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CERTIFICATE OF REINSURANCE
FOR THE
AGREEMENT OF REINSURANCE
between the
WORKERS' COMPENSATION REINSURANCE ASSOCIATION
and
AMERICAN COMPENSATION INSURANCE COMPANY
January 1, 1997 - December 31, 1997 Retention Limit: $1,080,000
This certifies that the entity named above is a Member of the Workers'
Compensation Reinsurance Association (Association) as of the date indicated
below, and that the Association reinsures the Member's liability for benefits
pursuant to Minn. Stat. Ch. 176 in excess of the Member's retention limit for
the period indicated above. This certificate shall not be valid for any portion
of the indicated period during which the entity is not a Member of the
Association.
Workers' Compensation
Reinsurance Association
/s/ Xxx Xxxxxxx
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Xxx X. Xxxxxxx
President and Chief Executive
Officer
Dated: Monday, February 17, 1997
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[LETTERHEAD ADDRESS]
