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League of Minnesota Cities Insurance Trust �7�C <br /> Group Self-Insured Workers Compensation Plan t'� , <br /> An M,NISTRATnR <br /> EMPLOYEE BENEFIT ADMINISTRATION CO. <br /> 8441 Wayzata Blvd. Suite 200 Minneapolis, Minnesota 55426-1392 Phone (612) 544-0311 <br /> • <br /> To: City of St. Anthony <br /> 3301 Silver Lake Road <br /> St. Anthony, MN 55418 <br /> S T A T E M E N T <br /> Deposit Premium for. participation in the League of Minnesota Cities <br /> Self-Insured Workers ' Compensation Program. <br /> For the period 6-1-88 to 6-1-89 $ 68951 .00 <br /> • <br /> Remittances should be made payable to the LEAGUE OF MINNESOTA CITIES <br /> INSURANCE TRUST and mailed on or before the effective date of your <br /> coverage to: <br /> Employee Benefit Administration Co. <br /> 8441 Wayzata Blvd. Suite 20.0 <br /> Minneapol-is, MN 55426-1392 <br /> • <br /> ESA 444 (9/86) Self-funded Workers"Compensation Specialists <br />