# Berkshire Hathaway Specialty Insurance

## National Liability & Fire Insurance Company
1314 Douglas Street, Suite 1400
Omaha, NE 68102-1944

## Follow Form Excess Liability (Short Form)

### Common Policy Declarations
This Declarations Page is attached to and forms part of the Policy

| Item 1. | a.) "Named Insured": International Business Machines Corp.
|         | b.) Mailing Address: 1 New Orchard Rd Armonk, NY 10504-1722 |
|         | The "Named Insured" is: Organization (other than a Partnership or Joint Venture) |
|         | The Business of the "Named Insured" is: Conglomerate |
| Item 2. | Policy Period: From: 05/21/2017 to 05/21/2018 Both days at 12:01 a.m. local standard time at Mailing Address listed in Item 1, above. |
| Item 3. | Limit of Insurance: Per Occurrence: $25,000,000 Part of $100,000,000 Aggregate Limit: $25,000,000 Part of $100,000,000 |
| Item 4. | "Followed Policy": a. Policy Number XOO G27983212 002 b. Insurer ACE Property & Casualty Insurance Company c. Type of Insurance Umbrella Liability d. Policy Period 05/21/2017 to 05/21/2018; |
| Item 5. | Premium: Total Advance: $72,530 Total Minimum Annual: $72,530 Minimum Earned: 35% Terrorism Premium Included in Advanced: $725 Estimated Total Annual Exposure: $79,918,820,850 of Total Sales Auditable / Not Auditable: Not Auditable Rate: Flat |

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

Class Code: 2-13000
Page 1 | FF-XS-DSF-10/2014