Document OMk9gnBypdJ1OExn6nVpQ6Yj

FILE NAME: Talc (TALC) DATE: 1976 DOC#: TALC481 DOCUMENT DESCRIPTION: W orker's Compensation Claim and Public Liability Report R . G . BRRDRII 9 S ^ i v i s i e n ' Srctejn JOUR?. -' '-'.'-.'''I L I T-'. GOR?PR ATj.ON v. ~;-r t e 1 r r , \ ^ r `'~ " Tr ';______ sr.; PUFLlC LTAFILI' p?o: - C T!?- 50-G-8 0 .1 /7 6') Report of A ctusl Veyroi-i F o r Qu a r t e r E n d i r - t - . . " 1 9 Cross -1-- 1 s) J ^ -eiusrec ( ._y j Lxcess | i\et in s tr a c le ; i Cc, i F a y r e l l j Quart ers Grosg Qu r t s r s Premiuri Gross Pavrollj Unit 1 Pavroll Cl s s s i f i e c i c-r. i- ': T> i: i r -G Osee ] Pevroll Or. UVc CIT: ci (1 - 2 ) ' 1 ' ;'St s . t e L i t t i i ] ; ( 3 ' - L) . . ' - ` i 1 5=^ O --- ; \ 1 ii - 1 ` r>* ' ' " . / p <r V/ r_ . i _ . _ v 1 A"" -' I S * 5.- - __________ - -- -F-- -------:------ --------:------- i' - i - t .1 - . i . ! ' i - I K 1' ( r.3 Ce . l js io o o f . . c c r u e c . j p a y r o l l . ,(6 5; i\ ! j__ \ \ -tr-- - ! . ` ! , n KH 0Ooo1 -- ----' !.St -- ``:* - 05 __________ _---i:-v.--v-w:-:- - ' --. . .........i.-. --~----"-rtJ!r.r /3 ^ f 11/5/75 Rvision 'Acdits on ; = . ,-- i ,- * irlaa? :AR:AvwA;vH;iR>#A:GAi^ m i *S. ! i r~.~______ --;1------,----:-- ! -- ! - ...i-----' !;-------i* _ . .-. i . V _i . .O'" /:" f ` kxKRibi^ixouix . i--' prepared-bv ' ~ - ' " : .-o -0 ` -' at ? r : .53j 551,'97, 9y & -`(j.^^r-s-*-*'*V * ' ) LOMPOC Ti.G. BORDEN 98 d - 7 '/ _oc o c i o n P I v i s i o n /Co de J~\ Q. 's JOHN'S - MANVI ILK CORPORATION W m rFRg ' COMPENSATION and ; PUBLIC LIABILITY REPORT . Form.5080-8 (11/76) Jr ') J l Report of Actual Payroll . jrcitis for S ta te of ; -xus- a ra n c e -1 Code ; C l a s s i f i c a t i c n | if For Quarter Ending irA .i 2 |i .3 .4 | 5 Payroll Yr t o Date ' Quarters Gross Q uarters Adjusted Premium Gross Payroll nxcess Unit P a y r o l l . On Overtime (1 - 2) State Limit Ret in su ra b le Payroll (3 - 4) ? / b / i < 7 7 6 I' 7 Kate Per! " P r e m iu m $100 o f j Accrued Payroll (6x5) : Clerical | 8310 /1i, ./r M /a f/?- ; -' <7 ! / / 2-^ i * O '. . n i ` fhi-f3i 1<" ^ n . . oO> -. _ .............. ........ oN> VUO> `. . L;'-L. xxxxx. . XXXXX \ TOTAL FROM ABOVE xx xxxxxxXx l l Li : '\ 1 1 61C{ . \. K \ * \ 11M ( L _ 1 ____ l ______ : yiju f- \ " ! /2 `7 9 I _________ 1 1. * \ / r[ f !\ A t! "t I . / L / \i 1 . 'i --f -- 7 , ." / I : > > XKXXXXXXXXX) :x>:xxxxxxxxxx: :xxxxxxxxxxx k x x x x x x x x x x x x x XXXXXXXXXXX.' .xxxxxxxxxxxx: x x x x x x x x x x x tx x x x x x x x x x x x x .a r J ^0' LU C 11/5/76 * R e v is io n ** Addition. b Prepared by , at ) / /// / -y-- <17 r . / 53,551,97 ,98,-99 /-V b? "v^ i> v.'.lA,* rV 1- " ` , t - W* ^ ifi- . w + A J < - $V 9 A> Ai^AA-: cAbb U't' iStey C%` f e ? . "4 LOMPOC R . G , BURDEN 98 . JOHNS-MAIVILLR CORPORATION ' ' . wniVFRg r r - ^ H ^ A T l o a ...... . and . - 3931 9 CRMC-HT-TALC-000240 1.1/5/76 * R evision ** A ddition - jcj ' M * LOMPOC p Q BU^DEH $8 ' ' ' ` o si ^ in - a tir n P ir is i e n 'l;Y e -O , j & X A L- ~~ C ? ~ ' 5 . , P e r r r t ir.o f c r 9 .