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r <br />League of Minnesota Cities Insurance Trust <br />Group Self-Insured Workers’ Compensation Plan <br />Administrator <br />Berkley Administrators <br />145 University Avenue West SL Paul, MN 55103-2044 Phone (612) 281-2100 <br />Self-Insured Workers' Compensation Quotation <br />(RENEWAL of Agrssmsnt No. 02-00056S-12) <br />ORONC' <br />01/01/199S ':'1/01/1?99 <br />STREET CONSTRUCTION I MAINTENANCE <br />WATERWORKS <br />POLICE ’ <br />CLERICAL <br />MUNICIPAL EMPLOYEES <br />ELECTED OR APPOINTED OPFICIALS <br />ANIMAL CONTROL <br />CLUB-COUNTRY/ uOLF <br />ESTIMATED DEPOSIT <br />CODE RATE PAYROLL PREMIUM <br />5506 4.12 272450.11225. <br />7320 2.90 49095.1424. <br />7720 2.82 789385.22261. <br />8S!0 0.44 399050.1756. <br />9410 0.89 348565.3102. <br />9411 0.34 18200.62. <br />S831 1.67 12000.200. <br />9060 1.53 62650.959. <br />Manual Premium 40909. <br />EKDsrisnrs Modification 0.70 <br />Standard Premium 28692. <br />Managed! Care Credit OX 0. <br />Deductible Credit 0%0. <br />Premium Discount 2231. <br />Discounted Standard Premium 26441. <br />Insurance Trust Discount OX 0. <br />Net Deposit Premium 26441. <br />I <br />quotation is for a deposit prem um based on your estimate of payroU. Your final actual premium wiU <br />DC computed ^er an audit of payroll subsequent to the close of your agreement year and will be subject to <br />revisions m rates, payrolls Md experience modification. While you are a member of the LMCIT Workers' <br />be ehgible to participate in distributions from the Trust based upon claims experience <br />Any Questions Please call Barb Meyer at 612-215-4173; <br />LM4410 (8/97)