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7 v Declarations: <br />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 />$280 <br />$26 <br />%n. RwEwEo&A"R vtn Br <br />1 �111 I� 1 A+j�, A'a'ad <br />MOMIMIR Risk Management Sped Aist <br />