**ZURICH Series C. A. Form X**

**POLICY NO.:** S3
**REN. OF:** 261555

**AGENCY NO.:** 50-515
**AGENCY NAME:** JOHNSON & HIGGINS
**BROKER NO.:** BROKER OR SUB AGENT NAME

**ENDORSEMENTS ATTACHED:** 4075-8, 4096, 4050

**Item 1. Name:** INTERNATIONAL BUSINESS MACHINES CORPORATION (SEE END. #1 ATTACHED)
**Address:** 590 MADISON AVE., NEW YORK CITY, N.Y.
**Item 2. Policy Period:** From DEC. 31, 1962 to DEC. 31, 1963

**Item 1. (Continued)** Business of the named insured is BUSINESS MACHINES
The named insured is: ☐ Individual; ☐ Partnership; ☒ Corporate.

**Item 3. The insurance afforded is only with respect to such and so many of the following coverages as are indicated by specific premium charge or charges. The limit of the company's liability against each such coverage shall be as stated herein, subject to all the terms of policy having reference thereto.**

| **Coversages** | **Limits of Liability** | **Advance Premiums Including Special Coverage Premiums** |
|----------------|-------------------------|----------------------------------------------------------|
| A - Bodily Injury Liability | $500 thousand dollars each person | $ |
|                             | $1 MILLION dollars each accident | $ |
|                             | $1 MILLION dollars aggregate products | $ |
| B - Property Damage Liability-Automobile | $100 thousand dollars each accident | $ |
|                             | $100 thousand dollars each accident | $ |
|                             | $100 thousand dollars aggregate operations | $ |
|                             | $100 thousand dollars aggregate protective | $ |
|                             | $100 thousand dollars aggregate products | $ |
|                             | $100 thousand dollars aggregate contractual | $ |
| The three year advance premium (for policy and endorsements attached at issuance of policy) shall be payable: | In advance | Additional premium for endorsements attached at issuance of policy (if any): $ |
|                                                                                           | 1st anniversary | $ |
|                                                                                           | 2nd anniversary | $ |
| Total Advance Premium | $137,000.00 |

**Item 4. The declarations are completed on attached schedules designated A and B.**
**Item 5. The schedules disclose all hazards insured hereunder known to exist at the effective date of this policy, unless otherwise stated herein:**
**NOT STATED**
**Item 6. The schedules contain a complete list of all automobiles and trailers owned by the named insured at the effective date of this policy and purposes of use thereof, unless otherwise stated herein:**
**Item 7. The schedules contain a complete list of all persons within the definition of Class I persons, at the effective date of this policy, unless otherwise stated herein:**
**Item 8. During the past three years no insurer has canceled insurance issued to the named insured, similar to that afforded hereunder, unless otherwise stated herein:**
**Item 9. Complete the following for each location owned, rented or controlled by named insured:**

| **Location of all Premises owned, rented or controlled by named insured** | **Named insured is** | **Part occupied by named insured** |
|-----------------------------------------------------------------------|---------------------|-----------------------------------|
| AS PER SCHEDULES IN COMPANY FILES | AS PER SCHEDULES IN COMPANY FILES | AS NECESSARY |

**RC:AE** Countersigned on behalf of ZURICH INSURANCE COMPANY
**Form D-919-C.** Duly authorized agent:
**THIS DECLARATIONS PAGE IS ISSUED IN CONJUNCTION WITH AND IS A PART OF POLICY SERIES 919.**

Z 006804