Document 3QgO8abB7dwR24kgboqzwnmOa
LEONARD W. RILEY, JR. EXECUTIVE DIRECTOR
TAMPERING WITH THIS LABEL NULLIFIES THE CERTIFICATION
TEXAS WORKERS' COMPENSATION COMMISSION
SOUTHFIELD BUILDING, MS-96,4000 SOUTH IH-35, AUSTIN, TEXAS 78704-7491 (512)448-7900
STATE OF TEXAS COUNTY OF TRAVIS
CERTIFICATION OF SPECIFIED INSTRUMENTS
I, Rachel Solis, Data Entry Operator and Custodian of the Records of the Texas Workers' Compensation Commission of the State of Texas, DO HEREBY CERTIFY that the attached are complete copies of the LAB Form 9's(Notice ofCancellation ofCompensation Insurance) and IAB Form 20's(Notice that Employer has become Subscriber) for the period of 07-01-68 to 04-01-87 for:
Celanese Corporation MBI#904142700
I FURTHER CERTIFY that I am the lawful possessor and custodian of the records of the Texas Workers' Compensation Commission of the State of Texas.
IN TESTIMONY WHEREOF, I have officially affixed my name and caused to be impressed hereon the seal of the Texas Workers' Compensation Commission at 4000 South IH-35, in the City of Austin, Texas on this 5th day of February, 2001.
"This document is signed under the authority delegated to me by Leonard W. Riley, Jr., Executive Director, pursuant to the Texas Workers' Compensation Act, Texas Labor Code Sections 402.041-402.042."
Rachel Solis, Insurance Coverage Department
Tex. Lab. Code 402.042, 402.081. Do not remove any of the records or detach this certification page. These actions nullify the certification.
An Equal Opportunity Employer
NOTICE THAT EMPLOYER H
E' SOU.HS^*fl1DBIIrJ;
TEXAS WORKERS' COW^tKSATIOH ACT
Original to Industrial Accident Board 200 C. HNarSlW Brito, Best Root Auatln. Taaaa78704
~~No()c N N--^tay ptvan by lha namadinauranoa company aa taquaad by (ha Taaa^Wot^ilar5onpanaat*on (nauranca Pel. Chap(a 103.<JanaralLaa. 1917.a
mama (ftaaahxlhal Ilia namadamolorwhaabacoiiiaaaubacdhanindarK Act awlamandmanlaBiatalo and proridadar IHapayina<itoloa<iipanaantBaimito|WM undar tha lamia and pnwtalana ttiaraot Any Inaumcs company Wto# to Na thla nodoa ahaH ba SaNa lor and ahan pay to tha Siala ol Tana a panalty el not atomSian FWa Humkad OoRaia<*SOOJX tor aacl> aHanaa. lAidda830&1to aaaandatf#-1 -S3) naa coaaraga wM remain In allact vnM Nodca olCancaiatton or Nonranaml ol Coaipanaadon Inawanca |IAB Fonn #) la mad wllh tha Indualrlal AodtfaM Soafdor unH aubaaquetrt nolicaofcovaraoa (a racatvadby tha(r>ouatrta( Aeddant Boaid(Art)CM630fl. 120a. amandad9-1-63)
INSURANCE COMPANY SIGN HERE IDO HOT USE QHOUP NAME)
POLICY NUMBER:.
WC-A-9562U
TEXAS EMPLOYERS' INSURANCE ASSOCIATION
INSURANCE COMPANY ON >
OX 2759. DALLAS, TEXtf WS21
EFFECTIVE FROM:________
XI NEW POLICY
(nature here constitutes notice on se lf OF INSURANCE company.
PRIOR POLICY NUMBER:.
REWRITE_____
(Pito> PMey Nanbad
AGENCY WRITING THIS COVERAGE:________________________________________________ NAME
AbfcBESd
phonE NuUBPr
IMMEDIATE PRIOR COVERAGE WAS IN EFFECT FOR PERIOD FROM:TO
through: (INS co.)
Horthveetern nationalpolicy number:
(HOT REQUIRED IF REHEWED IN SAME COMPANY
SCOPE OF COVERAGE:
B ENTIRE STATE OF TEXAS (ALL OPERATIONS)
PROPRIETOR AND/OR EXECUTIVE OFFICERS INCLUDED
NOTICE- FOR DIVIDED RISK POLICIES COVERING SPECIFIC JOBS JOINT VENTURES AND FOREIGN OPERATIONS MUST BE FILED ON IAB. FORM )54 REINSTATEMENT: REJOKES CANCELLATION EFFECTIVE
OCCUPATION OF
INSURED:
Amtlytt n1 Chwnrint
BOARD'S STAMP
RECEIVE^
APR 16 1984
ANY ADDITION OR DELETION OF A SUBSIDIARY CORPORATION WILL REQUIRE IMMEDIATE NOTICE TO THE BOARD GIVING DATE EFFECTIVE A SUBSCRIBER SHALL NOTIFY THE BOARD OF A
CHANGE OF NAME OR ADDRESS.
industrial AccHant Boafy Austin
BELOW: LIST PRINCIPAL CORPORATE NAME FIRST, GIVING HEADQUARTERS ADDRESS; THEN LIST EVERY SUBSIDIARY COR PORATION DOING BUSINESS IN TEXAS AND PROVIDE ITS PRINCIPAL TEXAS ADDRESS ALSO LIST EVERY OPERATING OR DIVISIONAL NAME USED IN TEXAS AND PROVIDE THEIR LOCATIONS CONTINUE LIST ON SEPARATE SHEET AND ATTACH.
EMPLOYER/INSURED:.
Cfilaneaw Corporation
3$
n1nMP rhwmtnwl f!r.mpwny;
nlnaP
Celanrme
REnpgnienteneltryinBgaBnoinnaInan ss
Cel.aneaF!
ralanpaa
Mater
Tthnw
SConrlaixpaabnyleiHPPqnllyyaareei ra^
Virginia Chrmlrnln,
Moran Seeds, Inc.
Karmen Material a-----------------------------------------------------------------------------------
1311 Avpnnp nf t.hn AmArlrim, Spy. YnrV, KftM. York--10Q3&
85 al It-lP-flh
<AB Totm 20 (Rev 9-831 TEIA 3013-H (10-83)
ORIGINAL COPY
' '$&:4'lr^i^48e- Chemical Company
5, N-rS.-^
Sai^vv '-,c.;
Jp&l&Box .509,. Bay City
^^pi807 Port Road, Seabrook (Bayport)
i'pjS#Bb*v58009',. Houston (Clear Lake) .
