# Document Image

This document appears to be an insurance premium computation endorsement for International Business Machines Corp. (IBM). The document details the rates and advance premiums applicable for the period from January 1, 1978, to January 1, 1979.

## Key Information

- **Policy Number:** 28 20 230
- **Effective Date:** 1-1-76
- **End Date:** 1-1-78
- **Agency No.:** 50 515 810
- **Additional Premium:** $955,007
- **Premium Computation Endorsement:**
  - For the period Jan. 1, 1978, to Jan. 1, 1979, the rates and advance premium applicable are as shown below:
  - Excluding Data Processing errors and omissions and IBM Marine Bridge System, a Maritime Anti-Collision System.
  - Comprehensive General Liability and Comprehensive Automobile Liability Premium shall be computed by applying to each $1,000 of Workers' Compensation Payroll, the Composite rates as follows:

## Coverage and Rates

- **Comprehensive General-Auto Liability:**
  - Composite Rates:
    - (S) Ratio: 1.3741
    - (E) Excess: 0.05853
  - Advance Premium:
    - (S) $540,007
    - (E) $230,000

- **Auto Non-Ownership:**
  - Flat Charge: $132,000
  - (E) $53,000

## Total Estimated Annual Payroll
- $3,929,902,861

## Premiums Payable
- **Date:** 1-1-78
- **Amount:** $159,168

## Signature
- **John H. Higgins**
- **CC: MA 1-4-78**

## Insurance Company
- **Zurich Insurance Company**

## Additional Notes
- The document includes a signature at the bottom right corner, indicating it has been authorized or signed off on.

## Footer
- **U-G-0110-0 REV. 11-76**

This document is a formal insurance endorsement detailing the terms and conditions of coverage, rates, and premiums for the specified period.