# Chubb Global Casualty

## Initial Statement of Adjustment

**Insured's Name:** INTERNATIONAL BUSINESS MACHINE  
**Insured's Address:** One New Orchard Road, Armonk, New York 10504

### General Liability

HDO G72491816

| State | Estimated Policy Premium ($) | Initial AARO Adjustment ($) | Total Estimated Written Premium ($) |
|-------|------------------------------|----------------------------|------------------------------------|
| Alabama | 453 | 209 | 662 |
| Arizona | 1,020 | 456 | 1,476 |
| Arkansas | 474 | 259 | 733 |
| California | 4,720 | (278) | 4,442 |
| Colorado | 1,671 | 735 | 2,406 |
| Florida | 3,648 | 0 | 3,648 |
| Georgia | 807 | 381 | 1,188 |
| Idaho | 847 | 375 | 1,222 |
| Illinois | 1,356 | 489 | 1,745 |
| Indiana | 1,205 | 507 | 1,712 |
| Kansas | 374 | 155 | 529 |
| Kentucky | 252 | 90 | 342 |
| Louisiana | 3,222 | 1,863 | 5,085 |
| Maryland | 1,029 | 426 | 1,455 |
| Michigan | 531 | 159 | 690 |
| Minnesota | 832 | 320 | 1,152 |
| Mississippi | 325 | 159 | 484 |
| Missouri | 658 | 268 | 926 |
| Montana | 582 | 324 | 906 |
| New Jersey | 746 | 315 | 1,061 |
| New Mexico | 472 | 259 | 731 |
| New York | 31,362 | 23,193 | 54,555 |
| North Carolina | 597 | 225 | 822 |
| Ohio | 302 | 119 | 421 |
| Oregon | 752 | 0 | 752 |
| South Carolina | 1,032 | 531 | 1,563 |
| Tennessee | 1,111 | 434 | 1,545 |
| Texas | 3,754 | 2,675 | 6,429 |
| Utah | 378 | 199 | 577 |
| Virginia | 1,806 | 0 | 1,806 |
| Washington | 698 | 224 | 922 |
| Wisconsin | 806 | 310 | 1,116 |

**TOTALS** | **67,722** | **35,381** | **103,103**

### Automobile Liability

INTERNA_05212022_Horace Washington  
04/13/2022  
Initial Statement of Adjustment Page 16 of 46