~ .i tr.a a i______ ' i,, A s .- jA -i._________ JOHNS-HAMVTLLE CORPORATION w n R N K H S '- r p y p ^ ^ r r o ? ^ ST.d PiJBLI C ' L I ABILITY REPO RT Form/5030-S ' ' (11/76) . - 3931. 9 Report of Actual Payroll For Quarter- Ending $ /3 / / 1 9 V 7 i ;--?r*i---------------- i 1 i r.surence | Code - c l a s s i f i c a t i o n i " Payroll 1 Yr t o Dace -- ! . i Quarters uros s Payroll 2 3 i _4 j 5 , Quarters Aajus tea E x c e s s . Net i n s u r a b l e premium Cross Payroll Unit Payroll On O v e r t i m e (1 - 2 ) ' S t a t e L i m i t ' ( 3' - 4) 6 1' 7 Kate P e r Premium $100 of Accrued Payroll (6 x' 5) . . . Clerical : Jl-A . S310 / < - - 3 Z .6 i f C 0 9 :r ...X r?" ^ _.... ' * ^ js r - ` .3 t ^-0 " _ * * \ * 1 1 2 H -4 > f - , ^-J > i' ; ; ,3 i .. t - \ ' ` , ; S ~ ' . . i s i ! i Q-C-TAl, `yccoLi nvrv 3 1" I'.-.:. U xxxx FROM ABOVE xxxxx ! - ` co | /V//! ' - 1 | ' -irO""" . I' ^<2. . M r"' . -c - xxxxxxxx>cix:Ux;axxx:o:xxx' x u ix p p x x x CXXXXXXXXXXXXX --jx>ix:cvc<:oc<x:{:co;:axxxxxx>L' cxxxxxxxxxxxxx 1- * 1 1 /5 /7 6 * Rev1s 1on ** A d d itio n - P r e p a r e d by at *-**.! ' A ! f a f j '.fS .I^-sm f, ' l:L 53,551,97,93,99 5;U:'1 f'l.-CI'Aj" 'r . T-J -"^- c-<~*-r^ r , i iR ii 393? b j s . buboes m Pi v i s i o n a i ; : s- r'X ! _ _ ; X X ,, = - i f TO H KS-^VTI-LE CO KPO RATIO l ^.tri^KFR^ 1 c o p c-ATI QIi------ ,? '?>>./ L- r~ ~ r T .T A 5 I1 IT Y R S P O ^ l____ P e rm ^5 t t -5 V r .-/ ^ J Report: of Actual P a y r o ll . - / " ' , P o r Q u a r t e r E n d i n g / > " -rV'...T-9-- i G l OJ3 _ T-1* i Payroll j ; Y r co Date i ! . { -j- - ... Quarters Gross Payroll ; Quart Premi On Ove T Adjus tec li U n i t I Payroll Is t a t e L im it I (3 - 4) T T $100 or (Payroll iJr e r r u n Accrued (6 :: 5) - - . 1 d ie ; X X " ' ! *--.-- ---- " ' f j ^ 1 --""-s"', t y ii ; ui-Z/l /Iu5~ / /. Revision iition- X , <^---10. -S' / O . '=? 53 a5 5 1 , 9 7 ,9 3 , 99 '^0-000243 ,"V` '.* ''' :: . /Z : : S:z:- jGBNS-MANVI LLE CORPORATION WO R KMEN'S CQMPEN SATO N and PUBLIC LIABILITY REPORT Report oi Actual Payroll ' o r or Quarter Ending .- ..TO 59 A 3=iS 5CSC-S'- {7/741. ; LLAA A p p r o v e d b y : ^ ______________________________;_____ R. G. BURDEN, P l a n t . C o n t r o l L a r . r : v - / :. -/. ' .....:.-r y v a''.- y v : . ,y.p;i ' ;.v;;p:.y,Ava : .ty.jj-ir.r. CRMC-HT-TALC-000246 -j. - ` r - ; t I s' 1 I / . 'T'..T / h . - e v / e s r% '= Z ' JOHNS-MAX V IL L E C O RPO R ATIO N WORKMEN' S COMPENSAI ION and PUBLIC LIA B ILIT Y REPORT / *> /V-t - / X i t f l M fr - 0 A +X 1 Report of Actual Payroll ' . . - For Quarter Ending io / 1* Ensu'snca ' Cj ... coi V-' / T T r - , . " ' !' * t'cae j \ N um b er ,j : s ; | ; J j 3310 1 > - Gross * P ^ y r o 1! . ,? 7 y q . Premium . On Overtim e* - . '- e - ' j' n ? . 1 / O V / Z S j j \ \ . i : l -j1 i * - . `] , ` i . 3 ?32 3 Adjusted Gross Payroll (1 - ?.) 