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League of Minnesota Cities Insurance Trust <br />Group Self>lnsured Workers* Compensation Plan <br />Administrator <br />Berkley Administrators <br />145 University Avenue West St Paul, MN 55103-2044 Phone (651) 2154169 <br />Self-Insured Workers' Compensation Quotation <br />(RENEWAL of Agresmsnt No. 02-000362-13) <br />ORON'j <br />Oi/01/1999 01/01/2000 <br />ESTIMATED DEPOSIT <br />CODE RATE PAYROLL PREMIUM <br />STREET CONSTRUCTION & MAINTENANCE 5506 A. 00 256000;11440. <br />WATERWORKS 7520 2.81 48000;1349. <br />POLICE 7720 2.74 829400.-22726. <br />CLERICAL 8810 0.43 340000.*1462. <br />MUNICIPAL EMPLOYEES 9A10 0.86 397000.-3414. <br />ELECTED OR APPOINTED OFFICIALS 9A11 0.33 16200.*60. <br />CLUB-COUNTRY/GOLF 9060 1.48 70000.'1036. <br />ANIMAL CONTROL 8831 1.62 30000.*486. <br />POLICE RESERVES <br />m <br />7722 3.42 38000.*1300. <br />Manual PreniuiT 43273. <br />Exoeriencs Modification 0.71 <br />Standard PremiuiT:30724. <br />Manaaed Care Credit 0'/0. <br />Deductible Credit 0'/.0. <br />Pre!v»iufn Discount S,$SV*. 2444. <br />Discountec Standard Premium 25280. <br />LMC Insurance Trust Discount 0)i 0. <br />Nlet Dseosit Premium 28280. <br />expeni <br />Compeo^on Plan^ you will be eli^^le to participate in distributions fiom the Trust based upon claims experience <br />and earnings of the Trust <br />If you desire the coverage offered libove, please complete the enclosed "Notice of Premium Options" and return it <br />and your check for the deposit premium (made payable to the LMCTT) to us at the above address. <br />LM4410 (11/98)