STOP GAP – EMPLOYERS LIABILITY COVERAGE ENDORSEMENT – PUERTO RICO
SUPPLEMENTARY PAYMENTS 100% BORNE BY INSURED

| Named Insured | International Business Machines Corporation |
| --- | --- |
| Policy Symbol | HDO |
| Policy Number | G71445653 |
| Policy Period | 05/21/2020 to 05/21/2021 |
| Endorsement Number | 116 |
| Issued By (Name of Insurance Company) | ACE American Insurance Company |

Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy.

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART

SCHEDULE

| Limits Of Insurance |
| --- |
| Bodily Injury By Accident | $15,000,000 Each Accident |
| Bodily Injury By Disease | $15,000,000 Aggregate Limit |
| Bodily Injury By Disease | $15,000,000 Each Employee |
| Deductible | $15,000,000 plus all Supplementary Payments |

A. The following is added to Section I – Coverages:
Coverage – Stop Gap – Employers Liability
1. Insuring Agreement
a. We will pay those sums that the insured becomes legally obligated by Puerto Rico Law to pay as damages because of "bodily injury by accident" or "bodily injury by disease" to your "employee" to which this insurance applies. We will have the right and duty to defend the insured against any "suit" seeking those damages. However, we will have no duty to defend the insured against any "suit" seeking damages to which this insurance does not apply. We may, at our discretion, investigate any accident and settle any claim or "suit" that may result. But:
(1) The amount we will pay for damages is limited as described in Section III – Limits Of Insurance; and
(2) Our right and duty to defend end when we have used up the applicable limit of insurance in the payment of judgments or settlements under this coverage.
No other obligation or liability to pay sums or perform acts or services is covered unless explicitly provided for under Supplementary Payments.
b. This insurance applies to "bodily injury by accident" or "bodily injury by disease" only if:
(1) The:
(a) "Bodily injury by accident" or "bodily injury by disease" takes place in the "coverage territory";
(b) "Bodily injury by accident" or "bodily injury by disease" arises out of and in the course of the injured "employee's" employment by you;

LD-38042 (07/12)
© Insurance Services Office, Inc., 2010
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