**Insurance Company of North America**

**CANADIAN DECLARATIONS**

| U.S. Agent, Mailing Address and Code | Johnson & Higgins 95 Wall Street New York NY | U.S. SIO & Code | 305 380083 |
|--------------------------------------|------------------------------------------------|-----------------|-------------|
| Canadian Agent and Mailing Address   | Johnson & Higgins WILLIS Varbey Ltd Place Victoria Suite 2300 Montreal Quebec H4ZIK2 | NO. XCP 14330 | |

**1. NAMED INSURED & ADDRESS (No., Street, Town, Co., State) (Also mailing address if different)**

* **IBM**
* **Armonk, New York**

**Named Canadian Insured**

* **Canada Mailing Address**
* **IBM Canada Ltd**
* **1150 Eglinton Avenue E.**
* **Don Mills, Ontario**

**Business of the Named Insured**: Computer Mfg.

**2. Policy Period: From 5/21/78 to 5/21/79** (12:01 AM)

**3. PREMIUM COMPUTATION: Description of Property, Coverages, including Limits of Liability. Premium must be broken down by province.**

| MAJOR PERIL OR LINE | PREMIUMS |
|--------------------|----------|
| Casualty Excess     | 200-     |

**Casualty Excess**

* **$5,000,000 part of $45,000,000**
* **Excess of $30,000,000**

**MJH**

**Secretary:** [Signature]
**John D. Rainey**, President