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BERKINN TUSK SERVICES, INC. <br /> DATE: 02/07/96 <br /> ST. ANTHONY Attn:Finance Dept. <br /> 3301 SILVER LAKE ROAD <br /> ST. ANTHONY MN 55418 <br /> RE: BRS CLAIM NO. : 00905534 <br /> TRUST MEMBER: ST. ANTHONY <br /> CLAIMANT: MICHAEL jINDRA <br /> DATE OF LOSS/OCCURRENCE: 09/16/92 <br /> CLAIMS MADE DATE: 09/30/92 <br /> The above claim has been concluded. <br /> This claim occurred when - <br /> SEWER BACK-UP (101 L 3726) . - <br /> On <br /> 726) .On behalf of your city, we have paid the following to conclude <br /> this claim: <br /> Paid Losses Paid Medical Paid Expenses Total <br /> 17,742.93 .00 3, 126.09 = 20,869.02 <br /> Ded.Recover PRIOR AGGREGATE <br /> This Bill This Claim This Covenant <br /> -10,000 .00 .00 -1,626. 73 <br /> Your city ' s deductible is $10,000 per occurrence/ $50,000 annual <br /> aggregate/$1,000 per loss per line of coverage (after aggregate is <br /> exceeded) . This applies under covenant number CMC1270293 effective <br /> 06/01/92 thru 06/01/93. <br /> Accordingly, please prepare a draft made payable to the "LEAGUE OF <br /> MINNESOTA CITIES INSURANCE TRUST" in the amount of $ 10,000. 00 <br /> and forward it to Berkley Risk Services, Inc. , 920-2nd Ave. So. <br /> Minneapolis, MN , 55402-4023, Attention:. Finance Department. <br /> Please include our claim number, as captioned above, with <br /> your remittance to insure proper credit. <br /> Should you have any questions relative to the disposition of this <br /> claim, please do not hesitate to contact the BRS examiner who <br /> supervised this claim, BOB WEISBROD at 1-800-925-1122, <br /> or locally at 612-281-1285. <br /> Sincerely, <br /> Finance Department <br /> Agent of Record: BERKLEY INSURANCE SERVICES <br /> 920 SECOND AVE. S. #700 <br /> MINNEAPOLIS MN 554024 <br />