**REINSURANCE LAYOFF SHEET**

- **ASSURED:** JBM
- **POLICY NUMBER:** 10310
- **EFF. DATE OF REINSURANCE:** 5/21/80
- **POLICY LIMIT:** $3,000,000
- **TYPE OF COVERAGE:** Casualty
- **UNDERLYING LAYER:** Excess
- **POLICY PREMIUM:** $98,933.50
- **POLICY PERIOD:** FROM 5-21-80 TO 5-21-81
- **PARTICIPATING/QUOTA SHARE:** 8m x 2m x 10
- **PREMIUM:** $124,965.94 (48% of $259,978.50)

| REINSURER | REINSURANCE BROKER/DIRECT | PERCENT OF PARTICIP. | % OF CHANGE | TOTAL COMM.TO COMPANY | CLOSING CERT. NUMBER | CEDED PREMIUM ANNUAL | PRO-RATA |
|-----------|--------------------------|----------------------|-------------|-----------------------|----------------------|-----------------------|-----------|
| National Union | - | 25% | 25% | 25% | 25% | 25% | 25% |
| American Cent | Nat'l Ac | 0.625 | 25% | 25% | 25% | 25% | 25% |
| Mead Re | - | 0.025 | 25% | 25% | 25% | 25% | 25% |
| S & A | - | 0.125 | 25% | 25% | 25% | 25% | 25% |
| Sherwood | - | 0.625 | 25% | 25% | 25% | 25% | 25% |
| Ensign Global | - | 0.125 | 25% | 25% | 25% | 25% | 25% |
| Moody Re | - | 0.625 | 25% | 25% | 25% | 25% | 25% |
| P & Re | - | 0.075 | 25% | 25% | 25% | 25% | 25% |
| Mission | - | 0.625 | 25% | 25% | 25% | 25% | 25% |
| Reco | - | 0.625 | 25% | 25% | 25% | 25% | 25% |
| Clarity Re | - | 0.625 | 25% | 25% | 25% | 25% | 25% |

**II EXCESS OF LOSS OR SECTION II CASUALTY**
- **LIMITS:** 5m 16m x 19m
- **PREMIUM:** $1,500

| REINSURER | REINSURANCE BROKER/DIRECT | PERCENT OF PARTICIP. | % OF CHANGE | TOTAL COMM.TO COMPANY | CLOSING CERT. NUMBER | CEDED PREMIUM ANNUAL | PRO-RATA |
|-----------|--------------------------|----------------------|-------------|-----------------------|----------------------|-----------------------|-----------|
| Nat Union | - | 50% | 25% | 25% | 25% | 25% | 25% |
| S & A | Nat'l Ac | 30% | 25% | 25% | 25% | 25% | 25% |
| Mission | - | 20% | 25% | 25% | 25% | 25% | 25% |

**III LIMITS:**

**AUTOMATIC EXCESS TREATY REINSURANCE**

**REMARKS:**
- **BRANCH:**
- **UNDERWRITER:**
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