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BERKLEY RISK SERVICES, INC. <br /> DATE: 08/01/96 <br /> • ST- ANTHONY A <br /> Atte:Finance Dept, <br /> 3301 SILVER LAKE ROAD <br /> . ST. ANTHONY MN 55418 <br /> RE: BRS CLAIM NO'. : 11005118 . <br /> TRUST MEMBER: ST. ANTHONY , <br /> CLAIMANT: PAIMQA MCQUARRY <br /> DATE OF LOSS/OCCURRENCE: 04/01/93 <br /> CLAIMS MADE DATE: 03/25/94 <br /> The above claim has been concluded. <br /> This claim occurred when - <br /> CHARGE OF DISCRIMINATION BY CLMT. <br /> On behalf of your city, we have paid the following to conclude <br /> this claim: <br /> Paid Losses Paid Medical Paid Expenses Total <br /> .00 .00 1,159.68 = 1,159.68 <br /> Ded.Recover PRIOR AGGREGATE <br /> This BM This Claim This Covenant <br /> -1,159.68 .00 .00 <br /> Your city' s deductible is $10,000 per occurrence <br /> aggregate/$1,000 per loss per line of coverage / $50,000 annual <br /> is <br /> exceeded) . This applies under covenant number CMC1358794fter aggregate effective <br /> 06/01/93 thru 06/01/94. <br /> Accordingly, please prepare a draft made payable to the "LEAGUE OF <br /> MINNESOTA CITIES INSURANCE TRUST" in the amount of $ 1,159.68 <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, MARK ROSSOW <br /> or locally at 612-281-1282, at 1-800-925-1122, <br /> Sincerely, <br /> Finance Department <br /> Agent of Record: BERKLEY INSURANCE SERVICES <br /> 920 SECOND AVE. S. #700 <br /> • MINNEAPOLIS MN 554024 <br />