# Excess Insurance Policy

## Liberty Insurance Underwriters Inc.

**(A Stock Insurance Company, hereinafter the "Insurer")**

- **Named Insured:** International Business Machines Corporation
- **Policy Number:** 1000040626-13
- **Effective Date:** 05/21/2014

**NOTICE:** THESE POLICY FORMS AND THE APPLICABLE RATES ARE EXEMPT FROM THE FILING REQUIREMENTS OF THE NEW YORK STATE INSURANCE LAW AND REGULATIONS. HOWEVER, THE FORMS AND RATES MUST MEET THE MINIMUM STANDARDS OF THE NEW YORK INSURANCE LAW AND REGULATIONS.

## Excess Forms and Endorsements Schedule

It is hereby understood and agreed the following forms and endorsements are attached to and are a part of this policy:

| Form Number | Form Name | Endorsement No. |
|-------------|-----------|-----------------|
| 100-XS (Ed. 03 00) | Excess Policy Liability Declarations | - |
| 104-XS (Ed. 03 00) | Excess Forms and Endorsements Schedule | - |
| 232-XS (Ed. 04 07) | Schedule of Underlying Policies - Excess | 1 |
| 188-XS (Ed. 03 00) | Asbestos Exclusion | 2 |
| 102-XS (Ed. 03 00) | Nuclear Energy Liability Exclusion Endorsement | 3 |
| 190-XS (Ed. 01 09) | Sub-Limit Exclusion | 4 |
| OFAC 08/09 | U.S. Economic and Trade Sanctions Clause | 5 |
| 230-XS (Ed. 04 07) | Uninsured and Underinsured Auto Liability Exclusion | 6 |
| Excess 4011 (05 06) | War Liability Exclusion Endorsement | 7 |
| 160-XS (Ed. 01 13) | Pollution Limitation Endorsement Follow Form | 8 |
| 103-XS (Ed. 03 00) | Following Form Endorsement | 9 |
| E-NY-XS (Ed. 01 13) | New York Amendatory Endorsement | 10 |

**1** **2**

104-XS (Ed. 03 00)

2 - 13000