^.^V-Bttx'-1428,:,Bishop
s
'<t^rr&$3-
...."-S5t
Jr nm "7'fS ^K.'ir-SS
Hp^% ;S(6ac?9077, ? 1901 Clarkwobd Rd., Corpus
Mockingbird Lane, Dallas' \.
:
fa*'*-..;. Pivej Greenway Plaza East, Concoco Tcwers, Sttite l710fioust5it3K?
?.?Boitl;i95'4, Houston '
4,.^;^..
?>#bx 937, Paapa
d
Celtran, Inc. 01
. ...........
.1250 W. Mockingbird Lane, Dallas
. .. i
Moran Seeds,. Inc 50.3 East Expressway 83, Pharr
.v.-.X. ' " V* T, ., '.'.-SrXrffft
Stein Hall and Company, Inc. 201 Harrison, Vernon
;? vCelanese Plastics and Specialties Company
f|^&i<'Box 1962, Bishop
feS? .' 7101 Burns Street, Ft. Worth ; . Box 1954, Houston
J;7198 Mykawa Road, Houston
-- .* V* v.*V
-,t ... V-.
pi^V
. : r::#&ks
NOTICE THAT EMPLOYER HAS
________________________________________Tpmywowtpir cowewsATKm act
ftt). 1^3^
HoamNhaiaWO*mbymnainWaia3loyaraiMH>a|iainadlnaiaanacm(aiTy.aaiaquliiMbyEwTcaaWoi1iam'CoinpanatonlnaiineaAeLC^feiiBa0fc3,-, Qantnt ijtmt, TBT7. and amandmaim mwmo. That ll> nagwdaniploifw Iwa baOOOM aul>crtt>Tundr aald ACT and arntndinmaTT>a,m and pnMdatfliNtfcarW' payment al companaatlon to ampl<>aa undw in# tanoa and provtakma maraol. Any amp/Oyac or anodaBoo w<Huy lall'ng or wtualng to fl> thitnoBoa aha* b* llabto lor and tlwll pay lo UwStM* o( Tm a penalty ol tMil mmVwn On* ThOuMnd Oollw* (SiADA lorKtioltanM.
INSURANCE COMPANY SIGN HERE ..O HOT USE GROUP HAME)
Northwestern National Insurance HAW OFMSURANCE COMPANY OR ASSOCIATION
P.O. BOX 150 .
SIGNED: SIGNATURE HERQfCONSTITUTES" NOTICE ON BE HALF OF INSURANCE COMPANY.
POLICY NUMBER: VC &3223P._
EFFECTIVE FROM: 1-1-80 To 1-1-81
D NEW POLICY PRIOR POLICY NUMBER:. REWRITE:
agency writing this coverage:
ARM International, Inc.-----------------------------------------------
NAME
One Executive Drive,
'
""
'
Fort Lee. NJ
address
'
_(201) 592-7100
phone number
IMMEDIATE PRIOR COVERAGE WAS IN EFFECT FOR PERIOD FROM:TO:
THROUGH: (INS. CO.)------------------------------------ ------------------------------------ POLICY NUMBER.-----------------------------------------------(not aeoumco <r renewed in eame companti
SCOPE OF COVERAGE: ;X ENTIRE STATE OF TEXAS (ALL OPERATIONS)
; PROPRIETOR AND/OR EXECUTIVE OFFICERS INCLUOEO
NOTICE: FOR DIVIDED RISK POLICIES COVERING SPECIFIC JOBS, JOINT VENTURES ANO FOREIGN OPERATIONS MUST BE FILED ON I.A.B. FORM 154 REINSTATEMENT: REVOKES CANCELLATION
EFFECTIVE____________________ _ _ - -________________________
OCCUPATION OF
insured
Stores -- Wholesale
ANY ADDITION OR DELETION OF A SUBSIDIARY CORPORATION WILL REQUIRE IMMEDIATE NOTICE TO THE BOARD GIVING DATE EFFECTIVE
BELOW' LIST PRINCIPAL CORPORATE NAME FIRST GIVING HEADOUAf.TERS ADDRESS THEM tiST EVERY SUBSIDIARY CORPORATION DOING BUSINESS IN TEXAS AND PROVIDE ITS PRINCIPAL TEXAS ADDRESS ALSO LIST EVERY OPERATING OR DIVISIONAL NAME USED IN TEXAS AND PROVIDE THEIR IOCATIONS CONTINUE LIST ON SEPARATE SHEET AND AT TACH
Celanese Corporation 1211 Ave. of the Americas New York, NY 10036__
(Please see Attached)
I A ft ko*m 20 (ft*v 6 79)
ORIGINAL COPY
UNIFORM PRINTIW. A SUFPLT OIV. WC 8262(1 |Ed 6-79'
CETHAliEMPLOYfc
i ** TEXAS WOWtdter COMfENSATONACT;
fH.-ia
385
t<wwbaMWy*--1t*a*w--cAcemipn;MiqiiK<ty.aiTw<lteiti,c><pi>qoiiliwww#
U^WlT.^<ipw1w^'iw>ai,Airt^M^^o^wao8w*obaA^'uiiar>M*iedWBdiiio<i j>irtAjilj
IMIimnl ml fnminwniTlifo >1) mhiwVwi wW fit Ml } MUlwi iHIniu tHimol fufr rnnliil* liTMAnninlnn irWiriljf fffiinn~ nrTtit|i|lnn Wrat II
INSUI&NCc COMPANY'!
*
si**?-' ;te;rii: ge*:
, nJfbx^^steiA-Nati^al.
>CaaitAitY GO,
..*'
t'-V.-V-T: HAMEX* WSURANCE OOMPANY OWWOMAUCw"
:^l?lf'SBM3ks9n' St., MilM&ttkaa, w-kbwSdaoz-
SKJNEDt
SIGNATURE HERE CONSTITUTES HALE OF INSURANCE COMPANY.
IlCE ON BE-
-.
NEW POLICY
; ; : v^HLtWWp^g^
- TTm79 *
EFFECTIVE: FROM
--TO _
AGENCY WRITING THIS COVERAGE:
ABM Internationa?, Inc.
600 Sylvan Ave., Boglewocxi Cliffs, NJ 07632
IMMEDIATE PRIOR COVERAGE WAS IN EFFECT FOR PERIOO FROM:
(201) 871-0001
PHONE HUMBER
1-1-78 TO:.
1-1-79
THROUGH: (INS. CO.) (tJOT PEOUMEO IF DENEWEO M SAME COMPANY)
POLICY NUMBER: WC 60-00-53.
