# DECLARATIONS, cont’d

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

- **a) All Notices of Occurrence, Claim or Loss:**  
  To:  
  Chartis Excess Limited  
  29 Richmond Road  
  Pembroke HM08 Bermuda  

- **b) All other Notices:**  
  To:  
  Aon Group (Bermuda) Ltd.  
  Aon House  
  30 Woodbourne Ave.  
  Pembroke HM08  

**Item 8.**
- **a) Premium:** US$ 373,208 (for 100% Flat Annual)
- **b) Minimum Earned Premium:** US$ 130,622  

**Item 9. The Company:**  
Chartis Excess Limited  
At the address stated at the top of the Declarations Page  

**Item 10. Policy Form; Endorsements:**  
The Bermuda Shorts Form – 103271(11/09)  
1 - 7 at Policy Issuance  

**Authorized Representative**

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