Document xz5DY8dVgw4MKzwLe4xObZewy
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 9(Notice of Cancellation of Compensation Insurance) and LAB 20(Notice that Employer has become Subscriber) for the period of 01-01-69 to 05-01-87 for:
American Hoechst Corp MBI#924861300
I FURTHER CERTIFY that I am the lawful possessor and custodian of the record^ 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 6th 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
amm
r<r .rvH jfe ,\ikfc^.~<&
>r *4*'wffir'SiS
' ^.vr f 3 ~r-'fly'taftrt ban Hoechat Coro
ADDRESS:
Route 202-206 Worth - Somerville. Nev Jergev
LOCATION OF RISK: 0 ENTIRE STATE OF TEXAS
DIVIDED RISK--EXPLAIN OPERATION COVERED BY THIS POLICY
ii.fm Mijy
r~
POLICY NUMOCR
WC 344 8013
EFFECTIVE DATE 12 01 AM
1-1-77
1 '
____CANCELLED____ INIUMNC8 C
Transportation. 9
Insurance
NEW POLICY
0 RENEWAL
EXPIRES AT 12:01 A.M. ON. ____ \z\z2t.
APPROXIMATE NUMBER OF EMPLOYEES: A. Stabl* Annual Employment:--------______ _ B. Seasonal Employment by Month: I JAN | FE~ J MAt
Mr' ag-t :< ""! -I
OCCUPATION
_____Pharmaceuticals
aot or broke*
Johnson & Higgins
AOORCS8 95 Wall Street
CITY New York
CTATt
NY
xie
10005
Notice Is hereby given by the named employer end the named insurance company, as required by the Tout Workman's Compensation tamnea ML Chapter 103, General Laws, 1917. and amendments thereto, that the above named employ* has become subscriber under ufd Act and amend ments thereto trd provided ter the payment of compensation to empluyees under the terms and provisions thereof. Any employer or association wOtejhr ferkftf or refusing to 1ie this not.r* shall be 'labie ter and shall pay to the State of Tern a penalty of not more than One Ttmnttd OoQars (J!,D0u) for neh offeme.I
gMPLOYER SIGN HWE
T
I j INSURANCE COMPANY SIGN HERE
SIGNED
x^JL
JfXa*v.fi^EA._ tiww.
U}>^.titlc or pfrson siGNiN<yj*OTtcr (4joc<L^lI
Transportation Insurance Company
NAME or iNRimturr COMPANY on ASSOCIATION
C:nNaA pPula.in - Chicago, Illinois 60665
OOffefi*
DATE
I
iSIGNATURE HfRKoh3TIT'jf|HOVZi ON b-.HAl T 0? EVPIOYtR
NOTE Utf>K\ run \OTK.I !(/
I I
:>(s \oi m mi ii) MIs Dilf vvrrhu'Mmf t :i<! m (
IIOAIttl.
^
SiGritu yxi44Ls
%
Hit <,r r-piesON S*CN(NC NOTICE
vIGNATHPf HERE CONSTITUTES NOTICE ON fit HALE Of INSURANCE COMPANT
ORIGINAL COPY
WC 8262b
umn,' atal 'eamtohsr i
*4*
, vwi fey Ifefo.qpttcy.Midff i
gfe--asaBeulu t-Bugp. Hoechst Roussel Pharmaceuticals
ADDRESS:
Somerville., M.J,
LOCATION OF RISK: ENTIRE STATE OF TEXAS
DIVIDED RISK -- EXPLAIN OPERATION COVERED BY THIS POLICY
POLICY NUMSCR WC9703658
errtenvs date 12 01 am 1/1/75
CANCELLKO
NEW POLICY
RENEWAL
X] EXPIRES AT 1201 A.M ON_
iwwiiiAwca ContlaentlO^^M
Casual
tLjSjj
APPROXIMATE NUMBER OF EMPLOYEES:
A, Stable Annual Employment______ ______
8. Seasonal Employment by Month:
Tan. "1 22
fti 23
MM 24
7 AM. | 23
MAY 24
JUN 24
JUl j 24 |
A'J% 24
see. 23
OCT. 25
sw 25
--HE25
Manufacturinq Machinery__________________
__________________________
OCCUPATION
~
____ Johnson & Higgins, 95 Wall St..New York, N.T. 10005
AOT. Of* ftROKtft
ADDRESS
' CITY
* STATS
XIF
Notice is heritor given tor the Mined employer sod the named insurance company, as requited by the Teas
Chapter 103, General Laws, 10; 7, and amendments thereto, that the abcve named employer has t*cgf merits thereto and provided for the payment of compensation to employees ondei the terms and mfleti
faiSng w refusing tn file (Ns notice shaft be liable for and shall pay to the S!gbM|j|0g^
91,000) for each offense.
