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League of Minnesota Cities Insurance Trust <br />Croup Self- Insured Workers' Compensation Plan <br />AOMINISTAATOA <br />EMPLOYEE BENEFIT ADMINISTRATION CO. <br />8441 Wayzata Blvd. Suite 200 P.O. Box 59143 Minneapolis, Minnesota 55459 -0143 Phone (612) 544 -0311 <br />Self — Insured Workers' Compensation Quotation <br />Name of City: CITY OF LITTLE CANADA <br />Policy Period: From: 01/01/1990 <br />Estimated Annual Premium: <br />To <br />01/01/1991 <br />ESTIMATED DEPOSIT <br />CODE RATE PAYROLL PREMIUM <br />STREET CONSTRUCTION Si MAINTENANCE 5506 9.32 57500. 5359. <br />WATERWORKS 7520 3.71 57500. 2133. <br />SEWAGE DISPOSAL PLANT 7580 6.16 IF ANY 0. <br />CLERICAL 8810 0.45 113500. 511. <br />PARKS 9102 5.77 52000. 3000. <br />STREET CLEAN /SEWER CLEAN /SNOW REMOVAL 9402 6.99 IF ANY 0. <br />GARBAGE OR REFUSE COLLECTION 9403 11.98 1000. 120. <br />MUNICIPAL EMPLOYEES 9410 3.35 36500. 1223. <br />Manual Premium <br />Experience Modification 0.88 <br />Standard Premium <br />Premium Discount <br />Discounted Standard Premium <br />LMC Insurance Trust Discount 0% <br />Net Deposit Premium <br />12346. <br />10864. <br />557. <br />10307. <br />0. <br />10307. <br />The foregoing quotation is for a deposit premium based on your <br />estimate of payroll. Your final actual premium will be computed after <br />an audit of payroll subsequent to the close of your policy year and <br />will be subject to revisions in rate or experience modification.' <br />While you are a member of the LMCIT Workers' Compensation Plan, you <br />will be, eligible to participate in distributions from the Trust based <br />upon claims experience and earnings of the Trust. <br />Employee Benefit Administration Co. <br />EBA 441 CG (11187) <br />a.rgA 107 <br />• <br />