# Berkshire Hathaway Specialty Insurance

## National Liability & Fire Insurance Company
### Follow Form Excess Liability (Short Form)
#### Common Policy Declarations
This Declarations Page is attached to and forms part of the Policy

| Item 1. | a.) "Named Insured": | International Business Machines Corporation |
| --- | --- | --- |
| b.) Mailing Address: | One 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: | From: 5/21/2015 to 5/21/2016 |
| --- | --- | --- |
| Both days at 12:01 a.m. local standard time at Mailing Address listed in Item 1, above. |

| Item 3. | Limit of Insurance: | Per Occurrence: $25,000,000 part of $100,000,000 | Aggregate Limit: $25,000,000 part of $100,000,000 |

| Item 4. | "Followed Policy": | a. Policy Number | XOO G 27 63 84 8 A |
| --- | --- | --- | --- |
| b. Insurer | ACE Property & Casualty Insurance Company |
| c. Type of Insurance | Umbrella |
| d. Policy Period | 5/21/2015 to 5/21/2016 |
| Both days at 12:01 a.m. local standard time at the mailing address of the insured. |

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

Class Code: 2-13000

Page 1 of 2 | FF-XS-DSF-10/2014