# Zurich Insurance Company

## Policy Details

**Policy No:** 86-68-700  
**Eff. Date of Pol:** 12/31/70  
**Eff. Date of End:** 1/1/73  
**Agency No:** 50-515-000  
**Add'l Premium:** $437,753.  
**Return Premium:** $  

**Named Insured:** International Business Machines Corporation

This endorsement is issued by that company named below which is the insurer under the policy designated above issued to the Named Insured and forms a part of said policy as of the effective date hereof, at the hour stated in the policy Declarations.

## Premium Computation Endorsement

For the period January 1, 1973 to January 1, 1974, the premium for such insurance as is afforded by the Policy shall be computed by applying to each $1,000. of Workmen's Compensation Payroll, the composite rate established for the Policy.

| Est. Ann. Payroll | Composite Rates | Est. Premium |
|-------------------|-----------------|--------------|
| $2,070,852,000    | .18000          | $372,753.    |
| Endorsement #13   |                 | 65,000. (Flat) |
| Total             |                 | $437,753.    |

Payable as follows:- Jan. 1, 1973 - $162,753.  
Mar. 1, 1973 - $137,500.  
Apr. 1, 1973 - $137,500.

## Signatures

**Johnson & Higgins**  
RME: NK 1/12/73

**ZURICH INSURANCE COMPANY**  
AMERICAN GUARANTEED LIABILITY INSURANCE COMPANY

**Counter-signed by:**  
**Attorney-in-Fact:**  
**Secretary:**  
**Z 007128**