Document dnXNa4xrXBvDMkE3RryQpyLvb

SYM POLICY NUMBER WLR C3 91 21 74 8 PACIFIC EMPLOYERS INSUR .CE COMPANY Q New; SYM WLR SI Renewal: D Rewrite of: PREVIOUS POLICY NO. C37375196 NCCI CARRIER COOE 10677 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY CIGNA FAC.REINS YES NO X 1.0.0. MFG RATE PLAN RT.PLN.CO. PERIOO LPR 12 SPEC.ACCT. SAFETY GROUfi YES NO X YES NO X YES TARGET RISK NO NUMBER X S800064012 COMMISSION PER CENT AMOUNT NC Item i. The Insured [REYNOLDS METALS COMPANY REYNOLDS METALS BUILDING RICHMOND, VA. 23261 Mailing Address j__ Inter/lntrastate Identification No.: 91 0000000 PIIC CODE: 33999 PRODUCER BILLED Q Individual O Partnership 0 Corporation PLAINTIFF'S EXHIBIT Employer's identification No.: Other workplaces not shown above: STATE OF TEXAS Item 2. Policy period from 09--3Q--92 to 09"30"93 ' RMC-5'9i 1 2:0 1 A.M., standard time at the insured's mailing address. item 3. A.Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: TEXAS B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in Item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident S 1,000,000 each accident Bodily Injury by Disease $ 1 ,000 , 000 policy limit Bodily Injury by Disease $ 1,000 , 000 each employee C. Other Stales Insurance: Part Three of the policy applies to the states, if any. listed here: Item 4. The oremium for this policy will be determined by our Manual of Rules. Classifications. Rates and Rating Plans. All information required beiow is subject to verification and change by audit. Classical ons Premium Basis Rate Code No. Estimated Total Per $100 of Estimated Annual Remuneration Remuneration Annual Premium ARTICLE 5.76-1 OF THE TEXAS INSURANCE CODE RE QUIRES THAT YOUR INSURANC:e company PROVIDE AND MAINTAIN ACCIDENT PREVENTION FACJ ILITIES TO YOU THE POLIC YH[OLDER. CONTACT YOUR INSURANCE COMPANY FOR FURTHER IINFORMAL ION. RAS TEXAS CLERICAL OFFICE EMPLOYEES--N.0.C. 8810 74 SALESMEN, COLLECTORS OR MESSENGERS -- OUTSIDE 8742 1.54 BUILDING MATERIAL DEALER: ALL OTHER EMP LOYEES D 8232 22.32 RSC BUILDING MATERIAL DEALER: ALL OTHER EMP LOYEES D 8232 22.32 Minimum Premium S 1000. COLLECTED If Indicated nere. mienm adjust ments of C'emium will be made: O Semi-Annually This policy ncluaes these endorsements and schedules: IN KY D Quarterly WC 000406 Total Estimated Annual Premium S (PAGE 1 CONTINUED Monthly Deposit Premium S 420301C 420306 420405 990608. agency nc 245177 MARSH MCLENNAN INC. Countersigned By PO BOX 1857 RICHMOND VA 23215 MARKETING OFFICE: PHILADELPHIA CKE-4266a s'.a. U.S.A. Copvngnt 1997 Nronal Council on Compensation insurance (AuthonreU Agent) S.R 92307 DOC PRODUCER'S COPY B.001412 6176A PHU WC 00 00 01A Sym WLR POLICY NUMBER C3 91 21 74 8 1 PACIFIC EMPLOYERS INSUf XE COMPANY New; S3 Renewal; 0 Rewrite of; SYM PREVIOUS POLICY NO. WLR C37375196 NCCI CARRIER CODE: 10677 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY CIGNA FAC.REINS YES NO 1.0.0. MFG RATE PLAN RT.PLN.CO. PERIOD LPR 12 SPEC.ACCT. SAFETY GROUP YES NO YES NO YES TARGET RISK NO NUMBER COMMISSION PAR CLASS PER CENT AMOUNT S800064012 NC item 1. The Insured [REYNOLDS METALS COMPANY REYNOLDS METALS BUILDING RICHMOND, VA. 23261 Mailing Address |__ Employer's Identification No.: Other workplaces not shown above: STATE OF TEXAS Item 2. Policy period from 09"'30--92 to 09--30"93 Inter/Intrastate Identification No.: 910000000 PIIC CODE: 33999 PRODUCER BILLED Individual Partnership 1X1 Corporation 1 2:0 1 A.M.. standard time at the insured's mailing address. Item 3. A.Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: TEXAS B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in Item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident S 1,000,000 each accident Bodily Injury by Disease $ 1,000,000 policy limit Bodily Injury by Disease $ 1,000,000 each employee C. Other States Insurance: Part Three of the policy applies to the stales, if any, listed here: Item 4. The premium for this policy will be determined by our Manual of Rules. Classifications. Rates and Rating Pfans. All information required below is subject to verification and change by audit. Classifications Premium Basis Rate Code No. Estimated Total Per $100 of Estimated Annual Remuneration Remuneration Annual Premium SALESMEN, COLLECTORS OR MESSENGERSQUTSIDE 8742 1.54 CLERICAL OFFICE EMPLOYEES--N. 0. C . 8810 .74 HOUSTON CAN PLANT CAN MFG. 3220 6.22 CLERICAL OFFICE EMPLOYEES--N.O.C. 8810 .74 RAR-TEXAS SALESMEN, COLLECTORS OR MESSENGERS' OUTSIDE CLERICAL OFFICE EMPLOYEES--N.O. C. 8742 8810 1.54 .74 Minimum Premium S 1000. If Indicated here, interim adjust- ments of premium will be made: This policy includes these endorsements COLLECTED O Semi-Annually and schedules: IN KY Q Quarterly WC 000406 Total Estimated Annual Premium S (PAGE 2 CONTINUED 0 Monthly Deposit Premium $ 420301C 420306 420405 990608 AGENCY NO 245177 *1ARSH MCLENNAN INC. Countersigned 8y =>0 BOX 1857 RICHMOND VA 23215 MARKETING OFFICE: PHILADELPHIA CKE-4266a ?td. m u.S.A. Coovfight 1987 Nfonal Council on Compensation insurance (Author red A genii S.R. 92307 DOC PRODUCER'S COPY B.001413 6176APHU WC 00 00 01A SYM WLR POLICY NUMBER C3 91 21 74 n 8 PACIFIC EMPLOYERS INSU. JCE COMPANY 0 New SYM WLR (2 Renewal; 0 Rewrite of; PREVIOUS POLICY NO. C37375196 NCCI CARRIER COOE: 10677 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY CIGNA FAC.REINS YES NO X I.O.O. MFG RATE PLAN RT.PLN.CO. PERI 00 LPR 12 SPEC.ACCT. SAFETY GROUP YES NO YES NO YES XX TARGET RISK NO NUMBER COMMISSION PAR CLASS PER CENT AMOUNT X S800064012 NC item i. The Insured [REYNOLDS METALS COMPANY REYNOLDS METALS BUILDING RICHMOND, VA. 23261 Inter/Intrastate Identification No.: 91 OOOOOOO PIIC CODE: 33999 PRODUCER BILLED Mailing Address j_ Individual 1X1 Corporation 0 Partnership I~~l Employer's Identification No.: Other workplaces not shown above: STATE OF TEXAS Item 2. Policy period from 09"30"92 to 09*-30"93 12:01 A.M.. standard time at the insured's mailing address. Item 3. A.Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: TEXAS 8. