# CHUBB EXCESS LIABILITY INSURANCE - SL

## Premium Bill

| Policy Period | MAY 21, 2014 | To | MAY 21, 2015 |
|---------------|-------------|----|--------------|
| Effective Date | May 21, 2014 |
| Policy Number | 7966-56-84 |
| Insured       | INTERNATIONAL BUSINESS MACHINES CORPORATION |
| Name of Company | FEDERAL INSURANCE COMPANY |
| Date Issued   | July 21, 2014 |
| Producer      | AON RISK SERVICES NORTHEAST, INC. |

**THIS BILLING IS TO BE ATTACHED TO AND FORM A PART OF THE POLICY<br>PLEASE SEND PAYMENT TO AGENT OR BROKER, IF APPLICABLE**

| Coverage | Commission Rate | Premium |
|----------|-----------------|---------|
| ADDITIONAL PREMIUM | 0.00% | $ 0.00 |
| COMMERCIAL EXCESS ENDORSEMENT | | |
| DELETE FORM 07-02-2174-INFO LAWS INCL UNAUTH OR UNSOLIC COMMUNI EXCL. | | |

| Total | $ 0.00 |
|-------|---------|
| Portion of total premium attributable for Terrorism and statutory standard fire where applicable is: | |
| $ 0.00 | |

Reference Copy

Form 07-10-0542 (Ed. 10-06) | Premium Bill | Page 1