# Audit Adjustment of Premium

**ZURICH**

**A. A. LAN GUARANTEE**

**SP. 54**
**Page 3**

**DATE:** 9-5-85

**AGENCY NO.:** 50-515-810
**AGENCY NAME:** Johnson & Johnson

**POLICY NO.:** OCL 32-78-678-00
**PERIOD OF AUDIT:** 5-21-84 to 5-21-85
**EXPIRATION DATE:** 5-21-89
**DATE (IF CANCL.)**

| STATE | CLASSIFICATION OF OPERATION | STD. PREMIUM | COM%, % | COM%, % | C/S |
|-------|------------------------------|--------------|----------|----------|-----|
| NY    | AP                           | 792,357      | "S"      | 6.1%     | 48,334 | N/A |
| NY    | AP                           | 52,799       | "S"      | 0        | 0     | N/A |
| NC    | AP                           | 304,754      | "S"      | 6.1%     | 13,590 | 9,295 |
| NC    | AP                           | 20,308       | "E"      | 0        | 0     | 0   |
| OH    | AP                           | 63,951       | "S"      | 6.1%     | 3,718  | N/A |
| OH    | AP                           | 4,062        | "E"      | 0        | 0     | 0   |
| PI    | AP                           | 20,317       | "S"      | 6.1%     | 1,239  | N/A |
| PI    | AP                           | 1,353        | "E"      | 0        | 0     | 0   |
| TX    | AP                           | 20,317       | "S"      | 6.1%     | 1,239  | 50  |
| TX    | AP                           | 1,353        | "E"      | 0        | 0     | 0   |
| VT    | AP                           | 20,317       | "S"      | 6.1%     | 1,239  | N/A |
| VT    | AP                           | 1,353        | "E"      | 0        | 0     | N/A |
| VA    | AP                           | 40,634       | "S"      | 6.1%     | 2,479  | N/A |
| VA    | AP                           | 2,708        | "E"      | 0        | 0     | N/A |
| FOR   | AP                           | 203,169      | "S"      | 6.1%     | 12,393 | N/A |
| FOR   | AP                           | 13,530       | "E"      | 0        | 0     | N/A |
| VRS   | RP                           | 116,345      | "S"      | 44.5%    | 51,774 | N/A |
| VRS   | RP                           | 152,632      | "S"      | 47.4%    | 72,348 | N/A |
| VRS   | RP                           | 135,751      | "E"      | 0        | 0     | N/A |
| VRS   | RP                           | 1,768,329    | "S"      | 0        | 0     | N/A |

**NAME AND ADDRESS OF INSURED:**
International Business Machines Corp.
Armonk, NY 10504

**TOTAL**

**LESS DEPOSIT OR OTHER CREDIT**

**ADDITIONAL PREMIUM**

**RETURN PREMIUM**

**nz/d/mjg 9-4-85**

**10144-B**
**A6**
**ITS COPY**

**MM 009816**