# DECLARATIONS, cont’d

Which in turn is excess of various insurances and/or retentions as more fully set forth in the Followed Policy

All Notices of Occurrence, Claim or Loss:

**To:**

Claim Department:

- Arch Insurance (Bermuda)
  - Victoria Hall, 4th Floor
  - 11 Victoria Street
  - Hamilton HM 11
  - Bermuda
  - Email: claims-casualty@archinsurance.bm

**To:**

Underwriting Department:

- Arch Insurance (Bermuda)
  - Victoria Hall, 4th Floor
  - 11 Victoria Street
  - Hamilton HM 11
  - Bermuda

**Item 8.**
a) Premium:
b) Minimum Earned Premium:
c) Commission:

US$69,125 (for 100% Flat Annual)
US$24,194
NET

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

**Item 10.**
a) Insured’s Representative:
b) Address:

Aon (Bermuda) Ltd
Aon House, 30 Woodbourne Avenue
Pembroke, HM 08
Bermuda

**Item 11.**
Policy Form:
Endorsements

The Bermuda Shorts Form – 02 (Ed. 07/09)
1 - 7 at Policy Issuance

**Authorized Representative**

Date: July 18, 2013
Title: Senior Vice President
Underwriting Manager,
Excess Casualty

Page 2 of 2

BSF-02 (Ed 7/09)