# Berkshire Hathaway Specialty Insurance

## National Liability & Fire Insurance Company
1314 Douglas Street, Suite 1400
Omaha, NE 68102-1944

## Follow Form Excess Liability (Short Form)
Common Policy Declarations

This Declarations Page is attached to and forms part of the Policy

| Policy No.: 43-XSF-100238-03 | Renewal of: 43-XSF-100238-02 |
|---|---|

### Item 1.
a.) "Named Insured":
- International Business Machines Corp.

b.) Mailing Address:
- 1 New Orchard Rd
- Armonk, NY 10504-1722

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:
- Conglomerate

### Item 2.
Policy Period:
- From: 05/21/2016
- To: 05/21/2017

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 G27983212 001
- b.) Insurer: ACE Property and Casualty Insurance Company
- c.) Type of Insurance: Umbrella Liability
- d.) Policy Period: 05/21/2016 to 05/21/2017;

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

Class Code: 2-13000
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