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kn. <br />Wisconsin <br />Employers <br />insurance <br />Company <br />District Office <br />6009 Penn Ave. S. <br />Minneapolis, MN 55419 <br />(612) 861 -6003 <br />October 6, 1978 <br />CITY OF LITTLE CANADA <br />PROPOSAL OF GROUP INSURANCE <br />Proposed Plan: Wisconsin Employers Group <br />Proposed Benefits: <br />PLAN II <br />$10,000.00 <br />AGE EMPLOYEE ONLY DEPENDENTS EMPLOYEE & DEPENDENTS LIFE AND AD &D <br />MALE 45 $ 40.00 $ 62.00 $102.00 $ 8.00 <br />29.00 62.00 91.00 4.00 <br />24.00 - <br />MALE 30 <br />MALE 30 <br />FEMALE 55 <br />MALE 57 <br />24.00 4.00 <br />52.00 62.00 114.00 17.00 <br />52.00 - <br />52.00 17.00 <br />$197.00 $186.00 $383.00 $50.00 <br />EVIDENCE OF INSURABILITY IS REQUIRED <br />$2.00 Per Month Administrative Fee <br />DEPENDENT LIFE PLAN <br />$1.50 month <br />Age 50 & Under <br />Age 51 thru 60 <br />Age 61 thru 65 <br />Children* <br />*Age 10 days to 1 <br />25 if full time <br />$2,000 <br />$1,500 <br />$1,000 <br />$1,000 <br />9 yrs (to age <br />student) <br />The benefits and premium rates as quoted are valid for a period of 45 days from the date of <br />this proposal. The health insurance premiums are guaranteed for one year. The final rate <br />may differ from what was indicated on this proposal as the final rate will be developed from <br />actual enrollment. <br />Only full time employees are eligible for coverage under the policy issued to the Trust. Part <br />time employees and those employees no longer active due to retirement are not eligible unless <br />a special retired class has been designated. <br />This quotation has been submitted by Phil Renslow on behalf of City of Little Car3ad <br />slp - VIII <br />_ 017 <br />JAMES PEDERSON <br />NO CLAIM FORD •egional Sales Director <br />