# General Purpose Endorsement

**Issued By:** City Insurance Company

**Policy Number:** HEC 1 19 84 10

**Named Insured:** International Business Machines Corp., Etal.

**Policy Inception:** 5/21/81

**Policy Expiration:** 5/21/82

**Producer:** Johnson & Higgins

**Producer No.:** 501 IA-081

**Endorsement No.:** 5

**Effective Date and Time of Endorsement:** 5/21/81

It is agreed that this policy is hereby amended as indicated. All other terms and conditions of this policy remain unchanged.

**Premium Adjustment:**

- **U.S. Premium:** $20,273.00
- **Canadian Premium:** $727.00
- **Total:** $21,000.00

**Canadian Producer:**

- **Johnson Higgins Willis Faber Ltd.**
- **Place Victoria, Suite 2300**
- **Montreal, Canada**
- **Producer #:** 10010 - 881

**Signature of Authorized Representative:**

**Date Prepared:** 6/12/81

**Premium Adjustment if the Premium is Payable in Installments:**

| Dates Due | Present Installment | Increase | Decrease | Revised Installment |
|-----------|---------------------|----------|----------|--------------------|
| $         | $                   | $        | $        | $                  |
| $         | $                   | $        | $        | $                  |
| $         | $                   | $        | $        | $                  |
| $         | $                   | $        | $        | $                  |
| $         | $                   | $        | $        | $                  |

**GML 6888 (P) 12/76**