SCOPE OF COVERAGE:
XXENTIRE STATE OF TEXAS (ALL OPERATIONS) r! PROPRIETOR ANO/OR EXECUTIVE OFFICERS INCLUDED
NOTICE. FOR DIVIDED RISK POLICIES COVERING SPECIFIC JOBS. JOINT VENTURES AND FOREIGN OPERATIONS MUST BE FILED ON I.A.B. FORM 154 t ; REINSTATEMENT: REVOKES CANCELLATION EFFECTIVE
OCCUPATION OF INSURED ,,t0rel"_V,h0ieSale
APPROXIMATE NUMBER
OF EMPLOYEES. .
2,391
ESTIMATED ANNUAL^
PAYROLL ...
____ ____
.
BELOW: LISI PRINCIPAL CORPORATE NAME FIRST. GIVING HEADCUARTERS ADDRESS: THEN UST EVERY SUBSIDIARY
CORPORATION DOING BUSINESS IN TEXAS AND PROVIDE ITS PRINCIPAL TEXAS ADDRESS ALSO LIST EVERY O.tRATING OR DIVISIONAL ,'AME USED IN TEXAS AND PROVIDE THEIR LOCATIONS CONTINUE LIST ON SEPARATE SHEET AND ATTACH
Celanese Corp. 1211 Ave. oE the Americas ----- New York,-NY nTCTJ6-------------------------
Celanese Polymer Specialties Co.ty
Stein, Hall & Co.^
___ Celanese' Corp.dy
____ _____
Celanese Piping Systems, Inc.~{J (_J
EMPLOY! SIGN HERE SIGNEO: .. __________
nae of person signing no>*c
DATE: ____ _____________ ____________ ..._________
SIGNATURE HEHE CONSTITUTES NOTICE ON BE
HALF OF EMPLOYER
f- --
----"--- --.................. f
I A B f f)'Gi 70 ,4,`4 * f Mciiiili:i n ui V'nM r.i.i(,h.c'
C.'.IGINAL COPY
y r.^-Tv
NOTICE THAT EMPLOYS fe'ds^EK
; >; ?*>*;'.. v-~
-- ------ .."_,
--''----J.L . "- '...'
. _. I '
J'` '! ** '-- - -.'-' " ' " " "''
/S ____1 --PI .n 1.1 -
,- Noticetottsis&y ge" Pyme named emptcyet end ms nensetf Inswenca comptny. ss moulted by Hm TmsJNMW!
Act CbeptofTM, DmmI Uerni WIT. snd emndmonls ttnrato. that the named employer ha became e sr-
menu theieto end feurlded for the peyment of oumoeneetlon to employese under in* ierme end proWsio
.
t(on MRnadMtrfusing foRmlttfa notice *HM baMHe tor end elwn pay to me SttJo of Toms penalty of ntxaxr* ttjB
.
DolI*(FLOOD) forweftOffanM. -
V.-s->;
P-
INSURANCE COMPANY SIGN HERE
(00 NOT USE GROUP NAME)
Northweatern National Casualty a
1 1 uNeAwMeE MOf tINueSnUBRAAUNACCE CAOAMuOPAlUNVY AODR AtMSSnOnCAIATTlYIOANl
`
..occupation of
a,
SIGNED:
SIGNATURE *ERE CONSTITUTES &OTICE ON BE HALF OF INSURANCE COMPANY
-V- Ari-i*
-'> ."*
NOTICE THAT EMPLOVSH
TEXAS WOKKM8K COMPEHSATKW ACT
PiiWOYFSi tincM. .li firta w w*i compWr iMElDg Mm. ooal hr <* t>l"r wrc <>*>> <*' mhM intawwhAiNne
uurwiuu mmumakimM
':
Oalaneaa Coatinaa & Speci^ll^e^ &^
Angara-
Stein. Hall 's Co. . incr ^ Calaneae Piping Svafcaaa. Ind.
t ..*. .. . . x
j.r,' x.- '?
- f. 'qt.-a-: %^/x^k
Box 509Bay City, Texas
LOCATION OF RISK: B ENTIRE STATE OF TEXA5
ft DIVIDED RISK--EXPLAIN OPERATION COVERED BY THIS POjlCI^
.......... ........... .
"
.,4
NEW POLICY
B RENEWAL
expires Ar 1201 a.m. on___January -1^ 19ia
APPROXIMATE NUMBER OF EMPLOYEES:
A. Stable Annual Employment:_________ 2500 .
D, Seasonal Employment by Month:
JAN.
FB.
MAR.
ARIL
MAT
JUN.
JUL
AUG.
SEP.
OCT.
NOV.
OEC.
OCCUPATION
Various
ACT. OR BROKER
'
ARM International,
AOORESS
Inc., 600 Sylvan Ave.,
CITY
VTATE
Englewood Cliffs,
ZIP
NJ 07632
Notice is Isereby given by the named employer end the named insurance comp.ny, as required by the Texes Workmen's Compensation Insurance Act.
Chapter 103, General Laws. 1917. and amendments thereto, that the above named employer has become a subscriber ued - said Act and amend
ments Uweto and provided for tiw payment of compensation to employees order the terms and provisions thereof. Any employer or association
wilfully fading or refusing to fife this notice shall be liable for and shall pay to the State of Texas a penalty of not more than One Thousand Oothrs (31,000) for each offense.
EMPLOYER SIGN HERS
7 " HBHBHHSH
*o Insurance Manaqer -vp ^q*
TITLE or PERSON 8IONiN3J*flfV&'V;qt' *
INSURANCE COMPANY SI&N MERE
HHHHBEB
Northwestern National Casualty Company
Sf.!N3Ji^Sc9?M^CY.op 'ssocl*T,ON Milwaukee, WI 53201
SIGNATURE HERE CONST^JB^SticE ON ^IF 0? EMPLOYER
NOTE. RETURN THIS NOTICE TO
*
DO NOT MAIL TO iNDLSXRp&JlttxiDENT
HOARD.
t.A.8. Asprowed R#v. rO-i-fcV Fom
*'
ORIGINAL COPT
0?O
TITLE OF PERSON SIGNING NOTICE SIGNATURE HERE CONSTITUTES NOTICE ON 8EHALF Of INSURANCE COMPANY
WC 8262b
*Y
' * L*
TICE THAT
1BCAI WORKMBTt CbMKMAIION ACT
| B4PLOYBU. [hcM atl
m^|V
Mvmd by <
^ Celahese Coloration_____________
(^Calanese Coatings < Specialties Company
A,.. Stains HalJfch^Co. a Inc.
fiSlaiBwB Pffiwft Syfc
;AW>RE$Sj Bo* .509 yr Bay City,TsxaB
LOCATION OF RISKED: ENTIRE STATE OFTBtAS
StUffM-Vf
oiVIDED RISK--EXPLAIN OPERATION COVStEO BY THIS PO
.
