# NATIONAL LIABILITY & FIRE INSURANCE COMPANY
FOLLOW FORM EXCESS LIABILITY
COMMON POLICY DECLARATIONS

This Declaration Page is attached to and forms part of the Policy

| Policy Number: | 43-XSF-100238-01 | Renewal of: NEW |
| --- | --- | --- |
| Item 1. | Named Insured: International Business Machines Corporation | Mailing Address: One New Orchard Road Mail Drop 109 Armonk, NY 10504 |
| The Named Insured is: | ☐ Individual ☐ Partnership ☐ Joint Venture ☐ Limited Liability Company ☒ Organization (other than a Partnership or Joint Venture) ☐ Trust |
| The Business of the Named Insured Is: Software Manufacturer |
| Item 2. Policy Period Effective From: 5/21/2014 to 5/21/2015; Both days at 12:01 am local standard time at the mailing address of the Named Insured |
| Item 3. Limits of Insurance: (as in Followed Underlying Policy) |
| Per Occurrence | $25,000,000 part of $100,000,000 |
| Aggregate Limit, except Auto | $25,000,000 part of $100,000,000 |
| Products-Completed Operations Aggregate Limit: | $25,000,000 part of $100,000,000 |
| Item 4. Scheduled Underlying Insurance |
| a. Underlying Policies | See attached schedule of underlying |
| b. Followed Underlying Policies | See attached schedule of underlying |
| Item 5. Total Scheduled Underlying Insurance Aggregate: | $100,000,000 |
| Item 6. Premium: |
| Total Advance: | $97,000 (25% Share of the Layer) |
| Total Minimum Annual: | $97,000 (25% Share of the Layer) |
| Minimum Earned: | 35% |
| Terrorism Premium Included in the Advanced: | $960 |
| Item 7. In the event of a claim, please notify National Liability & Fire Insurance Company, By email – claimsnotice@bhspecialty.com; or by fax – 617-507-8259 |
| This policy is comprised of this Declarations page, the policy form and the schedules and endorsements, if any, attached at inception or during the Policy Period. |
| Service of Suit may be made upon: Counsel, Legal Department, National Liability & Fire Insurance Company, 3024 Harney Street, Omaha, NE 68131 |
| **Signature** | **President** | Dated: 5/28/2014 |
| Predominate Class Code 169 |

**NOTICE:** THESE POLICY FORMS AND THE APPLICABLE RATES ARE EXEMPT FROM THE FILING REQUIREMENTS OF THE NEW YORK INSURANCE LAW AND REGULATIONS. HOWEVER, THE FORMS AND RATES MUST MEET THE MINIMUM STANDARDS OF THE NEW YORK INSURANCE LAW AND REGULATIONS.

NY-XS-DEC-01/2014
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