# EXCESS LIABILITY INSURANCE POLICY DECLARATIONS PAGE

**1. NAMED INSURED AND ADDRESS:**
- International Business Machines Corporation (As Per Underlying Insurance)
- One New Orchard Road, Mail Drop 109
- Armonk, NY 10504-1725

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

**2. POLICY PERIOD:**
- From 05/21/2017
- To 05/21/2018

**Insurance is afforded by: Great American Assurance Company**

**3. PREMIUM:**
- Total Advance Premium: $59,888
- Taxes: $
- Surcharges: $
- Terrorism Premium (Certified Acts): $
- Total: $59,888

**Basis of Premium:** (X) Non-Auditable ( ) Auditable

**4. LIMITS OF INSURANCE:**
- $ Per EXU 4006 Each Occurrence
- $ Per EXU 4006 Aggregate Limit (Where Applicable)

The Limits of Insurance apply in excess of the Underlying Limits of Insurance indicated in Item 5. Schedule of Underlying Insurance.

**5. 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).

**6. FORMS AND ENDORSEMENTS:**
- 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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