# CHUBB EXCESS LIABILITY INSURANCE - SL

## Schedule of Forms

| Policy Period | MAY 21, 2017 to MAY 21, 2018 |
|---------------|--------------------------------|
| Effective Date | May 21, 2017                   |
| Policy Number | 7966-56-84 DTO                 |
| Insured       | INTERNATIONAL BUSINESS MACHINES CORPORATION |
| Name of Company | FEDERAL INSURANCE COMPANY |
| Date Issued   | May 23, 2017                  |

## Form number

As of the effective date printed above, this is the Schedule of Forms applicable to this policy:

| Form Description | Form Number | Revision Date |
|------------------|-------------|---------------|
| PREMIUM BILL      | 07-10-0542  | (10/06)       |
| IMPORTANT NOTICE TO POLICYHOLDERS-TRIPRA | 99-10-0732 | (01/15)       |
| IMPORTANT NOTICE - OFAC | 99-10-0796 | (09/04)       |
| AOD IMPORTANT POLICYHOLDER NOTICE | 99-10-0872 | (06/07)       |
| ADDRESS CHANGE ENDORSEMENT | 99-10-0991 | (10/16)       |
| NY - EXCESS LIAB - SL DEC | 07-02-2325 | (12/09)       |
| CHUBB EXCESS LIAB-SL-NEW YORK CANCELLATION | 07-02-1305 | (11/04)       |
| NEW YORK AMENDATORY ENDORSEMENT | 07-02-1439 | (06/13)       |
| COMPLIANCE WITH APPLICABLE TRADE SANCTIONS | 07-02-1989 | (04/15)       |
| NEW YORK LATE NOTICE MANDATORY | 07-02-2313 | (01/09)       |
| LIMITS OF INSURANCE - EXCESS LIAB. INS. SL | 07-02-1334 | (12/97)       |
| CANCELLATION NOTICE CONDITION | 07-02-1576 | (04/15)       |
| CAP ON CERTIFIED TERRORISM LOSSES | 07-02-1953 | (04/15)       |
| INFORMATION LAWS INCL. UNAUTH COMMUNICATIONS | 07-02-2174 | (04/15)       |
| ASBESTOS EXCLUSION | 07-02-2248 | (04/15)       |

Form 07-02-0975 (Rev. 5/95) Schedule of Forms
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