**Zurich-American Insurance Group**

**Zurich Towers**
1400 American Lane
Schaumburg, IL 60196-1056

**AUDIT ADJUSTMENT OF PREMIUM**

**POLICY NUMBER** | **POLICY PERIOD FROM TO** | **INSURANCE COMPANY**
CGL 32 78 678-04 | 5-21-88 5-21-89 | ZURICH INSURANCE

**THE INSURED/MAILING ADDRESS**
INTERNATIONAL BUSINESS MACHINES
ARMONK, NY 10504

**PRODUCER - 50-515-810**
JOHNSON & HIGGINS
SDS4

**ST CODE NO. CLASSIFICATION EXPOSURE RATE PREMIUM**

**COMPOSITE RATED PER $1,000 PAYROLL**
VRS | 11,108,811,474 | .541284 | 6,013,022

**CALIFORNIA INSOLVENCY SURCHARGE**
100

**MAXIMUM EXCESS LOSS PREMIUM**
11,108,811,474 | .0229 | 254,392

**PAYROLL**
A. 11,108,811,474 X .0229 = 254,392
B. 8,016,477 X .0313 = 250,916

**TOTAL EARNED PREMIUM** | **DEPOSIT PREMIUM** | **ADDITIONAL DUE COMPANY** | **REFUND DUE INSURED**
6,267,514 | 6,150,100 | 117,414

**D/DMS 12-6-89**

**AGENT COPY**

**COMM. ONLY**
$5.9
4936 C 328037
4/26 # 328037
PT. 4/30/90

**MM 009835**