# DECLARATIONS, cont’d

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

a) All Notices of Occurrence, Claim or Loss:

To:
Claim Department:
Arch Insurance (Bermuda)
Waterloo House, Ground Floor
100 Pitts Bay Road
Pembroke HM 08
Bermuda
Email: claims-casualty@archinsurance.bm

b) All other Notices:

To:
Underwriting Department:
Arch Insurance (Bermuda)
Waterloo House, Ground Floor
100 Pitts Bay Road
Pembroke HM 08
Bermuda

**Item 8.**
a) Premium: US$101,500 (for 100% Flat Annual)
b) Minimum Earned Premium: US$25,525
c) Commission: 0.0%

**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: Endorsements**
The Bermuda Shorts Form – 03 (Ed. 03/14)
1 - 5 at Policy Issuance

**Authorized Representative**

Date: July 14, 2016

Page 2 of 3

BSF-03 (Ed. 3/14)

Arch Insurance