# U.S. SHORT EXCESS FORM

## DECLARATIONS

**Item 1.**
- **a. Named Insured:** International Business Machines Corporation
- **b. Address of Named Insured:** One New Orchard Road, Mail Drop 109, Armonk, NY 10504-1725

**Item 2.**
- **Policy Period:**
  - From: 05/21/2023 at 12:01 am standard time at the address of the Named Insured.
  - To: 05/21/2024 at 12:01 am standard time at the address of the Named Insured.

**Item 3.**
- **a. Followed Policy:**
  - **Insurer:** As Per USX8030 More Than One Followed Policy
  - **Policy Number:** 
  - **Coverage:** 
  - **Policy Period:**
    - From:
    - To:
      - i. USD each Occurrence
      - ii. USD Aggregate, where applicable
  - **b. Underlying Policy(ies):**
    - As per USX 8003 Schedule of Excess Policy(ies) Section II - Schedule of Underlying Policy(ies)
  - **c. Quota Share Policy(ies):**
    - As per USX 8003 Schedule of Excess Policy(ies) Section I - Schedule of Quota Share Policy(ies)

**Item 4.**
- **Limit of Liability: (Insuring Agreement 2):**
  - a. USD 25,000,000 each Occurrence
  - b. USD 25,000,000 Aggregate, where applicable

**Item 5.**
- **Underlying Limits: (Insuring Agreement 2):**
  - a. USD 50,000,000 each Occurrence
  - b. USD 50,000,000 Aggregate, where applicable
  - which in turn is excess of various insurances and/or retentions as more fully set forth in the Followed Policy

**USX 8002 (Ed. 02/18)**
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