# Excess Liability Insurance Policy Declarations Page

## Great American Assurance Company
- **Administrative Offices:** 301 E 4th Street, Cincinnati OH 45202-4201
- **Phone:** 513 369 5000
- **Policy No.:** EXC4100279
- **Renewal of:** EXC2464956
- **Producer's Name and Address:** Aon Risk Services Northeast, Inc., 199 Water Street, 33rd Floor, New York, NY 10038
- **Named Insured and Address:** International Business Machines Corp. (As Per Underlying Insurance), One New Orchard Road, Mail Drop 109, Armonk, NY 10504-1725
- **Policy Period:** 12:01 a.m. Standard time at the address of the Named Insured shown in Item 1 above.
  - From: 05/21/2016
  - To: 05/21/2017
- **Insurance is afforded by:** Great American Assurance Company
- **Premium:**
  - Total Advance Premium: $0
  - Taxes: $0
  - Surcharges: $0
  - Terrorism Premium (Certified Acts): $0
  - Total: $128,800
- **Basis of Premium:** Non-Auditable
- **Limits of Insurance:**
  - Each Occurrence: $25,000,000
  - Aggregate Limit (Where Applicable): $25,000,000
- **The Limits of Insurance apply in excess of the Underlying Limits of Insurance indicated in Item 5, Schedule of Underlying Insurance.**
- **Schedule of Underlying Insurance:** Underlying policies applicable to this Policy at the time of issue are listed on the attached Schedule of Underlying Insurance, EXU 66 01 (Ed. 05/16).
- **Forms and Endorsements:** Applicable to all Coverages Forms and made part of this Policy at the time of issue are listed on the attached Forms and Endorsements Schedule, EXU 66 02 (Ed. 05/16).

**EXU 6600 (Ed. 05/16)**
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