Schedule A (Pbgc Form 1) - Single-Employer Plan

2001 SCHEDULE A (PBGC Form 1)

Page 2

535814

EIN/PN from Form 1 line 3 (a) and (b):

EIN

SECTION FOUR: CERTIFICATIONS

Certification of Plan Administrator.

The plan administrator must sign and complete this line. See instructions, Part J.7.

I certify, under penalties of perjury (18 U.S.C. 1001), that I have examined the completed PBGC Form 1 (including Schedule A and

attachments) and, to the best of my knowledge and belief, the Form 1 (including Schedule A and attachments) and this certificate are in

conformance with the premium regulations and instructions, complete, and accurate, and any information I made available to the enrolled

actuary is true, correct, and complete.

I further certify, under penalties of perjury (18 U.S.C. 1001), that, for the plan year preceding the premium payment year, a Participant Notice

as provided for in ERISA section 4011 (29 U.S.C. 1311) and the PBGC's regulation on Disclosure to Participants (29 CFR Part 4011):

(a)

Was not required to be issued; Or,

(b)

Was issued as required; Or,

(c)

An explanation is attached.

M M

D D

Y Y Y Y

Signature of Single-Employer Plan Administrator

Date

Print or type first name of individual who signs

Print or type last name of individual who signs

Business E-mail Address (Optional)

Certification of Enrolled Actuary.

An Enrolled Actuary must sign and complete the certification below if: (1) box 1(a) is checked; or (2)

any one or more of boxes (a), (b), and (c) below are applicable. (See the

Certification Requirements

instructions in Part J, Item 4 for the

filing method you selected to determine which of boxes (a), (b), and (c) below are applicable.)

NOTE:

If any one or more of boxes (a), (b), and (c) below are applicable, the Enrolled Actuary must also check the applicable box(es).

I certify, under penalties of perjury (18 U.S.C. 1001), that I have examined the completed Schedule A and to the best of my knowledge

and belief, the schedule and this certificate are in conformance with the premium regulations and instructions, complete and accurate, and

any information I made available to the plan administrator is true, correct, and complete, and further that:

The plan had 500 or more participants as of the premium snapshot date; the actuarial value of plan assets equals or exceeds the

(a)

value of all accrued benefits under the plan (valued at the Required Interest Rate); and the entry on line 2(b) is the present value of

accrued benefits.

The adjusted value of vested benefits on line 2(b) was determined using the plan interest rate, and the plan interest rate was equal

(b)

to or less than the Required Interest Rate.

The adjusted unfunded vested benefits reported on Schedule A reflect, in a manner consistent with generally accepted actuarial

(c)

principles and practices, the occurrence, if any, of any of the significant events described in the premium regulation and

instructions. (NOTE: If you check this box, you must complete the following information.)

(1)

Check each significant event (S.E.) that occurred between the determination date entered on line 2 of this

Schedule A and the premium snapshot date (see Part J 5(d) of instructions for definitions):

S.E. (1)

S.E. (2)

S.E. (3)

S.E. (4)

S.E. (5)

S.E. (6)

S.E. (7)

No Significant Events

(2)

Total amount included in line 4 due to significant events

(If this amount is negative, please check this box:)

. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

M M

D D

Y Y Y Y

Enrollment Number

Signature of Enrolled Actuary

Date

Print or type first name of individual who signs

Print or type last name of individual who signs

Business E-mail Address (Optional)

Street Address

City

State

Zip Code

Schedule A (Pbgc Form 1) - Single-Employer Plan - 2001 Page 2

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