POUCY NUMBER
~
v:: v'v;
EFFECTIVE DATS lt:OI AM
WC 622945
n NEW POUCY
January 1, 1976
R&JEWAL
EXPIRES AT i2K)i am. on January 1. 'l9'7'7^?rVs;
APPROXIMATE NUMBER OF EMPLOYEES:
RECEIVED
INOUSTRIAI. ACCIDENT BOARD.
A..Stable Annual Employments.__ ?.?Q0. B. Seasonal Employment by Month:
WR1576-
JAN.
V
FEB.
MAE.
At*.
UAV
Juit.
JUU
ZEuESAUG. --ar "SC -SWT'
INS JRaN
Xa
i
Various
ACT. Oil SROKKIt
ARM International, Inc.. 600 Sylvan Ave., Englewood Cliffs. NJ Q7fif2
Ctaptsr IOLGmmI Ims, 1917, and msodtosats ttorato, tM tilt store unto employer tot toctM t sebscritar under siM Act and aamdfi* '^Sr* *M pmyUto lor tte payneal el caaeaesetloa lo employaes under the tanas and provtsioas Unreel. Aar eenloyer or assodaUea SjSfcfc^Me^oHeoS* to * *oB" a ** PV <o tto State oI Tens a penalty el eel awn maefae Ttaesand Oellars
EMPLOYE* SIGN HERE
BHHHHH
' r/
_____ Insurance Manager
TITLE OP PERSON SIGNING NOTICE
niir. April 4, 1976
SIGNATURE HERE CONSTITUTES NOTICE ON BEHALF OF EMPLOYER
NOTE: RETURN THIS NOTICE TO:
DO NOT MAIL TO ININ iTSIAL ACCIDENT BOARD.
INSURANCE COMPANY SIGN HERE
BBBBBBBI
Northwestern National ^
Casualty Company
73iMVr Ta5feNsc5ncoS^v,OB AMOC,AT,ON
Milwaukee. WI 51202
, * AOORE88
-3------
RICHTO.
-^2h, <^!* **->
//<>
TITLE OP PERSON SIGNING NOTICE
SIGNATURE HERE CONSTITUTES NOTICE ON BEHALF OF INSURANCE COMPANY
' * v1' r
rT' nxj*w6mm&&OS^^ WflWWiWlfir^F' r: fi* 'i
mm* vtr cwepMn ** a+tova, emrud bv IM> poGcy dar *.*: <*tll> #r nUiW-ln'-.l
neeericry ednr*antarJ
......
`. :'v..i*E3
-. c '
' : v - '
Cffilanmie Corporation-
- -; .. -
' ________ - ' : . <
___ _
ADDRESS: 1211 Atfawne of that Amaricaa, ^xJIcay\SM:ti!^;-ia^A^^
LOCAVON OF RISK: O ^TiFE STATE 6F 7Ei(AS
''
H DIVIDED RISK-- EXPLAIN OPERATION COVERED BY THIS lUCV .-^^Ifll
-
Attached_____ _____________ ;----------- ; `
.." 'j:i,"-'';';-;-^|
POLICY NUMBIA
emcnv-*----o---a--t---s----i-*--:-ot am
i1 cancelled
WC9 00 98 43
1/1/75
1
NEW POLICY
s RENEWAL
gg EXPIRES AT 1201 A M. GN_
IHBURAMCC CP*!?
The Ind Co*
1/1/16:-
APPROXIMATE NUMBER OF EMPLOYEES: A. Stabls Annual Employment:_________ tW__ 2600
B. Seasonal Employment by Month:
jaW. ! rs:
MAE.
An.
MAT
JVM.
JUL
AUG.
sep. |
ocr.
MOV.
DEC.
Stnrn th ks-Wholesale and Retail:
OCCUPATION
Arm International Inc. 600 Sylvan Ave.,Englewood Cliffs,New Jersey
ACT. OR BROKER
ADDRESS
CITY
STATS
ZIP
'Mia is hereby given by the named employer end the named insurance company, as required by the Terras Workmen's Compensation Insurance Act
Chapter 103, Gen*ral laws, 1917, and amendments thereto, that the above named employer has become a subscriber under said Act and amend ments thereto and proitded for the payment cf compensation to employees oncer the terms and provisions thereof. Any employer or association wilfully tailing or refusing to filo Urn notice shall bo liable for and shall pay to tea State ot leans s penalty of not more than One Thousand Dollars BLOW) for each offense.
EMPLOYER SIGN HERE
INSURANCE COMPANY SIGN HERE
SIGHED;
The Home Indemnity Company
NAME OF INSURANCE COMPANY OR ASSOCIATION
TITLE OP PERSON SIGNING NOTICI
DATE-______ January 31T 1975___
SIGNATURE HERE CONSTITUTES NOTICE ON BEKALf OF EMPLOYER
iTL3L~^EBrFr
ul .
m
.NOTE. RETURN THIS NOTICE TO:
INEU
DO NOT MAIL TO INDLSTRJAL ACCIDENT BOARD.
0I.A.I. AirSrq>vd Rv. 101-49 Form 2069
ORIGINAL COPY
ORIGINAL COPY
TITLE OF PERSON SIGN!ING NOTICE
SIGNATURE HERE CONSTITUTES NOTICE ON 6EHAEF Of INSURANCE COMPANY
WC 8262b
.
-- terC-firrr
~_-u.
_S---
^36|>w
THATEMPtOl
TEXAS'
abty--* r^?<
SilPLaVkilt&**
*'* at*1*
**r lamri nJtwniiJ
addwm. '"'* br ooiicr Mrfw which oparettcaa ( > twdiicud hi TuaL Ah
Celangaa Rr^ipC^py and Specialties Ca.
address: 1211 Avenue of the Americas. Hear York* New .Yfrrk 1Q036-
LOCATION OF RISK: ENTIRE STATE OF TEXAS Q DIVIDED RISK--EXPLAIN OPERATION COVERED BY THIS POLICY
Box 14547 (6767 glrbyvllle Rd-)^-----------------------
` S-JV' -I
POLICY NUMBER
EFFECTIVE DATE ItiOt AM
CANCELLED
WC9 00 98 43 _________ 1/1/25___________
NEW POLICY
B RENEWAL
B EXPIRES AT 12:01 A.M. ON_
INSURANCE CO. '
The Home -2nd. .Co.-----
1/1/26-
APPROXIMATE NUMBER OF EMPLOYEES: A. Stable Annual Employment"__________ 3X B. Seasonal Employment by Month:
2608
OCCUPATION
Arm International Inc. 600 Sylvan AvenuerEnglewood CliffsrN.J.
