# CHUBB EXCESS LIABILITY INSURANCE - SL

## Premium Bill

**Policy Period:** MAY 21, 2016 To MAY 21, 2017  
**Effective Date:** May 21, 2016  
**Policy Number:** 7966-56-84  
**Insured:** INTERNATIONAL BUSINESS MACHINES CORPORATION  
**Name of Company:** FEDERAL INSURANCE COMPANY  
**Date Issued:** October 13, 2016  
**Producer:** AON RISK SERVICES NORTHEAST INC.

**THIS BILLING IS TO BE ATTACHED TO AND FORM A PART OF THE POLICY**

PLEASE SEND PAYMENT TO AGENT OR BROKER, IF APPLICABLE

| Coverage | Premium |
| --- | --- |
| ADDITIONAL PREMIUM | $ 0.00 |
| Deleted Endorsement- Form# 07-02-1989 Ed/Rev date- 04/15 | Form name- Compliance With Applicable Trade Sanctions |
| Deleted Endorsement- Form# 07-02-2174 Ed/Rev date- 04/15 | Form name- Information Laws, Including Unauthorized Or |

| Total | $ 0.00 |
| Portion of total premium attributable for Terrorism and statutory standard fire where applicable is: | $ 0.00 |

Unsolicited Communications Exclusion  
Deleted Endorsement- Form# 07-02-2248 Ed/Rev date- 04/15  
From name- Asbestos Exclusion

Form 07-10-0542 (Ed. 10-06)  
Premium Bill  
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