# CHUBB Schedule of Forms and Endorsements

## Named Insured
- **International Business Machines Corporation**

## Policy Information
- **Policy Number:** XOO G27983212 004
- **Policy Period:** 05/21/2019 to 05/21/2020

## Endorsements
| Endorsement Number | Form Number - Edition Date | Title |
|--------------------|----------------------------|-------|
| ALL-23445b (07/13) | Policyholder Notice - Commercial Lines Deregulation New York (NY FTZ) |
| XS-22695b (01/15) | Declarations ACE Umbrella Plus Commercial Umbrella Liability Policy |
| XS-9U57c (01/15) | Schedule of Underlying Insurance |
| XS-29461 (04/10) | ACE Umbrella Plus New York Commercial Umbrella Liability Policy |
| ALL-20887a (03/16) | Chubb Producer Compensation Practices & Policies |
| XS-28500a (08/13) | CHUBB Specialty Claims Loss Notification Form |
| IL P 001 (01/04) | U.S. Treasury Department's Office Of Foreign Assets Control ("OFAC") Advisory Notice To Policyholders |
| XS-22552 (06/07) | Catastrophe Management Notice |
| 001                | CC-24180c (03/14) | Signatures |
| 002                | XS-20745 (08/06) | Aircraft Products and Grounding Exclusion |
| 003                | XS-23669b (01/15) | Cap on Losses From Certified Acts of Terrorism |
| 004                | XS-22088 (04/07) | Catastrophe Management Coverage Endorsement |
| 005                | XS-41466 (07/14) | Designated Operations Exclusion |
| 006                | XS-35558 (05/13) | Difference In Conditions / Difference In Limits Endorsement |
| 007                | TRIA 11d (03/16) | Disclosure Pursuant To Terrorism Risk Insurance Act |
| 008                | XS-23634 (01/08) | Fellow Employee Exclusion Deleted |
| 009                | XS-28727a (01/11) | Foreign Loss Indemnity Endorsement |
| 010                | XS-24545 (03/08) | Named Insured Endorsement |
| 011                | ALL-25213 (10/08) | New York Changes |
| 012                | XS-15929b (11/14) | New York Changes-Cancellation, Nonrenewal |

**XS-27991 (08/09)**  
©Chubb, 2016. All rights reserved.  
Page 1 of 3