# Kemper Group

**Lexington Insurance Company**
100 Summer Street
Boston, MA 02110

**Long Grove, IL 60049**

**Telephone:** 312 | 540-2600
**TELEX:** 28 2501

**Please Return this stub with your payment to:**
Kemper Reinsurance Company
Post Office Box 91335
Chicago, IL 60693

**DATE:** September 8, 1986
**CERTIFICATE NO.:** 92536-0-00-86
**YOUR REFERENCE NO.:** 5528820

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**A/C International Business Machines**

**R/I Lexington Insurance Company - Boston, MA**

**EFFECTIVE:** 5-21-86

**PREMIUM:** $17,000.00

**RETURN PREMIUM:**

**BROKERAGE:**

**COMMISSION:** $4250.00 (25%)

**BALANCE DUE:** $12,750.00

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**PLEASE PAY THIS AMOUNT:** $12,750.00

**PREMIUMS ARE DUE AND PAYABLE ON THE DATE REINSURANCE IS EFFECTIVE**

**ORIGINAL**

**PRINTED IN U.S.A.**