# U.S. Short Excess Form

## Common Policy Declarations

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

| Policy No.: 47-XSF-100238-10 | Renewal of: 47-XSF-100238-09 |

## Item 1.
### a. Named Insured:
International Business Machines Corp.

### b. Mailing Address:
One New Orchard Road Mail Drop 109
Armonk, NY 10504

### 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: 05/21/2023 to 05/21/2024
Both days at 12:01 a.m. local standard time at Mailing Address listed in Item 1, above.

## Item 3.
### a. Followed Policy:
- **Insurer:** ACE Property & Casualty Insurance Co
- **Policy Number:** XEU G27983212 008
- **Coverage:** Excess Liability
- **Policy Period:** From: 05/21/2023 to 05/21/2024
- **Limits of Liability:** $25,000,000

### b. Underlying Policy(ies)
As per Endorsement - Schedule of Excess Policy(ies) Section II – Schedule of Underlying Policy(ies)

### c. Quota Share Policy(ies)
As per Endorsement - Schedule of Excess Policy(ies) Section II – Schedule of Underlying Policy(ies)

## 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
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