# Certificate of Casualty Facultative Reinsurance

**CERTIFICATE NUMBER:** C-12447

**FACULTATIVE MANAGERS CORP.**
25 BANK STREET
STAMFORD, CONNECTICUT 06901
(203) 324-6400
FOR
FREMONT INDEMNITY COMPANY

**CEDING CO. AND ADDRESS**
National Union Fire Insurance Co.
c/o NATIONAL FACULTATIVE SERVICES
5 Marineview Plaza
Hoboken, New Jersey 07030
ATTENTION: Mr. Leon Gonzalez

**DECLARATIONS**

| INSURED | INTERNATIONAL BUSINESS MACHINE CORP. |
| CITY | ETAL/Armonk, New York |
| COMPANY POLICY NUMBER | 991 03 10 |
| RENEWING CERTIFICATE | C-10808 |
| REPLACING CERTIFICATE |  |
| CO. POLICY PERIOD | 5/21/780-5/21/81 |

**ITEM 1 TYPE OF INSURANCE:** Following Form Excess Umbrella Liability

**ITEM 2 POLICY LIMITS AND APPLICATIONS:** $8,000,000 excess $2,000,000 excess underlying insurance and $5,000,000 part of $21,000,000 excess $19,000,000 excess underlying insurance and $15,000,000 part of $40,000,000 excess $40,000,000 excess underlying insurance

**ITEM 3 COMPANY RETENTION:** $7,500,000 part of $8,000,000 excess $2,000,000 excess underlying insurance plus the balance of limits of Item 2

**ITEM 4 REINSURANCE ACCEPTED:** $500,000 part of $8,000,000 excess $2,000,000 excess underlying insurance

**ITEM 5 BASIS OF REINSURANCE:** Contributing Excess

**ITEM 6 CANCELLATION:** 60 DAYS NOTICE

**CERTIFICATE PERIOD:** 05/21/780 TO 05/21/81
**TERM:** 12 MONTHS
**PREMIUM THIS CERTIFICATE:** $7,968.75
**INSTALLMENTS PAYABLE:** 
**ESTIMATED PREMIUM BASE:** 
**RATE:** 
**EST PREM:** 
**AUDIT PERIOD:** NIL
**MINIMUM PREMIUM - FOR REINSURANCE PERIOD:** $7,968.75

**FACULTATIVE MANAGERS CORP.**
FOR
FREMONT INDEMNITY COMPANY
**DATE:** Sept. 22, 1980 CP:jhr
**AUTHORIZED SIGNATURE:** Carl Poulsen, President
**FORM #:** 3