ACT. OB BROKER
ADDRESS
CITY
STATE
IIP
Metier is hereby given by the named employer and the named insurance company, as required by the Tetas Workmen's Compensation Insurance Act, Chapter 103, General laws, 1917. and amendments thereto, that the above named employer has become a subscriber under said Act and amend ments thereto and provided (or the payment of compensation to employees under the terms and provisions thereof. Any employer or association wilfuity failing or refusing to file this notice shall be liable for and shell pay to the State of Texas a penalty ot not more than One Thousand Dollars ($1.0001 for each effense.
EMPLOYER SIGN HERE
"7.
GNED:
/(a
INSURANCE COMPANY SIGN HERE
The Home Indeimrl tv Company
NAME OF INSURANCE COMPANY OR ASSOCIATION
Insurance Manager
TITLE OF PERSON SIGNING NOTICE
DATE______ January 31. 1975
SIGNED:.
SIGNATURE HERE CONSTITUTES NOTICE ON BEHALF OF EMPLOYER
WItkiUSlUUl _RA. .N, -N V-- '
NOTE: RETURN THIS NOTICE TO
DO N07 MAIL TO INDUSTRIAL ACCIDENT BOARD.
ADDRESS
Jj
.N.Y.
_
'J0
Sec'y.
TITLE OF PERSON SIGNING NOTICE
SIGNATURE HERE CONSTITUTES NOTICE ON BEHALF Of INSURANCE COMPANY
I.A.B. Appro-rat.' Rev. 10-l-tf Form JCM
ORIGINAL COPY
WC 8262b
ggpUl
{=S>wer';A
Srln. Hall gt Co.. Tne.
...........................
New York, New .Yogfc -10036"'^^^
1311 Auemw nf fhe Amavtofla,
LOCATION OF RISK: ENTIRE STATE OF TEXAS
S DIVIDED RISK--EXPLAIN OPERATION COVERED BY THIS POLICY .
POLICY KIMBCR
-RouTe.-l-r 201 Harrison Street,
Vernon >I93W8
EFFECTIVE DATE 12:01 AM
CANCELLED
.;.5^V.5a
iMuw*wcit CO- -
The
WC9 00 98 43
______ 1/1/15_____________
Tnd. Co.
NEW POLICY
S RENEWAL
a EXPIRES AT 12*1 A.M. ON_
-1/1/76.
APPROXIMATE NUMBER OF EMPLOYEES:
A. Stable Annual Employment:SOIL.122-.
8. Seasonal Employment by Month:
JAN.
FEB.
MAE.
APR.
MAY ~j
1 1
JUN7
JUL
aucT | sW.
1
OCT.
NOV.
Chemical and Dyestuff Rating Plan; Food Sundries Mtg.;
gql flamnn; marl eel___________________________________ O* CCUmPAatTnIOekNi '
Arm International Inc. 600 Sylvan Avenue,Englewood Cliffs,N.J.
ACT. OR BROKER
aodress
CITY
state
0ec. zip
Notice is hereby given by the named employer and the named insurance company, as required by the Texas Workmen's Compensation Insurance Act,
Chapter 1C3, General Laws, 1917, and amendments thereto, that the above named employer has become a subscriber under said Act and amend
ments thereto and provided for the payment of compensation to employees under the terms and provisions thereof. Any employer or association wHftrfhr faiGng or refusing to file this notice shall be liable for and shall pay to the Slate of Texas a penalty of not more than One Thousand OuUars <$l,000i to each offense.
EMPLOYER SIGN HERE
INSURANCE COMPANY SIGN HERE
SIGNED
y
J1
Insurance Managed
TITLE OF PERSON
EEif
At --<
The Home Indemnity Company
NAME OF INSURANCE COMPANY OR ASSOCIATION
' 59_Maflen Lane. N.Y.. N.Y.
NT 'JO-""'-
ADDRESS
fiAir. January 31, 1975
pi 3^IGNtO: .
.'
SIGNATURE HERE CONSTITUTES NOTICE ON BEHALF OF EMPL0T1YER
NOTE: RETURN THIS NOTICE TO:
1NSUFL/ NCti
DO NOT MAIL TO INDUSTRIAL ACCIDENT BOARD.
Sec'y.
TITLE OF PERSON SIGNING NOTICE
SIGNATURE HERE CONSTITUTES NOTICE ON BEHALF OF INSURANCE COMPANY
IA.B. Approved Rev.
Form 206?
ORIGINAL COPY
WC 8262b
Salwaiaaagg
"` L
- *?'-: ^QliCE; W*
r------- -. "-- ---
ADDRESS: 1211 Avemie of the Aaarlcfflg, Kew York,. M^Y. -1QQ36. _.
LOCATION OF RISK: ENTIRE STATE OF TEXAS B9 DIVIDED RISK -- KPLAiN OPERATION COVEREO BY THIS POLICY
1701 Burns St., Fort Worth,, Texas;---------------
POLICY NUMBER
WC9 00 98 43
imCTlVK OATS t8:Ot AM
1/1/75
CANCBLLEO
INSURANCE 'CO;?'
The Home '51'; Ind. Co. '
NEW POLICY
0 RENEWAL
EXPIRES AT 12:01 A.M. ON_____1/1/76.
APPROXIMATE NUMBER OF EMPLOYEES:
A. Stable Annual Employment':_____ B. Seasonal Employment by Month:
30
Mfg. of Synthetic fibres, chemicals, plastic & coating
OCCUPATION
Arm International Inc.. 600 Sylvan AveT Englewood Cliffst N.J,
Notice is hereby liven by the named employer end the named insurance company, as required by the Texas Workmen's Compensation Insurance Act
Chapter !03, General laws, 1917, and amendments thereto, that the above named employer has become a subscriber under said Act and amend ments thereto and provided lor the payment of compensation to employees under the terns and provisions thereof. Any employer or association wilfully lailihs or refusing to file this notice shall be liable for and shall pay !o the State of Texas a penalty of not more than One Thousand Dollars IflfiXa for each offense.
LA.#. Appcovrt i*v. KM*W form JOW
ORIGINAL COPY
'
WC 8262b
;''
wriLAflCE'IHAT
'EMPLOYER* ItncMda all. Bull M1M. a;M <nM **
kylMr |attV Mdat *Meh i
i;niflnifl mi-pnrnrtmi. ceiattean Ftniny ssmteiMi. lne.^
Stela HatU Co.. lac.. Celaneaa Coatings Company - l - ^
T-
^5
: r"rT
522 Fifth Avenue ( Haw York/New York___10036_________1
LOCATION OF RISK: B ENTIRE STATE OF TEXAS DIVIDED RISK --EXPLAIN OPERATION COVERED BY THIS POLICY
' '.>?-V4CD
POLICY NUMBER
EFFECTIVE DATE (2:01 AM
CANCELLED
WC99 01 75
__________ 1/1/23__________
NEW POLICY
gj RENEWAL
|fl EXPIRES AT 12:01 A.M. ON_
INSURANCE CO.-
The Home L,% tnrf. CaJv 1/-1/.74.
