# Certificate of Reinsurance

**Renewal of:** DAR05428  
**Certificate No.:** DAR08788  

**Dar Allen Reinsurance Agency, Inc.**  
**Suite 1200, State Bank Center**  
**P.O. Box 670**  
**Freeport, Illinois 61032**  
**Phone: 815/235-1047**  
**Telex: 257-476 • Cable DARI/ALLEN/FRPT**  
**Telex: 257-457 • Cable DARI/ALLEN/FRPT**

**Underwriting Managers for Domestic and Foreign Insurance Companies**

## Certificate of Reinsurance

### Item
1. Assumed by: **AMERICAN CENTENNIAL INS. CO., MORRISTOWN NJ 07960**
2. Reinsured: **NATIONAL UNION FIRE INS OF PA., NEW YORK NY**
3. Account of: **INTERNATIONAL BUSINESS MACHINE CORPORATION, ETAL**
4. Address: **ARMONK NY 10504**
5. Policy No(s): **991 03 10**
6. Effective From: **MAY 21, 1980** To **MAY 21, 1981**
7. Details of reinsurance afforded:
   - **Item A Description of Coverage**
     - **Item B Original Policy Limits**
       - **EXCESS FOLLOWING FORM UMBRELLA LIABILITY**
         - **8,000,000 CSL EACH OCC/AGG AS APPL. EXCESS 2,000,000 CSL EACH OCC/AGG AS APPL. EXCESS PRIMARY OR SIR.**
     - **Item C Reinsured's Retention**
       - **2,000,000 P/O EA OCC/AGG AS APPL. EXCESS 2,000,000 CSL EA OCC/AGG AS APPL. EXCESS PRIMARY OR SIR**
     - **Item D Reinsurance Assumed**
       - **8,000,000 CSL EA OCC/AGG AS APPL. EXCESS 2,000,000 CSL EA DCC/AGG AS APPL. EXCESS PRIMARY OR SIR.**
   - **Original Gross Premium:** $10,625.00
   - **Ceding Commission:** 25.00%
   - **Original Net Premium:** $7,968.75
   - **The Premium for this reinsurance is payable:** (X) Prepaid or ( ) Flat ( ) Deposits ( ) Installments
   - **Cancellation if other than as stated in Provisions:** 60 DAYS
   - **The Provisions printed on Page 2 hereof are incorporated in and made a part of this Certificate.**
   - **Dated at Freeport, Illinois This 26TH day of SEPTEMBER 1980**

**Authorized Signature:** [Signature]

**This Certificate of Reinsurance is issued by Dar Allen Reinsurance Agency, Inc. in accordance with authorizations granted by certain insurance companies or underwriters, hereinafter called the Reinsurer whose name or names are shown in item 1. The companies or underwriters do hereby bind themselves each for its own part, and not one for another, in favor of the Reinsured Company named herein.**

**PLEASE EXAMINE THE ABOVE CAREFULLY; IF INCORRECT, NOTIFY US IMMEDIATELY.**