# Arch Reinsurance Ltd.

**Waterloo House, Ground Floor**
109 Pitts Bay Road,
Pembroke HM 08
Bermuda

Telephone: 441-278-9200
Fax: 441-278-9230

## THE BERMUDA SHORTS FORM

**POLICY NO.:** UFP0044276-04  
**RENEWAL OF:** UFP0044276-03

### DECLARATIONS

**Item 1.**
a) **Named Insured:** International Business Machines Corporation  
b) **Address of Named Insured:** One New Orchard Road (MD 109), Armonk, NY 10504 USA

**Item 2.** **Policy Period:**  
From: May 21, 2015 at 12:01 am standard time at the address of the Named Insured.  
To: May 21, 2016 at 12:01 am standard time at the address of the Named Insured.

**Item 3.** **Retroactive Date:** None

**Item 4.**
a) **Followed Policy:**  
Company: ACE Property & Casualty Insurance Company  
Policy Number: XOO G2763848A  
Coverage: Lead Umbrella  
Policy Period: From: May 21, 2015 To: May 21, 2016  
Limits of Liability: US$50,000,000 Occ. US$50,000,000 Agg (where applicable)

b) **Underlying Policy(ies):** As per Endorsement No. 1 Schedule of Excess Policy(ies) Section I - Schedule of Underlying Policy(ies)

c) **Quota-Share Policy(ies):** As per Endorsement No. 1 Schedule of Excess Policy(ies) Section II - Schedule of Quota-Share Policy(ies)

**Item 5.** **Limit of Liability:** (Insuring Agreement 2):  
a) US$50,000,000 each Occurrence, Claim or Loss  
b) US$50,000,000 Aggregate (where applicable)

**Item 6.** **Underlying Limits:** (Insuring Agreement 2):  
a) US$500,000,000 each Occurrence, Claim or Loss  
b) US$500,000,000 Aggregate (where applicable)

Which in turn is excess of various insurances and/or retentions as more fully set forth in the Followed Policy

Page 1 of 3

BSF-03 (Ed. 03/14)