**REINSURANCE LAYOFF SHEET**

- **ASSURED:** J.B.M.
- **POLICY NUMBER:** 9910310
- **EFF. DATE OF REINSURANCE:** 5/21/80
- **POLICY LIMIT:** $8,000,000

**TYPE OF COVERAGE:** X/5 Umb.
**UNDERLYING LAYER:** 2m X 9
**POLICY PREMIUM:** $198,832.50
**POLICY PERIOD:** FROM: 5/21/80 TO: 5/20/81

**I PARTICIPATING/QUOTA SHARE**

| REINSURER | REINSURANCE BROKER/DIRECT | PERCENT OF PARTICIP. | % OF CHANGE + - | TOTAL COMM.TO COMPANY | CLOSING CERT. NUMBER | CEDED PREMIUM ANNUAL | CEDED PREMIUM PRO-RATA |
|-----------|--------------------------|----------------------|-----------------|-----------------------|----------------------|-----------------------|------------------------|
| Natl Union | -                        | .30                  | -               |                       |                      | 64,966                |                        |
| Met Re., Natl Sec Dew. | -                        | .3334                | 25%             |                       |                      | 7,742                 |                        |
| Scandia | -                        | .15                  | 25%             |                       |                      | 3,483                 |                        |
| Security Re | -                        | .0667                | 25%             |                       |                      | 1,549                 |                        |
| JNAO | -                        | .0666                | 25%             |                       |                      | 1,547                 |                        |
| Colonel Re | -                        | .05                  | 25%             |                       |                      | 1,161                 |                        |
| Mission | -                        | .0333                | 25%             |                       |                      | 773                   |                        |

**TREATY NO.:**

| REINSURER | REINSURANCE BROKER/DIRECT | PERCENT OF PARTICIP. | % OF CHANGE + - | TOTAL COMM.TO COMPANY | CLOSING CERT. NUMBER | CEDED PREMIUM ANNUAL | CEDED PREMIUM PRO-RATA |
|-----------|--------------------------|----------------------|-----------------|-----------------------|----------------------|-----------------------|------------------------|
| -         | -                        | -                    | -               |                       |                      | -                     | -                      |

**II EXCESS OF LOSS OR SECTION II CASUALTY**

| REINSURER | REINSURANCE BROKER/DIRECT | PERCENT OF PARTICIP. | % OF CHANGE + - | TOTAL COMM.TO COMPANY | CLOSING CERT. NUMBER | CEDED PREMIUM ANNUAL | CEDED PREMIUM PRO-RATA |
|-----------|--------------------------|----------------------|-----------------|-----------------------|----------------------|-----------------------|------------------------|
| -         | -                        | -                    | -               |                       |                      | -                     | -                      |

**III LIMITS:**

| REINSURER | REINSURANCE BROKER/DIRECT | PERCENT OF PARTICIP. | % OF CHANGE + - | TOTAL COMM.TO COMPANY | CLOSING CERT. NUMBER | CEDED PREMIUM ANNUAL | CEDED PREMIUM PRO-RATA |
|-----------|--------------------------|----------------------|-----------------|-----------------------|----------------------|-----------------------|------------------------|
| -         | -                        | -                    | -               |                       |                      | -                     | -                      |

**AUTOMATIC EXCESS TREATY REINSURANCE**

| REMARKS: | BRANCH: N.Y.-01 | UNDERWRITER: F. Dagnese | DATE: 12/1/80 |