# Excess Insurance Policy

## Liberty International Underwriters

**Liberty Insurance Underwriters Inc.**
- (A Stock Insurance Company, hereinafter the "Insurer")
- 55 Water Street, 18th Floor, New York, NY 10041
- Toll-free number: 1-800-677-9163

**Notice:** These policy forms and the applicable rates are exempt from the filing requirements of the New York State Insurance Department. However, such forms and rates must meet the minimum standards of the New York Insurance Law and Regulations.

## Excess Forms and Endorsements Schedule

| Effective Date | Expiration Date |
|---------------|----------------|
| May 21, 2012   | May 21, 2013    |

**Policy Number:** EXCNY078753-11  
**Issued To:** International Business Machines Corporation

It is hereby understood and agreed that the following forms and endorsements are attached to and are a part of this policy:

| Form Number | Form Name | Endorsement No. |
|-------------|-----------|-----------------|
| 0100-XS (03/00) | Excess Policy Liability Declarations | - |
| 0104-XS (Ed. 03/00) | Excess Forms and Endorsements Schedule | - |
| 0188-XS (Ed. 03/00) | Asbestos Exclusion | 1 |
| 0251-XS (04/07) | Violation of Statutes that Govern Emails, Faxes, Phone Calls or Other Methods of Sending Information | 2 |
| 0103-XS (Ed. 03/00) | Following Form Endorsement | 3 |
| 0102-XS (Ed. 03/00) | Nuclear Energy Liability Exclusion Endorsement | 4 |
| 0160-XS (Ed. 03/00) | Pollution Limitation Endorsement Follow Form | 5 |
| 190-XS 01/09 | Sub-Limit Exclusion | 6 |
| Excess 4011 (05/06) | War Liability Exclusion | 7 |
| E-NY-XS (Ed. 10 00) | New York Amendatory Endorsement | 8 |
| OFAC 08/09 | U.S. Economic and Trade Sanctions Endorsement | 9 |
| TRIA-N004-0208 | Disclosure – Terrorism Risk Insurance Act | 10 |
| TRIA-E002-0208 | Cap on Losses from Certified Acts of Terrorism | 11 |

**Page:** 1 / 2  
**Form Number:** 0104-XS (03 00)  
**Page:** 2 / 13000