**ZURICH INSURANCE COMPANY**
**AMERICAN GUARANTEE AND LIABILITY INSURANCE COMPANY**

**AUDIT ADJUSTMENT OF PREMIUM**

**POLICY NO:** 86-68-700  
**AGENT/BROKER NO:** 50-515  
**AGENCY NAME:** Johnson and Higgins

**AUDIT NO:** 19927  
**PERIOD OF AUDIT:** 1/1/73 to 1/1/74  
**DATE (IF CANCELLED):** 9/4/74  

**NAME AND ADDRESS OF INSURED:** International Business Machines Corp., Armonk, NY

| STATE | CLASSIFICATION OF OPERATION | CLASS NO. | PAYROLL, SALES OR OTHER | RATE | PREMIUM |
|-------|-----------------------------|-----------|-------------------------|------|---------|
| NY    | VAR                         |           | Payroll                 | Per 1,000 | 377,414 |
|       | 1/1/73 to 1/1/74            |           | Composite rate          | Flat   | 65,000  |
|       | Endorsment # 13             | N/A       |                         |        |         |

**TOTAL:** 442,414  
**LESS DEPOSIT OR OTHER CREDIT:** 437,753  
**ADDITIONAL PREMIUM:** 4,661

**IBM 062396**