# Reinsurance Layoff

| Field | Value |
|---|---|
| Assured | [Unreadable] |
| Policy No | 702875 |
| Effective Date of this Reinsurance | 5-1-70 |
| Policy Limit | 1,000,000 |

## I. Quota Share

| Field | Value |
|---|---|
| Limits: | 250,000 |
| Reinsurance Premium: | 720.00 |

| Reinsurer | Broker | Percent of Quota Share | Total Comm. To Lex. | Closing Cert. No |
|---|---|---|---|---|
| [Unreadable] | [Unreadable] | 100% | 17% | [Unreadable] |

## II. Excess of Loss

| Field | Value |
|---|---|
| Limits: | 250,000 |
| Reinsurance Premium: | 480.00 |

| Reinsurer | Broker | Percent of Excess Line | Total Comm. To Lex. | Closing Cert. No |
|---|---|---|---|---|
| [Unreadable] | [Unreadable] | 100% | 17% | [Unreadable] |

Form 2170
Underwriter: [Unreadable]