APPROXIMATE NUMBER OF EMPLOYEES: A. Stahl# Annual Employment:______H808flf-
B. Seasonal Employment by Month:
| JAN.
1
ftt.
MAI.
APR.
MAT
JUN.
JUu
AUG.
SEP.
OCT.
NOV.
oet
1_________
4821-Chemical Extraction; 8810-Clerical; 738Q-Drivers; 8742-Salesmen
OCCUPATION
Arm TntpmaHanal Tnc.
600 Sylvan Avenue. Englewood Cliffs. N.J.
AOT. OR BROKER
ADDRE--S---S--
CITY
STATE
Z.P
Notice is hereby girt.) by (be itemed employer end t!r. named insurance company, os required by the Tews Workmen': iX pensotion Insurance Act rhcpter 103, General Lain, 1917, and amendments thereto, that the above named employer has become a subscriber umier said Act end amend
ments thereto and provided for the payment of compensation to employees under the terms end provisions thereof. Any employer or associctlon vriltullr ailing or refusing to file this notice shall be liable for and shall pay to the State of Teias a penalty of not more than One Thousand Dollars 131.000) lot each olfense.
eMPtO/ER SIGN HERE /J
INSURANCE COMPANY SIGN HERE
HBBBS9
INSURANCE MANAGE* /
______
The Home Indemnity Co.
mamf pe-ifcoyiWAejrr COMPANY OR ASSOCtATION
JJ^^l40^ana^XuA_NaY,_____
TITLE OF PERSON SIGNU j NOTICE
> * *
ADDRESS
DATE: AUGUST 30. 1973
S'GNATURE HERE COffSTIlUTIS NOTICE ON BEHALF Of EMPLOYER
NOTE: KJETUKy THIS NOTICE TO: DO NOT MAIL TO INDUSTRIAL ACCIDENT BOARD.
sir.HHh'-- O-' M r
y??
oc
-ISec'y.
TIT LE OF PERSON SIGNING NOTICE
SIGNATURE HERE CONSTITUTES NOTICE ON BEHALF Of INSURANCE COMPANY
1.AB Apoec/ec Rev. ID-1-69 Forn 2069
*
ORIGINAL COPY
.... WC 8262b
Notice of
|:4Cb
" "............." '
'
INDUSTRIAL ACCIDENT BOARD
AUSTIN. TEXAS
:
y
."-. ..
'
' r.-Cv.^S?
'
... -fv4
. r. x.-2 -.& ;Vi-'
The Industrial Accident Board is hereby given notice of the CANCELLATION OF A Pf^CY qif lnsuraeioe
under the terms and provisions of the Employers'Liability Law, to--
'
EMPLOYER_______CeAM.e,,Co^.r*tion.^..
i<nntnN* hamv mmu vmiieewi mnimm ii cowmictwi
address............ 522 FifthJyenue................ Jft&t.............New York.______ ___
( NUMIII AMO HAMV,
(mahc or citt o rwai
occupation....... .c.ier.iGfl3Lj...eiea.RL..J^iYer.s.
(MAIMTUI Of OUMMIM IN WHICH VHOAOVOy
NUMBER OF EMPLOYEES.:......................ANNUAL PAYROLL $...... ...................... POLICY NUMBER...ff.C..9.SL.QQ..81 ; ,
DATE EFFECTIVE..
..Jan*...!.,.................... 19.7.Z.., hour effective.............12:01............... A...... m.
(MONTH Amo Ntl
(A. M.OVf. M.l
DATE OF CANCELLATION......Jan-l,................ 19.7.3:.., HOUR OF CANCELLATION........12:01...............A--M.
reason: rewritten und8t,"NC"99 01 75
(HOOCl (A. M. CH f, M.l
INSURER........ .The.floae..Indeqinit^..Coapany-
imu MAM or inNotoofmMncc company oo aMociAnom
address.......5.9...MAiden.Lane,...........................JPES**............... New..York,..
(MAHt OS C*T OH TOWHI
INSURER ADDRESS.
a V'-''w
Dated at....New. Yorkj .
.................................................. day of.............
(NAMIO*ClTT OMTOMM)
\*
' `
NOTE:
This form mutl be executed by he ptftAIER promptly upon the CANCELLATION OF A POLICY of insurance under the term* end provisions of the Employers' Liability Lew, end mailed to the Industrie! Accident Board. Austin. Texes.
If en employer ceases to be e subscriber etcher because his policy hes expired or has been cancelled he shed on or before the dete on which his policy expires give notice to h<s employees by posting notnw* to that effect m three public places around such subscriber's plans, and also to the Industrial Accident Board.
If more than one o'ace of business it conducted under same name, mm separate Wank for each.
WC 8282 (Ed 4-36)
The Industrial Accident Board is liereby given notice of the CANCELLATION OF A POLICY of insuraf|<aisst*
under the terms and provisions of the Employers' Liability Law, to--
''
EMPLOYER
Celanese Piping Systems , Inc.
inm hams uwia mcn mwm
address............... 522 Fifth Avenue............................................................ New York, N.Y.
tttWMWCW ANO NAMIt
occupation........ ciextcAli
(CMAAACTM Of
IN '
NUMBER OF EMPLOYEES........................ ANNUAL PAYROLL $............................... POLICY NUMBER....WC...95..AQ...81
DATE EFFECTIVE................. Jfln- .l,...................... I9....72HOUR EFFECTIVE......................12LS.01............
fMwttH AMO DA*I
DATE OF CANCELLATION..... JaiU.JL,................19 .73.., HOUR OF CANCELLATION..........12l01............ A..~M. reason: rewritten underTc'l9 01 75
INSURER
.............................................................
irvu. mams o* inewaAMce comaam v oat association*
address......... 59..Maiden...Lane.x....................... mm.............. Mew.York,
(MUMOaa AMO SAMI|
IMAMI OA CITY OM TOWH>
NOTE
Ths I -r.n mutt be executed by thf. CARRIER promptly upon the CANCELLATION OF A POLICY o! insurance under the terms and provisions of the Employers Liability Lew. and mailed to the indwstml Accident Board, Austin. Texas.
If an employe' ceases trJ be a subwbe* either because h.s pulicy has exp.rod or has been cancelled he shall on or before the date nn which his policy expires tpv* nct.ce t-*, hi\ employees b> posting ncl.ces to thf effect in rtsree public places aroui-d such subscriber's plant, and also to the Industrial A'ncenr Beard
If m >re thxn >/r>e place business is C'.r.C,,ct*s<J under same name, use separate blank for eeek.
WC 8282 M J 2.6-,
wm ''\<'. ;?r-' i?
