Document RprgK09rzoxa9r0JpQeGBxnGv
lAlVlt'JtKllMj WJLlti IJUIIS LAJSLL
NULLIFIES THE CERTIFICATION
VIRGINIA A. MAY
ACTING EXECUTIVE DIRECTOR
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 ofthe State ofTexas, DO HEREBY CERTIFY that the attached are complete copies of the IAB 20's(Notice that Employer has become Subscriber) for the period of 04-01-73 to 04-01-78 for:
Standard Oil Co ofTexas MBI#93 6761100
I FURTHER CERTIFY that I am the lawful possessor and custodian of the records of the Texas Workers' Compensation Commission of the State ofTexas.
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 ofAustin, Texas on this 4rd day of May, 2001.
"This document is signed under the authority delegated to me by Virginia A. May, Acting 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.
Am Equal Opportunity Employer
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'ADDRESS: 3230 AUb*a*
El Paao. Texas 79930
LOCATION OF RISK: O ENTIRE STATE OF TEXAS DIVIDED RISK -- EXPLAIN OPERATION COVERED BY THIS POLICY
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POLICY NUMBER
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EFFECTIVE OATC IXtOt AM
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.. ustim iwunAMcy'CoAvl
410 020851 6 QQ RENEWAL
^APPROXIMATE NUMBER OF EMPLOYEES:
April 1. 1977
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^OCCUPATION .....
^ Saaford^Greve-Perry
2$07 E Yandell , 1. Paso, .Texas 79903 .
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FCiLICY NUMBER
EFFECTIVE DATE 11:01 AM
VC 77 26 67 ,.; 4*11 1, 1976,;............. ...
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INSURANCE 'SO. > UastcbsatW ...
NEW POLICY
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jaOBpEXPIRES AT 12:01 AM. ON 4wrfl 1 1*77
gAPPROXIMATENUMBER.OF, EMPLOYES:
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|B,\Seatonal Employment by Month:
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MtferilWiky'ifiM hy'ttei MiMd^Mpicyr Md tta`N^'hMnd^OMp(Ry, f rutered bjr'ttwkT0<t .Ktortmu't Comp6n<iarJ>>iwr
iq^l^ewwl Lm, 1917, fld amandmanb tlknb, tM ttM ibow.iiMMd wtfqrtr hit teamr* wtocfibef under aid Act md:il
Md proviM for tin pcynttnt of compilation to ompteyttt ondtr tt ttnu Md provisions thsreof. Any employ* ortssoc
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*'; 'LOCATION OF RISK Jt SATIRE STATE OF TEXAS
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DIVIDED RISK --EXPLAIN OPERATION COVEREO BY THIS POLICY ^
POLICY NUMBER 39 59 78
"* ' * EFFECTIVE DATE 12*01 AM April 1, 1975
" CANCELLED
INSURANCE * CO,":' WaitchMtcr^
:' NEW POLICY
30 RENEWAL
0XEXPIRES AT 12.01 A.M. ON April 1. 1976
H __ p; ` APPROXIMATE NUMBER OF EMPLOYEES:
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i ty tfia Tna* Woritmea's CM$Sftab|ap
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ht become a subscriber --(--vr" * "
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-r,O, FredWegnog, dba Fred'e Chevron & Standard Oil Co, of Texae ,:.
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H Peo. Toxee 79930
^LOCATION OF RISK: ffl ENTIRE STATE OF TEXAS
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DIVIDED RISK --(PLAIN OPERATION.COVERED.BY.THIS POLICY cfli
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POLICY NUMBER
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CANCELLED
INSURANCE CO.^
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WC 39/60/18 -Ap.rn.l,.t974________________
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fern NEW POLICY
Q RENEWAL
0 EXPIRES AT 12.01 A.M. ON April 1, 1975
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. APPROXIMATE NUMBER OF EMPLOYEES:
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jf'ADDRESS:
3230 Alabama, El Paso, Texas
I'lOCATION of RISK: ENTIRE STATE OF TEXAS
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\> , DIVIDED I--EXPLAIN OPERATION COVERED BY THIS POLICY ' ^$6
POLICY NUM11P
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CANCELLED
INSUPANCK CO.
WC 03 90 86
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RENEWAL
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EXPIRES AT 1201 A.M. ON_
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aaata Nana mi provided for th* paymant of twnpcwaifton to aaploym andrr ti trrms and prortstaw tfwaof. Ay aaptufai'.1 NBwBBBSiBj
rilMjy fafSaf or renMaf ta flta thi* aoiict (M ba BaWafor and aMl.pay to tha Stata of Tam a panatty of not more than Ooa Ttxxnaod p8ate
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EL Pagcu--SCaxag '^799^
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- ^'"Special A?ent
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l,OPP^PON SIONiNO NOTtC
^.MMOURE.intE cotcsTmirai ^ W INSURANCE.COR
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