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’"'■Tt'. <br />• oowLeague of Minnesota cities insuiaucc • <br />Group Self-Insured Workers’ Compensation Plan <br />Administrator <br />Berkley Administrators <br />Berkley Risk Management Services Group <br />P.O.Box 59143 Minneapolis. MN 55459-0143 Phone (612) 544-0311 <br />j^elf-Tnsiirgd Workers* Compensation Quotation <br />(RENEWAL of Agreement No. 02-000362-10) <br />ORONO <br />01/01/1996 <br />STREET CONSTRUCTION L MAINTENANCE <br />WATERWORKS <br />POLICE <br />CLERICAL <br />MUNICIPAL EMPLOYEES <br />ELECTED OR APPOINTED OFFICIALS <br />ANIMAL CONTROL <br />CLUB-COUNTRY/GOLF <br />Cl,/01/1997 <br />ESTIMATED DEPOSIT <br />CODE RATE PAYROLL PREMIUM <br />5506 4.86 243700.11844. <br />7520 3.86 54200.2092. <br />7720 3.53 696000.24569. <br />8S10 0.44 308800.1359. <br />9410 1.25 334000.4175. <br />9411 0.47 18200.86. <br />8831 1.87 10500.196. <br />9060 2.15 58300.1253. <br />Manual Premium 45574. <br />Experience 1Modification 0.73 <br />Standard Premium 332691 <br />Manaaed Care Credit 0*/#0. <br />Deductible Credit O’A 0. <br />Premium 1Discount 2686. <br />Discounted Standard Premium 30583. <br />; Insurance Trust Discount 0'/.0. <br />N et Deposit Premium 30583. <br />Th^ fnrepoinp Quotation is for a deposit premium based on your estimate of payroll. Your final actu^ <br />be comDuted after an audit of payroll subsequent to the close of your agreement ye^ an <br />Trust based upon claims experience and earnings of the Trust. <br />Administrator, Berkley Administrators. <br />I <br />BA 44ICG (12/92)