Notice of Canceiiation of Compensation Insuraitop^^^^^P
" -'
-'`T'- ->.-iV; ; - ......
INDUSTRIAL ACCIDENT BOARD
AUSTIH. TEXAS
v.,'- ...
.'. "
^-'V^Y.sg
- > '."' :,<*. .-`v.Itff
;......... "r*
-irJ5
f ' "V-V-:v ' V. 7 .'V-. ..-.r.-.'.
- ... .. w." .
. '.W.A;...
The Industrial Accident Board is hereby given notice of the CANCELLATION OF A POUCY I under the teims and provisions of the Employers' Liability Law, to--
EMPLOYER___________..................................(.P..l.a.n..H..A.N..K..I.f.H.O..K.M..W...W..C.H...W...tt.R..C..M...I.B..C..O.M..O..V.C.T..C.O..)................................................
I
address....................... .............................................................. MuiR................ MeM..Xark*..lLX...
4MVMNSN ARM NAtftS
(HANK OF ClTT OM tOWM)
occupation............ Clerical ;..Sa.ie8en;..-Drivers......................................................................
tCMfACtM OF WUKIII IM WMlCM gNeWl
NUMBER OF EMPLOYEES........................ANNUAL PAYROLL $............................... POLICY NUMBER...KC..99..00..B1
DATE EFFECTIVE................... Jan.-l,....................19....72, HOUR EFFECTIVE............12:01........................ A, M.
(MONTH AMO OAV|
<MOUM> <A. M. ONP. M.)
DATE OF CANCELLATION...........Jan.-l-,..........19.73.., HOUR OF CANCELLATION...........12*01-....... -A;--Mreason: rewritten ufl88rWT'99 01 75
INSURER........ Ihe..HcHne..Indetmity..Coinpany..
(IPFJaUlk. MAMN* OF I1MNSSOMMNANMCa COMPANY ON ASSOCIATION*
ADDRESS........5.9..Maiden-Lane,.........................xSttnet...........-Mew-York..................... .
(NUMSKN AMO MAMS)
(NAN* OF CTV OC TOWN)
NOTt-
This form must be executed by tbs CARRIER orompfly upon the CANCELLATION Of A POLICY of insurance under the terms And provisions of the Emu'cyers' Liability Law, and ma-ied to the Industrial Accident Board, Austin. Texas.
If an employer ceases to be a subscriber etther because his policy has expired or has been cancelled he shall on or before the date on whicn his policy aspires give notice to his employees by posting notices to that effect m three public places around such subscriber's plant and also to the Industrial Accident Board.
II more than one t'ixe o* bu\ ness .s conducted under same name, use separate blank for each.
WC 8282 <Ed a-36! uM.roAM rNiM.vo A Sum.'
notice
__ nxAs)
-;
*
Jfj'BrfftQViffit (taMi 8:j|Hi'NMM,
camptah'*m&v ififini; ruirtfi f Mf M pjBcy Mr tMcfc cpenJltfi'
--T rywirytada^wN^ ">>-
*-.**-.
-..........-..-.r..-
-- , - .-hfi.Vftvr------.-5
CalflTtPBB Corpm-ntiniV .fOd
. --E.-
, . ,*T- . *H - - Atf.*% - 2 1.. .*
Stain Hall -and
iSt: anafia Piping SyatamB Ipiy Ififtljmgftft Plfl tiegSCa*.r*a*ggg^
\:: -
- .-v. .. .,.a' ..'.
;. rv .,r..
-. - - -.
* .> --
s.. ADDRESS: 522 -Fifth. Avenue, -New York,
York., --:-_
.- LOCAT.ON OP RISKr H ENTjRE STATE OF TBCAS
DIVIDED RISK ~ EXPLAIN OpgiATJON COVERED BY THIS POLICY ;;
.. - ;t "/ 1 . +-, al.T>P.V-yi^^
POLICY NUMBER
EFFECTIVE DATE'lfeCt AM '
CANCELLED rV"-, J.rHSURAHCS'.' .CGtSSS
WC 99 00 81
t'nf __________ U1L22-_________
S NEW POLICY
RENEWAL
3 EXPIRES AT 12.01 A.M. ON_
'
-lMciZM
IZIZZI
APPROXIMATE NUMBER OF EMPLOYEES:
A. Stable Annual Employment:_____ 7..QQQ .
B. Seasonal Employment by Month:
JAN.
KB.
MAR.
APR.
MAY
JUN.
JUL.
AUG.
SEP.
OCT.
NOV.
D6C.
Chemical and Plastic Goods Mfe.
OCCUPATION
Arm International Tnc _ 60f) Sylvan Avenue,
ACT. OR BROKER
ADDRESS
CITY
Englewood Cliffa,N..T.
STATE
IIP
07632
Notice is hereby given by the named employer and the named insurance company, as required by the Texas Workmen's Compensation Insurance Act Chapter 103, Cereral Use, 1S17, and amendments thereto, that tho above named employer has become a subscriber under said Act and amend ments thereto and provided for the payment of compensation to employees aider the terms and provisions thereof. Any employer or association vnnoliy failing or refusing to file this notice shall be liable for and shall pay to the State ot Texas a penalty of not more than One Thousand Dollars ($1,009) for each nffutse.
EMPLOYER SI9N HERS ,
/
INSURANCE COMPANY SIGN HERE
SIGNED
_
MIL.
/_______
A-TITsLsE.iPsi.tPaERnStON
^SIGNING NOVICE
Treasurer
The Home Indemnity Company
NAME OF INSURANCE COMPANY OR ASSOCIATION
_ 5<? Malden Lane. N.Y..N.Y.
AQDRESS
SIGNED:.__
SIGNATURE HERE CONSTITUTES NOTICE ON BEHALF 0E EM^LpfiC lVS^
NOT!: RETURN THIS IX TICE TOO*^' V."'-
DO NOT MAIL TO INDUSTRIAL ACCIDENT BOARD.
S ec 'yt
TITLE OF PERSON SIGNING NOTICE
SIGNATURE HERE CONSTITUTES NOTICE ON BFHALT Of INSURANCE COMPANY
IA.B. Approved Rev. 1CM-69 Form 204?
rfrORIGINAL"COPY
WC 8262b
x
42425 NCStCETHAT t^PLOi .l? tows-1
EMPLOYER: (facterfwefl fare wik, mJ compter*
ddran, cm-td by tfcte policy od*r wfc.dk opewtiom emtdvcHd fa To
-Celaaeae,, Corporation.
MM
- -Cel Btieae-Plping SyatuHM, Ttuv,.... -------------------ADDRESS:__522. Fifth Avenue, New York.. .Hew ..York--1QQ36.
