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League of Minnesota Cities Insurance Trust <br />Group Self- Insured Workers' Compensation Plan <br />ADMNISTRATDR <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 />(RENEWAL of Agreement No. 02- 000064) <br />Name of City: <br />LITTLE CANADA <br />Policy Period: From: 04/01/1991 <br />Estimated Annual Premium: <br />To <br />04/01/1992 <br />ESTIMATED DEPOSIT <br />CODE RATE PAYROLL PREMIUM <br />GENERAL MAINTENANCE 5506 9.79 34000. 3329. <br />WATERWORKS 7520 3.90 34000. 1326. <br />SEWAGE DISPOSAL PLANT 7580 6.47 34000. 2200. <br />CLERICAL -- 8810 0.47 141500. 665. <br />BUILDING MAINTENANCE & REPAIR 9015 12.01 4800. 576. <br />PARKS 9102 6.06 72600. 4400. <br />STREET CLEAN /SEWER CLEAN /SNOW REMOVAL 9402 7.34 34000. 2496. <br />MUNICIPAL EMPLOYEES 9410 3.52 48000. 1690. <br />Manual Premium 16682. ' <br />Experience Modification 0.75 <br />Standard Premium 12512. <br />Premium Discount 714. <br />Discounted Standard Premium 11798. <br />LMC Insurance Trust Discount 0% 0. <br />Net Deposit Premium 11799. <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 />EBA 441 CG (11/871 <br />Employee Benefit Administration Co. <br />Page 103 <br />