<wv
*t
Hiociatoi
oof more ttai on Ttamad Mm ^ ,_a
EMPIO'
SIGNED 0ATI_
Insurance Manager
Tine or reason sioninq notice ^January 6, 1976_____
SiGNATUffC MERE CONSTIlUTES NOTICE ON 8EHAIF OF EMPLOYER
NOTE KtTt.'RS HUS SOTlCf: tO
DO SOT MAtl ro 1K!)r<rTRlM. AtUiU.ST t
BOARD.
II
I A.B AcrO'Cr't'i ** i&) SB
'0&B
INSURANCE
Continental Casualty Co.
namc or insurance company on association
!27 John St.,Hew York, M.Y.
SIGNED
/j /UrJfeuW
nti.i or ren&oN siqnino notice SIGNATURE HFRE CONSTITUTES NOTICE ON BEMAlf OF INSURANCE COMPANY
WC 9262b
^Til'^SS/^JSJtei^; ;
NOTICE that| ______ _
i^::<;t?Rrt'IHlt'/icOj
' TWA* WOWMW* <
EMPLOYKt (Ikdidi tl firm mm. *l <wi>M melltes irfdwM, eMrd by tab policy t *w am MMMf? MdoNVKttHJ
The American Hoecht Corp,
ADDRESS:
Route 202-206 North, Somerville, N.J.
LOCATION OF RISK: Q0 ENTIRE STATE OF TEXAS
^ (,-> 5
V'
DIVIDED RISK --EXPLAIN OPERATION COVERED BY THIS POLICY
---=------=--==
>
v ''.life.
policy NUMnsn | KPPKCTIVK OATS IS-OI AM
WC 9706358
1/1/74
CANCCLLCD
n:r.,'xy;:n,flt-,::rjsis
cone inenta|*i-!
Ca ualtyCO^:
Q NEW POLICY
RENEWAL
0 EXPIRES AT 13:01 A.M. ON____ 1/1/76
APPROXIMATE NUMBER OF EMPLOYEES:
A. StsbU Annua) Employmanf:_____ Z5____
0. Seasonal Employment by MonHi:
ntJAH.
1 MAR-
Aht
MAY
JUN
JWl
AU<V
r* 1 125 25
25 25 25 25 25
. OCT.
25
--SW. 25
--BBT 25
Manufr^turl ng Machinery
occupation `
'
Johnson $ Higqlns, 95 Wall Street,
act. on nnoKtn
~adc.\
New York, New York 10005
' city
stats
Notice it herab; fiven by the named employer and the named .nsurance company, as required by the Texas Workmen's CompettUtfoa _
i Act
Chapter 103, General law*. 1917. and amendments thereto, that the above named employer has become a subscriber under said Act
stents thereto end provided tor the payment nf compensation to employees onder (he terms and provisions thereof. Any unalojer ei
' or refusini to f.< ihn not.ee shall be liable tor and shall pay to the State ot Texas a penalty of not more than One Thousand Mff
EMPLOYER SIGN Ht^t
I INSURANCE COMPANY SIGN HERE
SIGHED
'^^V'VVV^^
TITLE or r*e**SON AIQp^JiG NOTICE DATE
`JGHATURE HfRf COHSTlTUrfS NOUCf ON BEHAU Of fMPlOYfk Nr) rj Wll K\ I ?(is SOlt< i Ht
i>() 'O) VIII IO (MU SIH 1/ A< t !'//.> / HO iKls
:ontfnentai Casualty Company
NAME OF INSURANCE COMPANY OX ASSOCIATION
1222John Street, New York, M.V.
