# JOHNSON & HIGGINS
Premium Adjustment Billing Invoice

**International Business Machines**
Old Orchard Road
Armonk, New York 10504
Attn: Mr. J.M. Costello
Director of Risk Management

**Invoice No:** 281-6132
**Billing Date:** 03/13/89
**Amount Due:** $491,366.00

**Insurance Description:** Retro Adjustment
**Department:** Casualty
**J&H Representative:** Richard Michel

| Effective | Policy Number | Description | Amount |
|-----------|---------------|-------------|--------|
| 05/21/82 | Various       | LOSS FUND HELD CREDIT | $(117,075.00) |
| 05/21/82 | Various       | PAID LOSS BILLING CREDIT | $(499,344.00) |
| 05/21/82 | TO 5-21-84    | 5TH RETRO ADJUSTMENT | $355,839.00 |
| 05/21/82 | Various       | REQUIRED LETTER OF CREDIT | $(1,136,392.00) |
| 05/21/82 | Various       | PREVIOUS LETTER OF CREDIT | $1,863,843.00 |
| 05/21/84 | Various       | PAID LOSS BILLING CREDIT | $(3,209,971.00) |
| 05/21/84 | TO 5-21-88    | 4TH RETRO ADJUSTMENT | $(1,797,191.00) |
| 05/21/84 | Various       | REQUIRED LETTER OF CREDIT | $(5,135,992.00) |
| 05/21/84 | Various       | PREVIOUS LETTER OF CREDIT | $3,012,281.00 |
| 05/21/87 | Various       | DEFERRED AUDIT | $127,208.00 |
| 05/21/87 | Various       | 13TH PREMIUM INSTALLMENT | $7,028,160.00 |

**Prepared by:** Johnson & Higgins
**Casualty Department**
**Actuarial Division**

**AMOUNT DUE===>** $491,366.00

PLEASE MAKE CHECK PAYABLE TO ZURICH-AMERICAN INSURANCE CO.

AND MAIL TO THE ADDRESS INDICATED AT THE RIGHT:
Johnson & Higgins
125 Broad Street
New York, New York 10004
Attn: W. C. Gardner
Vice President

PLEASE WRITE THE INVOICE NUMBER ON YOUR CHECK

MM 009840