# Declarations - Special Coverage Policy

**Stock Company**

**First State Insurance Company**

**Wilmington, Delaware**

**Administrative Offices: 60 Batterymarch Street, Boston, Massachusetts 02110**

**Named Insured and Mailing Address**

- **International Business Machines, Inc., et al (See Endorsement #1)**
- **IBM**
- **Old Orchard Road**
- **Armonk, New York 10504**

**Item 1. Policy Period:**
- From May 21, 1979
- To May 21, 1980
- 12:01 A.M., Standard Time at the address of the named insured as stated herein.

**Item 2. Premium:**
- Advance Premium: $5,000.
- Rate: Flat
- Minimum Premium: $5,000.
- If the Policy Period is more than one year and the premium is to be paid in installments, premium is payable on:
  - Effective Date: $ -- 
  - 1st Anniversary: $ --
  - 2nd Anniversary: $ --

**Item 3. Coverage:**
- Excess Umbrella Liability

**Item 4. Limits of Liability:**
- The limit of the Company's liability shall be as stated herein, subject to all the terms of this policy having reference thereto.
- See Endorsement #2

**Item 5. During the past three years no insurer has cancelled insurance issued to the named insured, similar to that afforded hereunder, unless otherwise stated herein.**

**Cameron & Colby Co.**
**Countersigned by:** [Signature]

**Date of Issue:** 5-30-79
**BP**

**No.:** 927856
**Renewal of No.:** 925921