'",eNT)^rq 7" X?
|IS^|: ^^C iT
--_____ __
j'X'yK-
OF PERSON SIQNINO NOT.CC
SIGNATURE HERE CONSTITUTES NOTICE ON BEHALF OF INSURANCE COMPANY
ORIGINAL COPY
WC *262fc
mxs
APPROXIMATE NUMBER OF EMPLOYEES
A. Stable Annual Employment___ iS__ ___
B Seasonol Employment by Month
;an.
]. fcb ...
mar
A.p.e. | may i . JUN ! yUL- I AUG.
SCP.
19 19 1 19
1? 19 . 19 ! 19 1 19 __ 12__
OCT.
MOV.
J3-. ___ 12__ ___ 19--
. Salesmen__________________ _________________________________________________ .--_
OCCUPATION
-_ifihnaonJLJUMiaa
.35 Wall 5treatRem. YorkRot .York_____ <00 ft*
Air on noun
aoors
city
tat*
zip
Notice is hereby fnwn by the warn*} employe and the nam*-' --.urance co.-npany. as required Ip the Texas Workmen's Compensation Insurance Act Chapter 103, General laws. 1917. and amendment! thereto. Jr.a! the above named empteytr has become a wbvnbef under said Act and MMnd-
mems thereto and provided for me payment r.f cnmpensatton to employees under the tamo and provisions thereof. Any employer or association wilfully failidf or refusmf to tile tn.s notice snail be inbie to> and shall pay to the Stale of Texas a penalty of not more than One Thousand DoBars ($1,000) for each often*
FMPlOYfft SIGH HtRE
INSURANCE COMPANY SION MERE
, '^a
SIGNED*
(\
INSMtANCE SUPERVISOR title or PtasoN oionino nonce
HARTFORD ACCIDENT & INDEMNITY CO.
KAMI OP INIUKANCI COMPANY OR ASSOCIATION
HARTFORD, CONNECTICUT 06115
DATE .1.9.7.]______
SIGNATURE HERE CONSTITUTE'S NOTICE ON^^BEJHOAULFSOTF8ELM,P/L,OYErR
E 3GHED NT BO,
sort: lu.rrns- this \otict to
[."r jj -
i
DO SOT MAIL TO ! VIA srfif.U. M.'TDEST hU\r,l) j
U.
insurance t
title or rtneoN honinq notice
SIGNATURE HERE CONSTITUTES NOTICE ON BEHALf Of INSURANCE COMPANY
I.AB 1o<m 20-6'? ffipy .0--AV roam l<2S4-2 Pr.nW-nU S
ORIGINAL COPY
jn NEW POLICY
.5___10 WH 296833
LOCATION Of *ISK
m RENEWAL Of POLICY
NO 10 WH_288659 '
gj EMTIkf STATE Of TEXAS
I j If
"Til. R'v. OFAfQliTA covfJ by lh'. pbl'Cv
EffECTlVE AT 13:01 AM ON
1-1-7Q
EXPIRES AT 13.01 AW. ON
|-|7|
APPROXIMATE NUMBER OF EM
A. StoWe onnwol employment ft, Soot' il employment by month
............................
SALESMEN,
OCCUPATION
JOHNSON 6
AGENT OR BROKER ~
COLLECTORS,
HIGGINS
"'
-
ETC.
63 WALL ST
NO i STREET
. Jwrr FrOrwerr
Mardi Aenl
Vi*
June
1
I |
NEW YORK, N. Y.
CITY
1 **
l
I k'*m t
! innr*n ) ) Octet* |
1 bemw i I Pumaw |
Notice * R>wby aiw#n try the employer and fh named tr.turorc* fpmpony, at reoutred t>Y the Te*Ol WdAwm t Comptmollon InturOnCo Act, Ql^lW [M. Cwwtbl
Lmvt, 1TI7. ond omendmenr* rr*/**?. the* he oimue nomad employer hot become a tubtc'iber under o>d Act end amendment* thereto and pmnflw oi compentotfon o employees under *l%e e'r*n ond provivont thereof Any t^pove' or oitoCiofion *>llfully foilniQ o refutino to til# thr* notice inott be liable tot
ond tnoll poy to its* it&if rt Tos o peno`t o* not more fhoo Ore Thout/vd Do'iot i|1,Q0Q) tor eoch ottente
f *
*V Form 1AB 20 68 (Formerly 20-56)