3X V ? / fB g s ' - .. 4 Excess U nit State Lim it* 5 : N e t Insurable `Payroll (3 - 4 ) ! .6 -- -- ------------- Rate Par S1C0 of P a y ro ll* * 7 . Premium ` Accrued . IS X 5) , ? 2 L/ q / / zc( 3 .2 /? , .. i --------- cs.-.-s --o-- / f i / J / f 2 ,1 X 1 ' i: 1 f ! . -j . . - F./' 3 l - i ' *v . ' TOTA t 5 X X X X X X a X X X X x ; ! /0 ^ 3 ^ J f? ct / - J A, / o K /v y v '/ V V n . ____ , _ ' fX X X X X X 1 . _ _ ./ !xxxxxxxxxxxx x x x x x x x x x x x x xxxx-xxxxxxxx: xxxxxxxxxxxx . J i-RQ.V: A B O V E jX X X X X X j / 0 7 X / T |X X X X X X X X X X X X x x x x x x x x x x x x x x / x ^ x x x x x x x : < x x x x x x x x x x x y xx ! / / / / 7 , r ; wc ?L r-.sriy Payroll. Report, General Instructions (Systems.. 3931) :i.-c Annually by. Corporate Insurance Department ' S030-S 17/?*) . . .Prepared by: . \$ flh fsi*c u // J / M T H c n n e s s y , Loxnffc. P l a n t (/ - A pproved by: R^G, Burden* P l a n t C o n t r o l l e r rrf^b. Total / ( o - 3 3 . XI / \ \ , \ :.r y- \ CA A)\'0. W O H KIV!EM'S COMPENSATION ori'J PUBLIC LiAB'-.iTY REPORT Roper'; of Actual.. Payroll Fo r Quarter .Ending' x C 13 3 k ' Cede r i Member i Gross Payroll P rem ium On O vertim e * 4 .... ] -. 5 6 ! 7 . Net insurable Rate Per j premium oil Excess U n it . . Payroll ' S I 00 of ] ' Accrued State L im it" (3 - 4 j Payroll * * ] !5 X S) 1 ' 8rL'0*)fK )TVI"LH "O W ) S310 ~\\ r- =X_ 3.0ei.1 ! XX>C<XX .!- |X X X X X X | ryxxxx ? CI U xiA I. L \ / \ / A / \ / V A * - ` 1 i - ! o .> L \ I ! .3. A A d IA A i W 1 ' 1i } \ ' * i t 1 1 * i ' --------- --- .-- j ... : . i . j i \ i~ ~ X A / \ . V XXX X X XX X AXX X X X X k X XX XX XX X XX X v X X X l< X X X X X X X X X X X X X X X X X X X X X X X ' ,< > * .1 . A 1 V.'C !- ci n l t 5 . 3 0 > ,U < s s i Q ) -1 /. . ? A S r i O e a rti- iy Payroll Recor.:. General Instructions (Systems 3S3T) SMccled Aor.uaPy by Corporate Insurance Department ' .. . . '\^X '3 m L Ma Y'ivCYSN, JO HNS-iViAM VIL WOR K,V1EiSi'S COi.iPE NSAT ION WOR K.VIE:\i 'S COIliPEN SAT ION Tiflc S a le s -- Tons D om estic and Canada A/ijniUaAlyy s oi.s-. b yx T o n s - - D i n t r i b u t i ' o n o f G r a d.e...s- ...b...Ay-.. H r t e t M onth/Yoar Ceram ic P a in t P lastic Paper T otal Aug/1973 ' 2,343 1 ,-458 . - 397' 639 . ' Sept/1973 1,805 897 386 865 O ct/1973 2,637 1,151 301 . 848 N o v /1 9 73 . 2,640 1,118 530 1,365 Dee/19 73 1,989 808 317 1,365 Jan/1974 2,377 944 334 1,01P Feb/1974 1., 6 5 3 1,002. 34 3 1 , C69 M ar/1974 'A pr/19 74 1,731 2,086 1,106 1,059 ' 650 547 789 1,14 5 May/1974 . 1,973 1,090 . 433 1,338 June/1974 o u iy /iy /4 2,037 . 1,769 1,011 110 1,24b , 87 .1,007 ' 1,19 U ' 1 1 A ug/1974 1,941 1,006 204 ,1,128 Sp p t / 1 9 74 1,918 881 151 90 4 O ct/1974 2,652 1,092 251- 971 N o v /1 9 7 4 2,161 ' 552 165 554 . D ec/1 9 7 4 1,846 506 149 .404 Jan/1975 F e b /1 9 75 1,594, 2,117 807 . 273 619 101 4 84 3,15 8 443 3,280 * * # ' ' * ' Plann Tt.a , -3,2 3,2 . - ! _ CRMC-HT-TALC-000205