GVHR » Topics » SECTION 1-POLICY NUMBERS, POLICY COMPANIES

These excerpts taken from the GVHR 10-K filed Mar 16, 2009.

SECTION 1          -               POLICY NUMBERS, POLICY COMPANIES

 

Policy Number

 

States Covered

 

Company Written In

 

Type of Coverage

WC Various

 

Various

 

VARIOUS

 

Statutory Workers’ Compensation and Employers’ Liability

GL 1872057

 

All States

 

NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH PA

 

General Liability (Liability other than Automobile)

CA 9725653

 

FL

 

ILLINOIS NATIONAL INSURANCE COMPANY

 

Automobile Liability

 

ACKNOWLEDGED ON BEHALF OF:

 

This Binder is intended to be a statement of the mutual interest of the parties with respect to the Workers Compensation, Automobile Liability and Commercial General Liability Risk Management program described above and is subject to execution and delivery of a mutually satisfactory Payment Agreement, RCAMP Agreement, and Collateral Trust Agreement.  The parties will become legally obligated with respect to the Workers Compensation, Automobile Liability and Commercial General Liability Risk Management program described above only in accordance with the terms contained in the Payment Agreement, RCAMP Agreement and Collateral Trust Agreement relating thereto if, as and when such document has been executed and delivered by the parties.

 

SIGNATURES

 

Signed by

 

 

Signed by

 

 

 

 

 

Thomas Becconsall

 

 

Garry J. Welsh

Regional Manager, AIGRM National Accounts

 

 

Chief Financial Officer, Gevity HR Inc.

 

 

 

 

Dated       12/23/2008

 

Dated

 

 


*THIS CONFIDENTIAL INFORMATION HAS BEEN OMITTED AND FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION

 

3



 

SECTION 1          -               POLICY
NUMBERS, POLICY COMPANIES



 









































Policy Number



 



States Covered



 



Company Written In



 



Type of Coverage



WC Various



 



Various



 



VARIOUS



 



Statutory Workers’
Compensation and Employers’ Liability



GL 1872057



 



All States



 



NATIONAL UNION FIRE
INSURANCE COMPANY OF PITTSBURGH PA



 



General Liability
(Liability other than Automobile)



CA 9725653



 



FL



 



ILLINOIS NATIONAL
INSURANCE COMPANY



 



Automobile Liability




 



ACKNOWLEDGED ON
BEHALF OF:



 



This Binder is intended
to be a statement of the mutual interest of the parties with respect to the
Workers Compensation, Automobile Liability and Commercial General Liability
Risk Management program described above and is subject to execution and delivery
of a mutually satisfactory Payment Agreement, RCAMP Agreement, and Collateral
Trust Agreement.  The parties will become
legally obligated with respect to the Workers Compensation, Automobile
Liability and Commercial General Liability Risk Management program described
above only in accordance with the terms contained in the Payment Agreement,
RCAMP Agreement and Collateral Trust Agreement relating thereto if, as and when
such document has been executed and delivered by the parties.



 



SIGNATURES



 










































Signed by



 



 



Signed by



 



 



 



 



 



Thomas Becconsall



 



 



Garry J. Welsh



Regional
Manager, AIGRM National Accounts



 



 



Chief Financial
Officer, Gevity HR Inc.



 



 



 



 



Dated       12/23/2008



 



Dated



 




 






*THIS
CONFIDENTIAL INFORMATION HAS BEEN OMITTED AND FILED SEPARATELY WITH THE
SECURITIES AND EXCHANGE COMMISSION



 



3
















 



SECTION 1          -               POLICY
NUMBERS, POLICY COMPANIES



 









































Policy Number



 



States Covered



 



Company Written In



 



Type of Coverage



WC Various



 



Various



 



VARIOUS



 



Statutory Workers’
Compensation and Employers’ Liability



GL 1872057



 



All States



 



NATIONAL UNION FIRE
INSURANCE COMPANY OF PITTSBURGH PA



 



General Liability
(Liability other than Automobile)



CA 9725653



 



FL



 



ILLINOIS NATIONAL
INSURANCE COMPANY



 



Automobile Liability




 



