# Chubb Global Casualty

## Initial Statement of Adjustment

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

### General Liability

| State | Estimated Policy Premium ($) | Initial AARO Adjustment ($) | Total Estimated Written Premium ($) |
|-------|------------------------------|----------------------------|------------------------------------|
| Alabama | 473                          | 72                         | 545                                |
| Arizona | 682                          | 76                         | 758                                |
| Arkansas | 1,050                        | 181                        | 1,231                              |
| California | 3,282                        | 2,390                       | 5,872                              |
| Colorado | 1,160                        | 100                        | 1,260                              |
| Connecticut | 294                          | 30                         | 324                                |
| Delaware | 159                          | 22                         | 181                                |
| Florida | 2,553                        | 0                          | 2,553                              |
| Georgia | 1,407                        | 186                        | 1,593                              |
| Idaho | 220                          | 17                         | 237                                |
| Illinois | 1,615                        | 127                        | 1,742                              |
| Indiana | 590                          | 44                         | 634                                |
| Iowa | 310                          | 29                         | 339                                |
| Kansas | 261                          | 20                         | 281                                |
| Kentucky | 421                          | 33                         | 454                                |
| Louisiana | 1,032                        | 189                        | 1,221                              |
| Maine | 67                           | 9                          | 76                                 |
| Maryland | 1,066                        | 82                         | 1,148                              |
| Massachusetts | 631                          | 63                         | 694                                |
| Michigan | 724                          | 47                         | 771                                |
| Minnesota | 775                          | 69                         | 844                                |
| Mississippi | 479                          | 70                         | 549                                |
| Missouri | 464                          | 41                         | 505                                |
| Montana | 353                          | 57                         | 410                                |
| Nebraska | 230                          | 15                         | 245                                |
| Nevada | 144                          | 25                         | 169                                |
| New Hampshire | 212                          | 34                         | 246                                |
| New Jersey | 1,323                        | 141                        | 1,464                              |
| New Mexico | 222                          | 37                         | 259                                |
| New York | 41,389                       | 10,333                      | 51,722                             |
| North Carolina | 1,257                        | 94                         | 1,351                              |
| Ohio | 1,371                        | 107                        | 1,478                              |
| Oklahoma | 496                          | 48                         | 544                                |
| Oregon | 289                          | 0                          | 289                                |
| Pennsylvania | 1,734                        | 109                        | 1,843                              |

**International Business Machines Corporation**  
**05/17/2018**  
**Initial Statement of Adjustment Page 14 of 36**