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WORKERS' COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 06 <br />(Ed. 02104) <br />OTHER WORKPLACES SCHEDULE <br />It is agreed that Item 1. Insured of the Information Page includes the following Other Workplaces. <br />Loc Name and Address <br />46074 - 1 - 1 White Bear Mitsubishi Suzuki <br />3400 Hwy 61 N <br />White Bear Lake, MN 55110 <br />46074 - 1 - 2 Volkswagen of Inver Grove <br />1325 50th St E <br />Inver Grove Heights, MN 55077 <br />46074 - 1 - 3 Rydell Motorsports Outlet <br />2375 Mounds View Blvd <br />Mounds View, MN 55112 <br />This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise <br />stated. <br />(The information below is required only when this endorsement is issued subsequent to preparation of <br />the policy.) <br />Policy No: WCO20-0046074-2020A <br />Endorsement Effective: 10/1/2020 0 <br />Insured: Saturn of St Paul Inc <br />Additional Premium: $44,711 <br />Insurance Company: First Dakota Indemnity Company <br />Countersigned by: <br />WC 99 06 06 <br />Ed. 02/04 <br />