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1 <br /> INVOICE NUMBER <br /> No 42044 OF ESSIO'v Midwest Area, Inc. <br /># PLEASE RETURN �Te r INSURANCE <br /> THIS PORTION WITH �7• _� 6900 HUMBOLDT AVENUE NORTH <br /> YOUR PAYMENT G4ANC6 AG8 BROOKLYN CENTER, MINNESOTA 55430 <br /> 612 - 566.8100 <br /> i City of St. A nthony <br />' 3301 Silver Lake Road <br /> St. Anthonyp Minnesota 55418 <br /> c <br /> t <br /> 1 <br /> 1 i CUSTOMER NO. INSURED'S NAME IF DIFFERENT FROM CUSTOMER FILE DATE <br /> SAI 55 F-7-27 <br /> POLICY NUMBER EFFECTIVE DATE RENEWAL DATE <br /> BA70927 —� g -1 Ar•YR. Moi DAY-YR. VOICE NUMBER <br /> N_ 42044 <br /> BUSINESS R COMPANY <br /> CODE N CODE DESCRIPTION OF COVERAGE PREMIUM <br /> 64 17 30 Business Automobile 1 172.50 <br /> 2nd Installment <br /> 0 0 <br /> PREMIUMS ARE DUE ON BALANCE <br /> EFFECTIVE DATE OF POLICY <br /> Midwest Area, Inc. <br /> INVOICE NUMBER <br /> N° 42039 SOF ESS IO^,' Midwest Area, Inc. <br /> PLEASE RETURN _ INSURANCE <br /> THIS PORTION WITH _� 6900 HUMBOLDT AVENUE NORTH <br /> YOUR PAYMENT N°4A N c e ,G1 BROOKLYN CENTER, MINNESOTA 55430 <br /> 612 - 566-8100 <br /> City of St. Anthony <br /> 3301 Silver Lake Road <br /> St. Anthony, Minnesota 55418 <br /> i <br /> CUSTOMER NO. INSURED'S NAME IF DIFFERENT FROM CUSTOMER FILE DATE <br /> I <br /> —S I 556 r 1 7 7 g3 <br /> POLICY NUMBER EFFECTIVE DATE RENEWAL DATE <br /> MO.-DAY-YR. MO.-D Y.YR. INVOICE NUMBER <br /> PWC1340150 81 83 9/1/83 <br /> N_p <br /> 42039 <br /> I BUSINESS w COMPANY <br /> CODE N CODE DESCRIPTION OF COVERAGE PREMIUM <br /> 71 17 30 Worker's compensation- <br /> 3.150-00 <br /> 2nd Installment <br /> CO El T <br /> • 3 �� _ 3 g�. v� <br /> z � 0 <br /> }�PREMIUMS ARE DUE ON BALANCE <br /> EFFECTIVE DATE OF POLICY <br /> Midwest Area. Ing. <br />