**Johnson & Higgins Insurance Company**

**Employee Benefits Division**
M Wall St, New York, NY 10038

**Part Two: This page and Declarations page**

**POLICY NUMBER:** JU 0183

**DECLARATIONS**

**1. Named Insured:**
- **Address:** Number & Street, Town, County, State & Zip No.
- **International Business Machines Corporation, E.T.A.L (Per Schedule)**
- **Armonk, New York 10504**

**2. Policy Period:**
- **From:** 5-21-76
- **To:** 5-21-79

**Producer:**
- **Agent or Broker:** L.W.Birgler Inc.
- **Office Address:** 100th Floor Sears Tower
- **Town and State:** 233 S. Wacker Drive, Chicago, Illinois 60606

**C&F**
**CRUM**

**Description and Location of Risk:**
- **230**

**The limit of the company's liability shall be as stated herein, subject to all of the terms of the policy having reference thereto.**

**COVERAGE OR CONDITIONS | AMOUNT OF INSURANCE | PREMIUM**
- **Excess Umbrella Liability**
  - **$27,000,000. Part of $50,000,000. Any one loss but in the aggregate annually for products and occupational disease excess of $80,000,000. Any one loss but in the aggregate annually for products and occupational disease.**
  - **$77,880, U.S.Funds**
  - **$3,120, Canadian Funds Payable:**
    - **5-21-76:** $25,960, U.S.Funds
    - **5-21-77:** $25,960, U.S.Funds
    - **5-21-78:** $25,960, U.S.Funds
    - **$1040, Canadian Funds**

**Forms Attached:**
- **SUBJECT TO THE MANUSCRIPT FORMS ATTACHED HERETO AND MADE APART HEREOF. ANY PREPRINTED TERMS AND CONDITIONS ARE HEREBY DELETED TO THE EXTENT THAT THEY VARY FROM OR ARE INCONSISTENT WITH THE AFORESAID MANUSCRIPT FORMS.**

**This policy is made and accepted subject to the foregoing provisions and stipulations and those hereinafter stated, which are hereby made a part of this policy, together with such other provisions, stipulations and agreements as may be added hereto, as provided in this policy.**

**Countersigned by:**
**Authorized: Representative**

**BROKER'S COPY**