# Zurich Insurance Company General Automobile Liability Policy

**Form D-850 (5/68)**

## Declarations

**Policy No.:** 66-68-700
**Ben. of:** 86-36-900
**Agent No.:** 50-515-000
**Broker No.:** 0
**New:** Yes
**Initial:** No
**Account No.:** 66017
**Agency Name:** JOHNSON & HIGGINS
**Named Insured and Address:**
- **Name:** INTERNATIONAL BUSINESS MACHINES CORPORATION
- **Address:** ARMONK, N.Y.
**Business or Occupation of the Named Insured:** BUSINESS MACHINES

**Item 4. The Declarations are completed on an accompanying schedule(s) designated as:**
- (1) General Liability Hazards
- (2) Automobile Liability Hazards

**Item 5. During the past three years no insurer has cancelled insurance issued to the Named Insured, similar to that afforded hereinafter, unless otherwise stated herein:** **No Exception**

**Audit Period: Annual, unless otherwise stated:** **No Exception**

**Countersigned on behalf of ZURICH INSURANCE COMPANY**
**Duly authorized agent:** [Signature]
**Attorney in Fact:**

**THIS DECLARATIONS PAGE IS ISSUED IN CONJUNCTION WITH AND IS A PART OF POLICY SERIES 850**

**IBM 062351**