# Liberty Insurance Underwriters Inc.

55 Water Street, 23rd Floor  
New York, NY 10041

## Statement of Premium Due

**Producer's Name and Address:**
James Mahoney  
AON RISK SERVICES NORTHEAST INC  
199 Water Street, 8th Floor  
New York, NY 10038

**Insured:** International Business Machines Corporation  
**Policy Number:** 1000040626-17  
**Total Annual Premium:** $72,530  

**Policy Premium:** $72,530  
**Terrorism Risk Insurance Act (TRIA):** $0  

**Commission:** $0  
**0.00%**  
**Total Amount Due:** $72,530  
**Due Date:** June 20, 2018  

Please attach this statement to your remittance and return to the address below.  
Thank you.

**Send Checks To:** Liberty Insurance Underwriters Inc.  
DBA Liberty International Underwriters  
29921 Network Place  
Chicago, IL 60673-1299  

**Overnight and Express Mail Instructions:** JPMorgan  
Attention: Liberty International  
Underwriters # 29921  
131 S. Dearborn, 6th Floor  
Chicago, IL 60603  

**Wire Transfers:** Liberty Insurance Underwriters Inc.  
DBA Liberty International Underwriters  
JP Morgan Chase Bank  
4 Chase Metrotech Center  
Brooklyn, NY 11245  
Account Number: 041-003500