# Endurance Specialty Insurance Ltd.

**Waterloo House, 100 Pitts Bay Road, Pembroke HM08, Bermuda**

**Telephone:** 441-278-0400 **Facsimile:** 441-296-1474

**For Claim Matters Only:** Facsimile: 441-296-5151 or excesscasualtyclaims@endurance.bm

## DECLARATIONS, cont’d

### Item 7. Notice to:
**(Conditions 3 and 5)**
a) All Notices of Occurrence, Claim or Loss:
To:
Endurance Specialty Insurance Ltd.
Waterloo House
100 Pitts Bay Road, Pembroke
Bermuda HM08

b) All other Notices:
To:
Aon (Bermuda) Ltd.
Aon House
30 Woodbourne Avenue
Pembroke, Bermuda HM 08

### Item 8.
a) Premium: USD 106,086 (for 100% Flat Annual)
b) Minimum Earned Premium: USD 37,130
c) Commission: Net

### Item 9. The Company:
Endurance Specialty Insurance Ltd.
At the address stated at the top of the Declarations Page

### Item 10. Policy Form:
The Bermuda Shorts Form – 03 (Ed. 03/14)
1 - 6 at Policy Issuance

**Authorized Representative**

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**Date of Issuance:** June 13, 2016
**BSF-03 Declarations (Ed. 03/14)**

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