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league of Minnesota Cities Insurance Trust <br /> Group Self-Insured NVorkers' Compensation Plan <br /> MIM IN]sin AI OR <br /> • EMPLOYEE BENEFIT ADMINISTRATION CO. <br /> 8441 Wayzata Blvd. Suite 200 P.O. Box 59143 Minneapolis, Minnesota 55459-0143 Phone(612)544-0311 <br /> 02-468 <br /> To: City of St. Anthony <br /> 3301 Silver Lake Road <br /> Minneapolis, MN 55418 <br /> S T A T E ME N T <br /> Deposit Premium for participation in the League of Minnesota Cities <br /> Self-Insured Workers ' Compensation Program. <br /> For the period 6-1-89 to 6-1-90 s 28,909.93 <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 200 <br /> P.O. BOX 59143 <br /> MINNEAPOLIS, MINNESOTA 55459.0143 <br /> Phone(612)544-0311 <br /> r{ ' <br /> ..y <br /> • <br /> JAN 17'90 <br /> FRA ddd (9/RF,1 Self-funded Workers' Compensation Specialists <br />