# CHUBB Schedule of Forms and Endorsements

## Enhanced Commercial Umbrella Liability Policy

| **Named Insured** | **Policy Number** | **Policy Period** |
|------------------|-------------------|-------------------|
| International Business Machines Corporation | G27983212 006 | 05/21/2021 to 05/21/2022 |

| **Endorsement Number** | **Form Number - Edition Date** | **Title** |
|-----------------------|---------------------------------|-----------|
| ALL-23445b (07/13)    | Policyholder Notice - Commercial Lines Deregulation New York (NYFTZ) |
| XSE - 50761 (07/18)   | Declarations - Enhanced Commercial Umbrella Liability Policy |
| XSE-50764 (07/18)     | Schedule of Retained Limits - Enhanced Commercial Umbrella Liability Policy |
| XSE-51108 (07/18)     | Table of Contents - Enhanced Commercial Umbrella Liability Policy |
| XSE-50762(05/18)      | Enhanced Commercial Umbrella Liability Policy |
| ALL-20887a (03/16)    | Chubb Producer Compensation Practices & Policies |
| IL P 001 (01/04)      | U.S. Treasury Department's Office Of Foreign Assets Control ("OFAC") Advisory Notice To Policyholders |
| XSE-52226 (03/19)     | Policyholder Notice - Catastrophe Management Coverage |
| XSE-52231 (03/19)     | Claims Loss Notification Form |
| 001                   | CC-K11i (02/18)                | Signatures |
| 002                   | XSE-53703 (04/20)              | "Scheduled Retained Limit" Amendatory Endorsement (All "Other Insurance" May Reduce Or Erode The "Scheduled Retained Limit") |
| 003                   | XSE-50714 (07/18)              | Additional Named Insureds |
| 004                   | XSE-50715a (10/19)             | Aircraft Products And Grounding Hazard Exclusion |
| 005                   | XSE-51819a (05/20)             | Amendatory Endorsement – New York Changes |
| 006                   | XSE-52219a (06/20)             | Amendatory Endorsement – Various Provisions |
| 007                   | XSE-50717 (07/18)              | Cap On Losses From Certified Acts Of Terrorism |
| 008                   | XSE-52227 (03/19)              | Difference In Conditions / Difference In Limits Endorsement |
| 009                   | TRIA 11d (03/16)               | Disclosure Pursuant To Terrorism Risk Insurance Act |
| 010                   | XSE-52232 (03/19)              | Earlier Notice Of Cancellation Provided By Us |
| 011                   | XSE-53711 (06/20)              | Enhanced Coverage Self-Insured Retention Amendment (Split Retentions) |
| 012                   | XSE-50735 (07/18)              | Fellow Employee Exclusion Deleted |

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