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in* Item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 1 ,000 , 000 each accident Bodily Injury by Oisease $ 1 ,000,000 policy limit 8odily injury by Oisease $ 1,000,000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any. listed here: Item 4-. The premium for this policy will be determined by our Manual of Rules. Classifications. Rates and Rating Plans. All information reduced below is subject to verification and change by audit. Classif'cat ons Premium 8asis Rate Code No. Estimated Total Per $100 of Estimated Annual Remuneration Remuneration Annual Premium CAN MFG. 3220 6.22 MALAKOFF INDUSTRIES CLERICAL OFFICE EMPLOYEES--N.O.C 8810 .74 SMELTING --ELECTRIC -- D 1438 7.61 RAW - SHERWIN ALLMINI A STEVEDORING N.O.C. 7309F| 109.91 CLERICAL OFFICE EMPLOYEES--N. 0. C 8810 .74 CALCIUM CARBIDE MFG Z D 1438 7.61 EL CAMPO ALUMINUM Minimum Premium $ 1000. If Indicated here. interim adjust- ments o< c-emium will be made: This policy mciudes these endorsements COLLECTED 0 Semi-Annually ana schedules: IN KY 0 Quarterly WC 000406 Total Estimated Annual Premium $ (PAGE 3 CONTINUED) 0 Monthly Deposit Premium $ 420301C 420306 420405 990608 AGENCY NO 245177 'lARSH Z MCLENNAN INC. Countersigned By PO BOX 1857 RICHMOND VA 23215 MARKETING OFFICE: PHILADELPHIA CKE - 4 266a td. m U.S.A. Copyright 1987 M'^onal Council on Compensation insurance t Author ued Agent) S.R. 92307 DOC PRODUCER'S COPY B. 001414 6176A PHU WC 00 00 01A SYM WLR POLICY NUMBER C3 91 21 74 8 PACIFIC EMPLOYERS INSUf ICE COMPANY New SYM WLR FAC.REINS YES NO X H Renewal; 0 Rewrite of; PREVIOUS POLICY NO. C37375196 NCCl CARRIER CODE: 10677 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY CIGNA I.O.O. MFG RATE PLAN RT.PIN.CO. PERIOD LPR 12 SPEC.ACCT. SAFETY GROUP YES NO X YES NO X YES TARGET RISK NO NUMBER COMMISSION PAR CLASS PER CENT AMOUNT X S800064012 NC item i. The Insured [REYNOLDS METALS COMPANY REYNOLDS METALS BUILDING RICHMOND, VA. 23261 J_Mailing Address Employer's Identification No.: Other workplaces not shown above: STATE OF TEXAS Item 2. Policy period from 09--30--92 to 09--30--93 Inter/Intrastate Identification No.:9 10000000 PIIC CODE: 33999 PRODUCER BILLED Individual 0 Partnership 1X1 Corporation 0 12:01 A.M.. standard time at the insured's mailing address. Item 3. A.Workers Compensation insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: TEXAS 8. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in Item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 1,000,000 each accident Bodily Injury by Disease $ 1 000,000 policy limit Bodily Injury by Disease S 1,000 000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any. listed here: Item 4. The premium for this policy will be determined by our Manual of Rules. Classifications. Rates and Rating Plans. All information required below is subject to verification and change by audit. Classifications Premium 8asis Rate Code No. Estimated Total Per $100 of Estimated Annual Remuneration Remuneration Annual Premium ALUMINUM WARE MFG.