**REINSURANCE LAYOFF SHEET**

- **ASSURED:** [Name]
- **TYPE OF COVERAGE:** [Type of Coverage]
- **POLICY NUMBER:** 9716310
- **EFF. DATE OF REINSURANCE:** 5/1/80
- **POLICY LIMIT:** $2,000,000
- **UNDERLYING LAYER:** 201P
- **POLICY PREMIUM:** $116,250
- **POLICY PERIOD:** FROM: 5/1/80 TO: 5/1/81

**I. PARTICIPATING/QUOTA SHARE**

| LIMITS | PREMIUM |
|--------|---------|
| 15m | $42,221 |

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

- **LIMITS:** [Not specified]
- **PREMIUM:** [Not specified]

**III. AUTOMATIC**

- **EXCESS TREATY REINSURANCE:** [Not specified]

**REMARKS:**
- **BRANCH:** [Not specified]
- **UNDERWRITER:** [Not specified]
- **DATE:** [Not specified]

**TOTAL COMM. TO COMPANY:** [Not specified]
**CLOSING CERT. NUMBER:** [Not specified]
**CEDED PREMIUM ANNUAL:** [Not specified]
**PRO-RATA:** [Not specified]

**REINSURER:** [Not specified]
**REINSURANCE BROKER/DIRECT:** [Not specified]
**PERCENT OF PARTICIP.:** [Not specified]
**% OF CHANGE:** [Not specified]
**TOTAL COMM. TO COMPANY:** [Not specified]
**CLOSING CERT. NUMBER:** [Not specified]
**CEDED PREMIUM ANNUAL:** [Not specified]
**PRO-RATA:** [Not specified]

**NET:** [Not specified]
**TREATY NO.:** [Not specified]
**Nat Union:** 30%
**Colony:** 34%
**Hartford:** 6.1%
**N.Y. Ins:** 33.53%
**Micro Ins:** 3.23%
**Lombard:** 6.67%
**Harbor:** 15%

**TOTAL COMM. TO COMPANY:** [Not specified]
**CLOSING CERT. NUMBER:** [Not specified]
**CEDED PREMIUM ANNUAL:** [Not specified]
**PRO-RATA:** [Not specified]