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V <br /> 300807 <br /> tiEL LEAGUE OF MINNESOTA CITIES INSURANCE TRUST <br /> IIII� c/o North Star Risk Services, Inc. <br /> iul IIII l�lll 1401 West 76th Street, Suite 550 <br /> III IU�U„J, Minneapolis, MN 55423 <br /> (612) 861-8600 DATE <br /> NT NUMBER FR,,.0 VERAGE PERIOD To COVERAGE PROVIDED BY AGENCY PAGE <br /> I.1C. f-'10k"'B 36 09 I 1•'t�t7 :b• u1 oa L_n.C . I .T_ 0000090 <br /> COVERED PARTY AND AD_DRESS AGENT'` <br /> S7 . :=1d i HONY HEALTH RESOURCES INS.-`AGENCY - <br /> S I LIJER LAKE ROAD <br /> 1401 W. 76TH STREET A 550 <br /> ST . i4t'JTHONY, "1N 55418 MINNEAPOLIS, MN. $5423 <br /> 612 861-8593 <br /> P R E M I U M I N V O I C E <br /> SPECIAL MULTI-PERIL <br /> ENDORSEMENT <br /> f - DUE 06,126,-89 <br /> -. ._ B;iLANCE $1 ,399.00 <br /> n <br /> �.:r-Ilu'_ifirT DUE <br /> ='t T SUE PREPAID 0.00 <br /> . <br /> 7_!7-A_ AMOUNT DUE $1 ,399.+.0 <br /> • <br /> SSE ICONITACT YOUR AGENT FOR EXPLANATION OF CHARGES <br /> :r C :)09336 09 0000090 0 D DATE DUE 0612,01'89 <br /> ST_ -,NTHONY . Invoice # 300807 . <br /> E ='=E P,EM I T WITH PAYMENT TO: <br /> L.M.C.I .T. TOTAL BALANCE s1 ,S09.00 <br /> C/O NORTH STAR RISK SERVICES MINIMUM DUE 31 ,389.00 <br /> 1401 W. 76TH STREET #550 (INCL SVC CHID IF ANY) <br /> MINNEAPOLIS, MN. 55423 <br /> AMOUNT PAID <br /> It,!SURED <br /> ST. ANTHONY <br /> IIII�1 3301 SILVER LAKE ROAD <br /> uu cuST. ANTHONY. MN 55418 <br />