**Document: Insurance Policy Renewal Form**

**Header:**
- **Account #:** 23055
- **Source #:** 00000
- **Insured:** R. Michel
- **Address Attention:** 0451
- **Check No.:** 2414
- **Date:** [Not specified]

**Bill To:**
- **Name:** Int'l Business Machines Corp.
- **Attn:** Mr. J.M. Costello, Ins. Dept.
- **Address:** 208 Harbor Plaza, P.O. Box 10501, Stamford, CT 06901

**Insured Name & Address:**
- **Same as Bill To**

**Renewal of Number:** CAL 3278678-03

**Policy Details:**
- **Policy Number:** CAL 3278678-04
- **Insurance Description:** Excess Max. Premium
- **Attachment & Expiration Dates:** 5/21/88 to 5/21/89
- **Underwriter:** Zurich Ins Co.
- **Payee Name and Address:** Same
- **Location of Coverage:** Various
- **Gross Premium:** $250,000
- **Commission:** 0%
- **Installments:** 11
- **To be Paid:** $20,833
- **Deposit:** $20,837
- **Tax Payments:** $100 (CAL Surcharges)
- **Tax Payee:** [Not specified]
- **BSD:** [Not specified]
- **Bill Type:** Income
- **Calc Share Comm:** [Not specified]
- **Orig. Inv.:** [Not specified]
- **Suspense:** [Not specified]
- **Issue:** [Not specified]
- **No. of Inst. Periods:** [Not specified]
- **Inst Term:** [Not specified]
- **Inst Deposit:** [Not specified]

**Footer:**
- **MM:** 009866