-FROM SHEET ALUMINUM mmm3227 11.79 CLERICAL OFFICE EMPLOYEES--N. 0 . C. 8810 mmm .74 mm PRESTO CLERICAL OFFICE EMPLOYEES--N.O. C. 8810 mmm .74 mm SALESMEN, COLLECTORS OR MESSENGERS -- OUTSIDE 8742 1.54 -- INCREASED LIMITS (PART TWO) 2.00% (MINIMUM PREMIUM $ 150.COLLECTED IN VA) PREMIUM SUBJECT TO EXPERIENCE MODIFICATION TENTATIVE EXPERIENCE MODIFICATION Mi Minimum Premium S 1000. COLLECTED If Indicated nere. interim adjustments of D'emium will be made: O Semi-Annually This policy ncludes these endorsements and schedules: IN KY Q Quarterly WC 000406 Total Estimated Annual Premium S (PAGE 4 O Monthly Deposit Premium $ 420301C 420306 420405 990608 AGENCY NC 245177 1ARSH 8 MCLENNAN INC. Countersigned By =0 BOX 1857 RICHMOND VA 23215 MARKETING OFFICE: PHILADELPHIA CK6-4266a 3td ** U.S.A. Copynqnt 1987 N*-onal Council on Compensation Insurance (Authorised Agent) S.R. 92307 DOC PRODUCER'S COPY B. 001415 6176A PHU WC 00 00 01A SYM WLR POLICY NUMBER C3 91 21 74 "1------------- 8 PACIFIC EMPLOYERS INSU. JCE COMPANY O New SYM WLR 0 Renewal; O Rewrite of; PREVIOUS POLICY NO. C37375196 NCCt CARRIER CODE: 10677 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY CIGNA FAC.REINS YES NO X I.o.o. MFG RATE PLAN RT.PLN.CO. PERIOD LPR 12 SPEC.ACCT. SAFETY CROUP YES NO YES NO YES XX TARGET RISK NO NUMBER COMMISSION PAR CLASS PER CENT AMOUNT X S800064012 NC Item 1. The Insured [REYNOLDS METALS COMPANY REYNOLDS METALS BUILDING RICHMOND, VA. 23261 Mailing Address |__ Employer's Identification No.: Other workplaces not shown above: STATE OF TEXAS Item 2. Policy period from 09"30~92 to 09--30"93 Inter/Intrastate Identification No.: 910000000 PIIC CODE: 33999 PRODUCER BILLED Individual Partnership Corporation f~1 12:01 A.M.. standard time at the insured's mailing address. Item 3. A.Workers Compensation insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: TEXAS B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in Item 3.A. The limits of our liability under Part Tv.o are: Bodily Injury by Accident S 1,000,000 each accident Bodily Injury by Disease $ 1,000,000 policy limit Bodily Injury by Disease $ 1 , 000,000 each employee C. Other States Insurance: Part Three o' the policy applies to the states, if any. listed here: Item 4. The premium for this policy will be de:ermmed by our Manual of Rules. Classifications. Rates and Rating Plans. All information required below is subject to verification and change by audit. Classifica: on$ Premium Basis Rate Code No. Estimated Total Per $100 of Estimated Annual Remuneration Remuneration Annual Premium PREMIUM ADJUSTED BY EXPERIENCE MODIFICATION LOSS CONSTANT ( $10. IF APPLICABLE)) ESTIMATED STANDARD POLICY PREMIUM LESS PREMIUM DISCOUNT DISCOUNTED PREMIUM (INCLUDED IN POLICY PREMIUM OF $ MAINTENANCE TAX SJRCHARGE (01.5003 ) ADDL. MAINTENANCE TAX SURCHARGE (0 .926%) EXPENSE CONSTANT 0900 Minimum Premium S 1000. COLLECTED If Indicated here, nterim adjustments of premium will be made: Semi-Annually This policy "deludes these endorsements and schedules: IN KY Q Quarterly WC 000406 Total Estimated Annual Premium $ (PAGE 5 LAST PAGE) Q Monthly Oeposit Premium $ 420301C 420306 420405 990608 AGENCY NO 245177 "1ARSH Z MCLENNAN INC. Countersigned By = 0 BOX 1857 RICHMOND VA 23215 MARKETING OFFICE: PHILADELPHIA CKE-4266a td U.S.A. Copr'ignt '987 Nr jna i Council on Compensation Insurance (Authori.'ed Agent) S.R. 92307 DOC PRODUCER'S COPY B.001416 6176A PHU WC 00 00 01A i