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h <br /> PAGE I <br /> Owners WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY <br /> - '4SURANCE COMPANY 18147 <br /> 01 ANACAPRI BLVD. , LANSING, MI 48917-3999 <br /> ENDORSEMENT EFF. 12-:29-2006 <br /> AGENCY ERICKSON INSURANCE AGENCY <br /> 06-0418-00 3811 W BROADWAY AVE (763)535-2455 POLICY NUMBER <br /> MINNEAPOLIS MN 55422 MKT TERR 016 051706 0802067 <br /> ITEM 1 <br /> INSURED SHARP HEATING & AIR CONDITIONING ITEM 2 POLICY PER OD <br /> INC COMPANY FROM 12:01 A.M. 12-2 -2006 <br /> ADDRESS 7221 UNIVERSITY AVE NE BILL TO 12:01 A.M. 12-2 -2007 <br /> FRIDLEY MN 55432-3134 At THE INSURED' <br /> MAILING ADDRESS <br /> INSURED IS - CORPORATION <br /> OTHER WORK PLACES NOT SHOWN ABOVE. <br /> ITEM 3 A. WORKERS' COMPENSATION INSURANCE: PART ONE OF THE POLICY APPLIES TO WORKERS' <br /> COMPENSATION LAW OF THE STATES LISTED HERE: MN <br /> B. EMPLOYERS LIABILITY INSURANCE: PART TWO OF THE. POLICY APPLIES TO WORK IN EACH STATE <br /> LISTED IN ITEM 3. THE LIMITS OF OUR LIABILITY, UNDER PART TWO ARE: <br /> BODILY INJURY BY ACCIDENT $500,000 EACH ACCIDENT <br /> BODILY INJURY BY DISEASE $500,000 EACH EMPLOYEE <br /> BODILY INJURY BY DISEASE $500,000 POLICY LIMIT <br /> C. OTHER STATES INSURANCE: PART THREE OF THE POLICY APPLIES TO THE STATES, IF ANY, <br /> LISTED HERE: AL, AR, A2, CO, FL, GA, IA, IL, MN, MO, NC, NE, SC, SD, TN, UT VA & <br /> WI UNLESS ALREADY LISTED IN ITEM 3A. <br /> ITF-'-.4 THE PREMIU-M FOR THIS POLICY WILL BE DETERMINED BY OUR MANUALS RULES, CLASSIFICATI NS, <br /> RATES AND RATING PLANS. ALL INFORMATION REQUIRED BELOW I.S SUBJECT TO VERIFICATIO <br /> AND CHANGE BY AUDIT. <br /> CLASSIFICATIONS OF OPERATIONS PREMIUM BASIS RATES <br /> ESTIMATED RATE ESIMATED <br /> CLASS TOTAL ANNUAL PER NNUAL <br /> CODE REMUNERATION $100 P EMIUM <br /> STATE OF MINNESOTA <br /> ID* 0010 DESC 001 <br /> HEATING, VENTILATION, AIR-CONDITIONING, <br /> AND REFRIGERATION SYSTEMS - <br /> INSTALLATION, SERVICE AND REPAIR & <br /> DRIVERS 5537 100,000 6.54 6,540 <br /> IDB 0020 DESC 001 <br /> SALESPERSONS, COLLECTORS OR MESSENGERS - <br /> OUTSIDE 8742 38,000 .65 247 <br /> IDS 0030 DESC 001 <br /> CLERICAL OFFICE EMPLOYEES NOC 8810 30,000 .23 69 <br /> 14SUED 12-14-2006 <br /> 27777 (10-88)(WC000001A) 2835 <br />