# ACE Bermuda Insurance Ltd.

## THE BERMUDA SHORTS FORM - 03 (03/14)

### DECLARATIONS

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

**Item 2.** **Policy Period:**
- From: May 21, 2016 at 12:01 am standard time at the address of the Named Insured.
- To: May 21, 2017 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 and Casualty Insurance Company
  - **Policy Number:** XOO G27983212 001
  - **Coverage:** Commercial Umbrella Liability
  - **Policy Period:** From: May 21, 2016 To: May 21, 2017
  - **Limits of Liability:** USD 50,000,000
- **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:**
- **a) (Insuring Agreement 2):** USD 50,000,000 each Occurrence, Claim or Loss Aggregate
- **b) (Insuring Agreement 2):** USD 50,000,000 Aggregate

**POLICY NO.:** IBM-0062/BSF03
**RENEWAL OF:** IBM-0025/BSF03

**BSF-03**