorized representative.