ACKNOWLEDGED ON
BEHALF OF:



 



This Binder is intended
to be a statement of the mutual interest of the parties with respect to the
Workers Compensation, Automobile Liability and Commercial General Liability
Risk Management program described above and is subject to execution and delivery
of a mutually satisfactory Payment Agreement, RCAMP Agreement, and Collateral
Trust Agreement.  The parties will become
legally obligated with respect to the Workers Compensation, Automobile
Liability and Commercial General Liability Risk Management program described
above only in accordance with the terms contained in the Payment Agreement,
RCAMP Agreement and Collateral Trust Agreement relating thereto if, as and when
such document has been executed and delivered by the parties.



 



SIGNATURES



 










































Signed by



 



 



Signed by



 



 



 



 



 



Thomas Becconsall



 



 



Garry J. Welsh



Regional
Manager, AIGRM National Accounts



 



 



Chief Financial
Officer, Gevity HR Inc.



 



 



 



 



Dated       12/23/2008



 



Dated



 




 






*THIS
CONFIDENTIAL INFORMATION HAS BEEN OMITTED AND FILED SEPARATELY WITH THE
SECURITIES AND EXCHANGE COMMISSION



 



3
















 



These excerpts taken from the GVHR 10-K filed Mar 17, 2008.

SECTION 1—POLICY NUMBERS, POLICY COMPANIES

Policy Number

  States Covered
  Company Written In
  Type of Coverage
WC Various   Various   VARIOUS   Statutory Workers' Compensation and Employers' Liability
GL 1595769   All States   AMERICAN HOME ASSURANCE COMPANY   General Liability (Liability other than Automobile)
CA 160732   FL   AMERICAN HOME ASSURANCE COMPANY   Automobile Liability

ACKNOWLEDGED ON BEHALF OF:

This Binder is intended to be a statement of the mutual interest of the parties with respect to the Workers Compensation, Automobile Liability and Commercial General Liability Risk Management program described above and is subject to execution and delivery of a mutually satisfactory Payment Agreement, RCAMP Agreement, and Collateral Trust Agreement. The parties will become legally obligated with respect to the Workers Compensation, Automobile Liability and Commercial General Liability Risk Management program described above only in accordance with the terms contained in the Payment Agreement, RCAMP Agreement and Collateral Trust Agreement relating thereto if, as and when such document has been executed and delivered by the parties.

SIGNATURES

Signed by /s/  THOMAS BECCONSALL      
Thomas Becconsall
Regional Manager, AIGRM National Accounts
  Signed by /s/  GARRY J. WELSH      
Garry J. Welsh
Chief Financial Officer, Gevity HR Inc.

Dated

12/14/2007

 

Dated

12/14/2007

3


SECTION 1—POLICY NUMBERS, POLICY COMPANIES









































Policy Number

 States Covered
 Company Written In
 Type of Coverage
WC Various Various VARIOUS Statutory Workers' Compensation and Employers' Liability
GL 1595769 All States AMERICAN HOME ASSURANCE COMPANY General Liability (Liability other than Automobile)
CA 160732 FL AMERICAN HOME ASSURANCE COMPANY Automobile Liability




ACKNOWLEDGED ON BEHALF OF:



This
Binder is intended to be a statement of the mutual interest of the parties with respect to the Workers Compensation, Automobile Liability and Commercial General Liability Risk Management program
described above and is subject to execution and delivery of a mutually satisfactory Payment Agreement, RCAMP Agreement, and Collateral Trust Agreement. The parties will become legally obligated with
respect to the Workers Compensation, Automobile Liability and Commercial General Liability Risk Management program described above only in accordance with the terms contained in the Payment Agreement,
RCAMP Agreement and Collateral Trust Agreement relating thereto if, as and when such document has been executed and delivered by the parties.



SIGNATURES



















Signed by/s/  THOMAS BECCONSALL      
Thomas Becconsall
Regional Manager,
AIGRM National Accounts
 Signed by/s/  GARRY J. WELSH      
Garry J. Welsh
Chief Financial Officer,
Gevity HR Inc.


Dated


12/14/2007

 


Dated


12/14/2007



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