1
[WCRA LETTERHEAD]
2001
CERTIFICATE OF REINSURANCE
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for the
AGREEMENT OF REINSURANCE
between the
WORKERS' COMPENSATION REINSURANCE ASSOCIATION
and
AMERICAN COMPENSATION INSURANCE COMPANY
JANUARY 1, 2001 - DECEMBER 31, 2001 RETENTION LIMIT: $330,000
This certifies that the entity named above is a Member of the Workers'
Compensation Reinsurance Association (WCRA) as of the date indicated below, and
that the WCRA 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 WCRA.
Workers' Compensation
Reinsurance Association
/s/ XXX XXXXXXX
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Xxx Xxxxxxx
President and Chief Executive Officer
Dated: January 1, 2001
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