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� Declarations: <br />7-7"J Other Charges <br />States laws and regulations may require you to pay taxes, fees, surcharges or other costs. We've listed those <br />charges below <br />Other Premiums <br />Policy Base Premium <br />Terrorism Premium <br />Form: SC 00 01 10 18 <br />$220 <br />$15 <br />HORaN <br />} r <br />Risk Mwag merdDMsian <br />REVIEWED & APPROVED BY.- <br />f R. VSA44a <br />Risk Management Analyst <br />