# AON SHORT EXCESS FORM (LONDON) 03-14 (OCC) (SELF PROCURED BASIS)

## DECLARATIONS

**Item 1.**
- **a)** Named Insured: International Business Machines Corporation and as more fully set forth in the Followed Policy.
- **b)** Address of Named Insured: IBM Corporation, One New Orchard Road, (Mail Drop 109), Armonk, New York 10504, United States of America.

**Item 2.** Policy Period:
- From: 21st May 2016 at 12:01 a.m. standard time at the address of the Named Insured.
- To: 21st May 2017 at 12:01 a.m. standard time at the address of the Named Insured.

**Item 3.**
- **a)** Followed Policy:
  - Company: ACE Property & Casualty Insurance Company
  - Policy Number: XOO G27983212 001
  - Coverage: Lead Umbrella – Occurrence
  - Policy Period:
    - From: 21st May 2016 at 12:01 a.m. standard time at the address of the Named Insured.
    - To: 21st May 2017 at 12:01 a.m. standard time at the address of the Named Insured.
  - Limits of Liability: USD 50,000,000
- **b)** Underlying Policy(ies): As per Endorsement Number One – Schedule of Underlying Policy(ies).

**Item 4.** Limit of Liability:
- (Insuring Agreement 2):
  - a) USD 200,000,000 each Occurrence.
  - b) USD 200,000,000 annual aggregate where stated in the Followed Policy.

## Market Submission - Wording
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