# Schedule of Forms and Endorsements

| Policy No. | Eff. Date of Pol. | Exp. Date of Pol. | Eff. Date of End. | Producer | Add'l Prem. | Return Prem. |
|-----------|------------------|------------------|------------------|----------|-------------|--------------|
| AEC 5574320-02 | 05/21/2015 | 05/21/2016 | 05/21/2015 | 50522000 | ---------- | ---------- |

**Named Insured and Mailing Address:**

INTERNATIONAL BUSINESS MACHINES CORPORATION  
1 New Orchard Rd  
Armonk, NY 10504  

**Producer:**

AON RISK SERVICES NORTHEAST INC  
199 WATER ST FL 32ND  
NEW YORK, NY 10038-3526  

## Form Name | Form Number | Edition Date
Disclosure of Important Information Relating to Terrorism Risk Insurance Act | U-GU-630-D CW | (01/15)
Following Form Excess Liability Policy Declarations | U-EXS-D-100-B FTZ | (01/12)
Following Form Excess Liability Policy | U-EXS-100-C CW | (01/12)
Certified Act of Terrorism Retained Amount Provisions | U-EXS-279-C CW | (07/14)
Absolute Pollution Follow Form | U-EXS-264-B CW | (04/11)
Amended Defense and Supplementary Payments | U-EXS-378-B CW | (04/11)
Knowledge of Occurrence - Risk Manager | U-EXS-411-A CW | (03/12)
Follow Form Excess Endorsement | U-EXS-150-A CW | (04/99)
New York Changes | U-EXS-241-C NY | (02/13)
Exclusion - Recording and Distribution of Material or Information in Violation of Law | U-EXS-312-F CW | (05/14)
Sanctions Exclusion Endorsement | U-GU-1191-A CW | (03/15)
Important Notice - In Witness Clause | U-GU-319-F NY | (01/09)
Cap on Losses From Certified Acts of Terrorism | U-GU-767-B CW | (01/15)

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