# IRON·STARR

## THE BERMUDA SHORTS FORM - 03 (cont'd)

**DECLARATIONS - attaching to and forming part of Policy No:** IS0001796

**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 (03/14)
1 – 5 at Policy Issuance

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

**Authorized Representative**

Date of Issuance: July 14, 2014
ISEABSF Declarations [03/14]