# Facultative Managers Corp.

25 Bank Street
Stamford, Connecticut 06901
(203) 324-6400

## Fremont Indemnity Company

**Attached to and forming part of Certificate #C-12447**

**Insured:** INTERNATIONAL BUSINESS MACHINE CORP., ET AL

**Ceding Company:** See Below

**Effective Date:** 5/21/80

**Company Policy No.:** See Below

It is hereby agreed that this certificate shall read as follows:

**CEDING COMPANY:** National Union Fire Insurance Co./American Home Assurance Co.

**COMPANY POLICY NUMBER:** 991-0310/CE 364 04 92

Nothing contained herein shall vary, alter or extend any provision or condition of this certificate other than as above stated.

**AUTHORIZED SIGNATURE**

Gerald S. King, Senior Vice President

FORM #1
GSK:jhr
11/21/80