-v -
LOCATION OF RISK: ENTIRE STATE OF TEXAS
a DIVIDED RISK--EXPLAIN OPERATION COVERED BY THIS POLICY
--See Attached---------------------------------------------------- -
POLICY NUMBER
EFFECTIVE DATE 12:01 AM
CANCELLED
_______ tfC9900fl3-- ------------------1/1/72-----------------
H NEW POLICY
RENEWAL
B EXPIRES AT 12*1 A.M. ON_
INSURANCE CO.^
The Home Tnri. Cn.
1/1/73-
APPROXIMATE NUMBER OF EMPLOYEES: A. Stable Annual Employtnnf:__d!^0UflQBfi8M?8PPPP0WiflQfft?fi@fifiSB--
B. Seasonal Employment by Month:
JAN.
FES.
maT | apT
1
MAY
JUN.
AUG.
jsef. ocr.
t
NOV. 1
I
fttMirhtMMvv-zMtof Chemical, Plastics and Coatings Manufacturing
>cc3p*tion
U
ASM--International T Inc--
ACMTV. MORD BBRBOMKMERB
ID
DEC.
Notice is hereby given by the named employer end the named insurance company, as required by the Texas Workmen's Compensation Insurance Act Chapter 102, General laws, 1917, and amendments thereto, that the above named employer has become a subscriber under said Act and amend ments thereto and provided (or the payment of compensation to employees under the terms and provisions thereof. Any employer or association wilfully failing or refusing to file this notice shall be liable lor and shall pay to the State of Texas a penalty of not mere than One Thousand Dollars
($1,000) for each offense.
EMPLOl/TYECRK SIGN rHtEEKRBE
INSURANCE company S1SN,H
, to
SIGNED:.
'OauU/i
Manager, Insurance Department
TITLE OF PERSON SIGNING NOTICE
ntTT. December 28, 1971________ _____
SIGNATURE HERE CONSTITUTES NOTICE ON BEHALF OF EMPLOYER
NOTE: RET'JRN THIS NOTICE TO:
DO NOT MAH. TO INDUSTRIAL ACCIDENT BOARD.
-Ihe.HG NAME OF INSURANCE COMPAMjfl
--
SIGNED:-
iI'M3 '72 '
^Soc'y. Ftitle cfXAE-$NOdUlmSSEbf2h!aMG not ce 1 SIGNATQC([^Mtfilks>MIN ; ^W^BtHRErOnRSOOTCE COMPANY
I_A_8 Approved Rrtv ICMM form 2069
ORIGINAL COPY
iting % lupp.i o*v WC 8262b
Box 428 '
.
Bishop* Texas 78343 .
Box 58009 Houston, Texas 77058
Box 9007 Corpus Christ!, Texas 78408
P.0. Box 4881 Corpus Cbriste, Texas 78408
P.0, Box 9077 Corpus Christ!, Texas 78408
3623 Apparel Mart Dallas, Texas 75207
2300 Stensions Freeway Dallas, Texas 75207
P.0. Box 1000 Deer Park, Texas 77536
3700 Greenway Plaza Dr. Houston, Texas 77027
513 South Lanar:48traet>^4^^1 Amarillo, Texas ' - 79106
7006 Burnet Road Austin, Texas 78757
2110 Blanco Road San Antonio, Texas 78212
10534 Garland Road Dallas, Texas 75218
1525 Hi-Line Drive Dallas, Texas 75207
2808 White Settlement Rd. Fort Worth, Texas 76107
3301 South Main Street Houston, Texas 77002
2110 Portsmouth Ave., Houston, Texas 77006
1311 East Southmore Pasadena, Texas 77502
Celanese Piping Systems, Inc. 8815 Diplomacy Road Dallas, Texas 752
s*' ^
*\v.**4 '/c;
SHS
__ __________________ . .
............
jr.... ;
$:?' (k>ncE that
a-.ta-itffis. "rrvf4*$.>>Y'-V*^ srMz/:'- . ' ';' '":" ::k':.'
^:'<} r- .. . . -
...: o^'^-
IpTICE THAT EMPLQyER V^AS
.WSM44MWH<rtM>
&'?
' NOTICE THAT EMPLOYER HAS BECOME SUBSCRIBER
TEXAS WORKMEN'S COMPENSATION ACT
NAME OF EMPLOYER: *** m ** <
*W EpmllBM M
I rt rMA, MR emniplMRt SSj)^jl<
CELANESE COATINGS CO.
" $%
6767 Kirbyville Rd., Houston, Texas
2110 Portsmouth, Houston, Texas
3701 Kirby Bldg., Houston, Texas
3301 Main St., Houston, Texas
IE
3515 Swiss Are., Dallas, Texas
10534 Garland Rd., Dallas, Texas 1525 Hi Line Dr., Dallas, Texas
JUl a 1388'
513 So. Lamar St., Amarillo, Texas __,Art...
4420 Padre Island Dr., Corpus Christ!, 'TexM INDUSTRIAL
White Settlement Rd., Ft.Worth, Texas /'CC'D'rr.!7 fln/ion I
1311 Bast Southmore, Pasadena, Texas
2110 Blanco Rd., San Antonio, Texas
NEW POLICY
N 241 WC 13-
LOCATION OF RISK:
RENEWAL OF POLICY
no- 131-WS_a.
Q ENTIRE STATE OF TEXAS
i I If divided rtek, give operation covered Lr thit policy
EFftCTIVt AT 12:01 A.M. ON
July 1, 1968
EXPIRES AT <2:df aTmToN
July 1, 1969
OCCUPATION
Paint Mfg.
AGENT OR BROKER
Compass Insurance Agency
NUMBER Of EMPLOYEES
estimated annual payroll
**
400 Park Avenue, New York, New York
Notice i* hereby given by the named employer and the named insurance company, as required by the Texas Workmen's Compensation Insurance Act, Chapter 103, General Laws, 1917, and amendments thereto, that the above named employer has become a subscriber under said Act and amendments thereto and provided lor the payment o compensation to employees under the terms and provisions thereof.
EMPLOYER SIGH HERE
siANfrv
sys*... .
Assistant Secretary
datf
July 11. 1968
SIGNATURE HERE CONSTITUTES NOTICE ON BEHAlf OS EMPLOYER
- *f " J. Arc WC 82*2
INSURANCE COMPAHT SIGN HERE
The Pennsylvania Insurance Co.
MAHC OP INIURAMt CAWPANV ON AaieCIAFrOI*
200 Park Avenue, New York, N.Y.
Si^Mpn
' --A--Jo.
lFLi OP PC*Ofe IliRlM follX* SIGNATURE HERE CONSTITUTES NOTICE QN BEHAlf Of INSURANCE COMPANY