# CHUBB Schedule of Forms and Endorsements

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

## Policy Information
- **Policy Number:** XOO G27983212 003
- **Policy Period:** 05/21/2018 to 05/21/2019

## 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-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 |

### Signature Endorsements
- 001: CC-24180c (03/14)
- 002: XS-20745 (08/06)
- 003: XS-23669b (01/15)
- 004: XS-22088 (04/07)
- 005: XS-35558 (05/13)
- 006: TRIA 11d (03/16)
- 007: XS-23634 (01/08)
- 008: XS-28727a (01/11)
- 009: XS-24545 (03/08)
- 010: XS-15929b (11/14)
- 011: XS-20756 (08/06)
- 012: XS-33307a (04/15)
- 013: XS-23501 (04/08)

**XS-27991 (08/09)**

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