# THE BERMUDA SHORTS FORM
Issued by
XL INSURANCE (BERMUDA) LTD

**Form XL XS-BSF-03 (03/14)**

**Policy Number:** BM00029768LI16A
**Renewal of:** BM00028732LI15A
**Producer:** Aon (Bermuda) Ltd.

## 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, U.S.A.

### 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 & Casualty Insurance Company
   - **Policy Number:** XOO G27983212 001
   - **Coverage:** Umbrella - Occurrence
   - **Policy Period:** May 21, 2016 - May 21, 2017
   - **Limits of Liability:** USD 50,000,000 each Occurrence, Claim or Loss, USD 50,000,000 Annual Aggregate (where applicable), USD 50,000,000 Products/Completed Operations Aggregate

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)