# Great American Assurance Company

**Policy No:** EXC1855195  
**Effective Date of Change:** 05/21/2017  

## POLICY CHANGES

### NAMED INSURED AND ADDRESS:
- **International Business Machines Corporation (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 at left.**
- **From 05/21/2017 To 05/21/2018**

### AGENT'S NAME AND ADDRESS:
- **Aon Risk Services Northeast, Inc.**
- **199 Water Street, 33rd Floor**
- **New York, NY 10038**

## THIS ENDORSEMENT CHANGES THE POLICY.
PLEASE READ IT CAREFULLY.

Insurance is afforded by company indicated below:
- **Great American Assurance Company**
  - (A capital stock corporation)

It is hereby understood and agreed that the Quota Share Endorsement is amended as per Form EXU 4006 (05/16) attached.

## Change Endorsement No. 1

### FORMS AND ENDORSEMENTS hereby added:

### FORMS AND ENDORSEMENTS hereby amended:
- EXU 4006 (05/16) - Quota Share Endorsement

### FORMS AND ENDORSEMENTS hereby deleted:

Countersigned: _________  
Date: ___________  
By: ________________  
Authorized Representative

GAI 6012 (Ed. 06/97)  
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