# Affiliated FM Insurance Company
Appalachian Insurance Company

## DECLARATIONS
- **International Business Machines Corporation** and as per endorsement No. 1
- **Address**: Armonk, New York 10504
- **Effective Date**: May 21, 1976
- **Expiration Date**: May 21, 1980

### Excess Third Party Liability

| Coverage | Company Limits | Underlying Limits | Type Limits |
|----------|----------------|--------------------|-------------|
| Each Person | $ | $ | $ |
| Each Accident or Occurrence | $ | $ | $ |
| Aggregate Products | $ | $ | $ |
| Each Accident or Occurrence | $ | $ | $ |
| Aggregate Operations | $ | $ | $ |
| Aggregate Protective | $ | $ | $ |
| Aggregate Products | $ | $ | $ |
| Aggregate Operations | $ | $ | $ |
| Each Accident or Occurrence | $ | $ | $ |
| Aggregate | $ | $ | $ |

### Excess Liability
See Endorsement No. 2

## Premium Basis
- **Flat Charge**
- **DNA (Dollars Not Applicable)**
- **Estimated Exposure**: DNA
- **Rate**: DNA
- **Estimated Premium**: $11,500.00

## Deposit Premium
- **$11,500.00**
- **Minimum Premium**: $11,500.00
- **Audit Period**: DNA

## Named Insured
- **End. No. 1**

## Limit of Liability
- **End. No. 2**

## E.R.I.S.A. Exclusion
- **End. No. 3**

## Aircraft Products Exclusion
- **End. No. 4**

**Date**: May 18, 1979
**Signature**: Thomas C. Goldman

**Allendale**