# COMMERCIAL EXCESS LIABILITY DECLARATIONS PAGE

## 1. NAMED INSURED AND ADDRESS:
- **International Business Machines Corp.**
  - (As Per Underlying Insurance)
  - One New Orchard Road, Mail Drop 109
  - Armonk, NY 10504-1725

## 2. POLICY PERIOD:
- 12:01 A.M. Standard Time at the address of the Named Insured shown at left.
- From 05/21/2015 To 05/21/2016

## 3. PREMIUM:
- Total Advance Premium $ 71,000
- Service Charge $
- Taxes $
- Surcharge $
- Total $ 71,000

## 4. LIMITS OF INSURANCE:
- $ Per GAI 6515 Each Occurrence
- $ Per GAI 6515 Aggregate Limit (Where Applicable)

## 5. UNDERLYING INSURANCE:
- Carrier Information As Per GAI6008 (06/97) Attached
- Type of Coverage
- Limits of Insurance

## 6. FORMS AND ENDORSEMENTS applicable to all Coverage Forms and made part of this Policy at time of issue are listed on the attached Forms and Endorsements Schedule, GAI 6013 (Ed. 06/97).

**PRODUCER'S NAME AND ADDRESS:**
- Aon Risk Services Northeast, Inc.
- 199 Water Street, 33rd Floor
- New York, NY 10038

**Insurance is afforded by:** Great American Insurance Co. of New York

**BASIS OF PREMIUM:** Non-Auditable (X) Auditable ( )

In the event of cancellation by the Named Insured, the company will receive and retain no less than $ as a policy minimum premium.

**Policy No.** EXC 2464970
**Renewal Of** EXC 1862519
**GAI 6600 (Ed. 06 97)**
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