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League of Minnesota Cities Insurance Trust <br /> Group Self-Insured Workers'.Compensation Plan •.-�. <br /> Administrator <br /> Berkley Administrators formerly EBA <br /> • a member or the Berkley Risk Management Services Group <br /> P.O. Box 59143 Minneapolis, MN 55459-0143 Phone (612) 544-0311 <br /> REVISED <br /> Self-Insured Workers'Compensation Quotation <br /> (RFAEWAL o7 Agreement No. 02-000466-6) <br /> Name of City: ST ANTHONY <br /> Agreement Period: From: 06 V1/ iiia To: 06i0ii ii7Y3 <br /> Fstimated Annual Premium: <br /> ES 1 11TH 1 ED DEPOSIT <br /> CODE RATE PAYROLL PREMIUM <br /> STREET CONSTRUCTION & i AIN T ENANCE 5566 7.zi5 E04300. 16242. <br /> WATERWORKS 4568. <br /> FIREFIGHTERS (NOT VOLUNTEER) 7706 06 39 275800. 25893. <br /> POLICE 7720 6.96 47oiOO. 32719. <br /> OFF SALE LIQUOR ST0RE z' isoii 2.99 2-%700. 8871. U- <br /> C I TY SHOP ,°x YARD 6227 6.68 280,50. 1702. <br /> CLERICAL SES io 0.57 246iOO. 1403. <br /> BUILDING MAINTENANCE & REPAIR 9Oi5 ii.40 5700. 650. <br /> ON SALE LIQUOR STORE 9079 4.90 2i05OO. 10315. �- <br /> PARKS 9 i 02 4.44 3r 00. 1754. <br /> MUNICIPAL EMPLOYEES 94iO 2.46 33860. 531. <br /> • SKATING RINK OPERATION 9016 4.64 iiaoo. 510. <br /> Hanuai 'Premium 105473. <br /> Experience Modification i.00 <br /> Standard Premium i05473. <br /> Premium Discount 9676. <br /> Discounted Standard Premium 95797. <br /> LHC insurance Trust Discount O . 0. <br /> Net Deposit "Premium 95797. <br /> The foregoing quotation is for a deposit premium based on your, estimate of payroll. Your final actual <br /> premium will be computed after an audit of payroll subsequent to the close of your agreement year <br /> and will be subject to revisions in rate or experience modification. While you are a member of the <br /> LMCIT Workers' Compensation Plan, you %vill be eligible to participate in distributions from the Trust <br /> based upon claims experience and earnings of the Trust. <br /> • Berkley Administrators <br /> BA 431 CG (5/91) <br />