# Insurance Policy Document

## Header Information
- **Renewal Of:** NEW
- **Producer:** PROFESSIONAL COVERAGE MANAGERS
- **PROG CODE:** 060

## Premium Details
- **Premium:** $10,000
- **CO. CODE:** 2525
- **S & C COMM %:** 1.7% (R)
- **Net Payable:** $8,250
- **Audit:** N
- **Month Due:** N

## Producer Information
- **Branch:** 40
- **Producer:** 7390
- **Trans. State:** BY
- **Trans. By:** PB/HR
- **Home Office Audit Control Card Made?:** NO

## Declarations
- **Insured's Name:** INTERNATIONAL BUSINESS MACHINES CORPORATION, ITAL
- **Insured's Address:** ARMONK, NEW YORK 10504
- **Type of Coverage:** EXCESS UMBRELLA LIABILITY
- **Amount or Limits:** PER FORM
- **From:** MAY 21, 1985
- **To:** MAY 21, 1986
- **Term:** 12:01 A.M. STANDARD TIME AT THE ADDRESS OF THE INSURED
- **Forms Attached:** BU 0096 (1/79), ENDORSEMENTS NO. 1-12

## Payment Information
- **Flat Premium:** $10,000
- **Total:** $10,000
- **Date:** JUL 06 1985
- **Time:** 02 TT - 3 65:58

## Insurance Company
- **Pacific Insurance Company**

## Additional Information
- **OATED:** NEW YORK, NEW YORK
- **THIS 20TH DAY OF JUNE, 1985**
- **AUTHORIZED REPRESENTATIVE:**
- **INSUREN'S COPY:**
- **PI 8000-7 (12/81)**