# Audit Adjustment of Premium

## Zurich Insurance Company

**Agency No.:** 50-515-810  
**Agency Name:** Johnson & Johnson  
**Policy No.:** CGL 32-7P-67R-90  
**Period of Audit:** 5-21-84 to 5-21-85  
**Expiration Date:** 5-21-89  
**Date (If Cancled):** N/A  

## Classification of Operation

| DATE | STD. PREMIUM | COMM. % | CCM. | C/S |
|------|--------------|---------|------|-----|
| 20,317 AP "S" | 6.1% | 1,239 | 620 |
| 1,353 AP "E" | 0 | 0 | 0 |
| 20,317 AP "S" | 6.1% | 1,239 | 50 |
| 1,353 AP "E" | 0 | 0 | 0 |
| 142,218 AP "S" | 6.1% | 8,675 | N/A |
| 8,478 AP "E" | 0 | 0 | N/A |
| 20,317 AP "S" | 6.1% | 1,239 | N/A |
| 1,353 AP "E" | 0 | 0 | N/A |
| 40,634 AP "S" | 6.1% | 2,479 | N/A |
| 2,708 AP "E" | 0 | 0 | N/A |
| 20,317 AP "S" | 6.1% | 1,239 | N/A |
| 1,353 AP "E" | 0 | 0 | N/A |
| 40,634 AP "S" | 6.1% | 2,479 | 620 |
| 2,708 AP "E" | 0 | 0 | 0 |
| 40,634 AP "S" | 6.1% | 2,479 | N/A |
| 2,708 AP "E" | 0 | 0 | N/A |
| 27,317 AP "S" | 6.1% | 1,239 | N/A |
| 1,353 AP "E" | 0 | 0 | 0 |
| 40,634 AP "S" | 6.1% | 2,479 | N/A |
| 2,708 AP "E" | 0 | 0 | 0 |
| 20,317 AP "S" | 6.1% | 1,239 | 50 |
| 1,353 AP "E" | 0 | 0 | N/A |
| 40,634 AP "S" | 6.1% | 2,479 | N/A |
| 2,708 AP "E" | 0 | 0 | N/A |
| 40,534 AP "S" | 6.1% | 2,479 | 50 |
| 2,708 AP "E" | 0 | 0 | 0 |
| 20,317 AP "S" | 6.1% | 1,239 | N/A |
| 1,353 AP "E" | 0 | 0 | N/A |
| 40,634 AP "S" | 6.1% | 2,479 | N/A |
| 2,708 AP "E" | 0 | 0 | N/A |

## Address of Insured

**International Business Machines Corp.**  
**Armonk, NY 10504**

## Total

| TOTAL | Fwd. |
|-------|------|

## Less Deposit or Other Credit

| LESS DEPOSIT OR OTHER CREDIT |  |
|-------------------------------|----|

## Additional Premium

| ADDITIONAL PREMIUM |  |
|-------------------|----|

## Return Premium

| RETURN PREMIUM |  |
|----------------|----|

## Agent's Copy

**MM 009815**