# 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: US$78,795 (for 100% Flat Annual)
b) Minimum Earned Premium: US$27,578
c) Commission: 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: Aon (Bermuda) Ltd
b) Address: Aon House, 30 Woodbourne Avenue
  - Pembroke, HM 08
  - Bermuda

**Item 11.**
Policy Form: The Bermuda Shorts Form – 02 (Ed. 07/09)
Endorsements 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)