**Policy No.:** BM00024254LI09A

**Date:** JULY 20, 2009

**THE BERMUDA SHORTS FORM DECLARATIONS (cont'd)**

| Item 8. | a) Premium: USD 243,750 (part of $650,000 Annual) |
| --- | --- |
| | b) Minimum Earned Premium: 35% |
| | c) Commission: 0% |

**Item 9. The Company:**

XL Insurance (Bermuda) Ltd  
XL House  
One Bermudiana Road  
P.O. Box HM 2245  
Hamilton HM JX  
Bermuda  
Facsimile: (441) 292 1566

**Item 10. Policy Form:**

The Bermuda Shorts Form - 01 (Ed. 02/09)

**Endorsements at Policy Issuance:**

- End. No. 1. Schedule of Underlying Policies (XSBSF-001.01)
- End. No. 2. Several Liability Notice Endorsement (XSBSF-010.01)
- End. No. 3. Arbitration Endorsement (XSBSF-003.01)
- End. No. 4. Choice of Law Endorsement - III (XSBSF-005.01)
- End. No. 5. Premium Payment Condition Endorsement (XSBSF-007.01)

**IN WITNESS WHEREOF, this Policy has been made, entered into and executed by the undersigned in Hamilton, Bermuda on this 20th day of JULY, 2009.**

By:
**VICTORIA BENEVIDES**
Title: ASSISTANT VICE PRESIDENT

XL XS-BSF-01 (Ed. 02/09)
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