**ZURICH INSURANCE COMPANY**
**AMERICAN GUARANTEE AND LIABILITY INSURANCE COMPANY**

**POLICY NO:** 86-68-700
**AGENCY/BROKER NO:** 500-515

**AUDIT ADJUSTMENT OF PREMIUM**

**AGENCY NAME:** Johnson & Higgins
**AUDIT NO:** 8469
**PERIOD OF AUDIT:** 1-1-72 to 1-1-73
**DATE (IF CANCEL):** 8-28-73

**NAME AND ADDRESS OF INSURED:**
International Business Machines Corp.
Armonk, N.Y.

| STATE | CLASSIFICATION OF OPERATION | CLASS 'N' NO. | PAYROLL, SALES OR OTHER RATE | PREMIUM |
|-------|------------------------------|---------------|-----------------------------|---------|
| Var   | Composite Rate              | 1,972,760,753 | .1562                       | 308,145 |
|       | Non-owned autos end. #13    | F/C           |                             | 65,000  |

**Gassman**
**TOTAL:** 373,145
**LESS DEPOSIT OR OTHER CREDIT:** 369,105
**ADDITIONAL PREMIUM:** 4,036

**FORM 800**
**Z 007130**