**Reinsurance Layoff Sheet**

- **Assured:** [Signature]
- **Policy Number:** 9910600
- **Eff. Date of Reinsurance:** 5/21/81
- **Policy Limit:** 30M
- **Type of Coverage:** Casualty
- **Underlying Layer:** 25M
- **Policy Premium:** $163,152.60
- **Policy Period:** From: [Date] To: [Date]

### I. Participating/Quota Share

| Reinsurer | Reinsurance Broker/Direct | Percent of Participation | % of Change | Total Comm to Company | Closing Cert. Number | Ceded Premium Annual | Pro-Rata |
|-----------|----------------------------|--------------------------|-------------|-----------------------|----------------------|----------------------|----------|
| Nat'l Union | Direct | 3.33% | + | 27.5 | 3,875.00 | 1671.05 |  |
| FCS | Direct | 3.33% | + | 27.5 | 3,875.00 | 675.18 |  |
| Transpex | Direct | 13.33% | + | 27.5 | 3,875.00 | 2,702.44 |  |
| Cologne Re | Nat'l Fac Semi | 6.67% | + | 27.5 | 3,875.00 | 1,352.84 |  |
| Continental Cas | Direct | 6.67% | + | 27.5 | 3,875.00 | 1,352.84 |  |
| Ina Re | Direct | 6.67% | + | 27.5 | 3,875.00 | 1,352.84 |  |
| Met Re | Direct | 3.33% | + | 27.5 | 3,875.00 | 675.70 |  |
| Mission Re | Direct | 3.33% | + | 27.5 | 3,875.00 | 1,352.84 |  |
| Security Re | Direct | 3.33% | + | 27.5 | 3,875.00 | 675.70 |  |
| Unity Fire & Gen | Direct | 3.33% | + | 27.5 | 3,875.00 | 1,352.84 |  |
| Peuco | Direct | 1.33% | + | 27.5 | 3,875.00 | 263.55 |  |
| Fealix | Direct | 2.74% | + | 27.5 | 3,875.00 | 547.39 |  |
| First N.Y. | Direct | 2.74% | + | 27.5 | 3,875.00 | 547.39 |  |

### II. Excess of Loss or Section II Casualty

- **Limits:** 2,010,450 x 3/130
- **Premium:** $1,930.80

### III. Automatic Excess Treaty Reinsurance

- **Remarks:** [Information Handling Systems]
- **Branch:** [Branch Name]
- **Underwriter:** Chuck Baccetta
- **Date:** [Date]