Laserfiche WebLink
l.eague of Minnesota Cities Insurance Trust <br />Group Self-Insured Workers' Compensation Plan <br /> <br /> ADMINIS TlqA I'O,l <br /> EMPLOYEE BENEFIT ADMINISTRATION CO. <br />8441 Wayzata Blvd. Suite 200 Minneapolis. Minnesota 55426-1392 Phone (612) 544-0311 <br /> <br /> RENEWAL <br /> <br />Name of City: <br /> <br />SelF-Insured Workers' Compensation Quotation <br /> <br />Ramsey <br /> <br />8-20-87 <br /> <br />Policy Period' From 10-1-87 <br /> <br />To 10-1-88 <br /> <br />Estimated Annual Premium: <br /> <br />Code <br /> <br />Street Construction & Maintenance 5506 <br />Ambulance Service 7380 <br />Waterworks 7520 <br />Electric & Steam Plant 7539 <br />Sewage Disposal. Plant 7580 <br />Firemen (Not Volunteer) 7706 <br />Firemen (Volurlteer) 7708 <br />Policemen 7720 <br />Off Saie Liquor Store 8017 <br />City Shop & Yard 8227 <br />Clerical Office 8810 <br />Building Maintenance & Repair 9015 <br />On Sale Liquor Store 9079 <br />Parks 9i02 <br />Sewer Line Ma i ntenance/ Snow Removal 9402 <br />Municipal Employees 9410 <br />HOSPITALS & NURSING ItOMES <br /> Hospital Professional <br /> Hospital All Other <br /> Nursing Homes <br /> Hospital Clerical Office <br /> Skating Rink <br /> <br /> 8833 <br /> 9O40 <br /> 8829 <br /> 8810 <br /> 9016 <br />Manual <br />Experience Modification Factor <br />Standard Premium <br />Premium Discount <br />Discounted Standard Premium <br /> <br />Rate <br /> <br /> Estimated Deposit <br /> Payro 11 Premi urn <br /> <br />$ 8.33 108,245 9,017 <br />7.54 <br />3.11 <br />5.12 <br />4.95 <br />4.17 <br />77.89 pop. <br />5.99 ---222.,-,5.~ -13,329 <br />1,69 <br /> 4.82 <br /> .36 105,q05 379 <br /> 5.86 <br /> 2.85 <br /> 4.13 1,690 70 <br /> 9.08 <br /> 5.88 !42,865 ---8~400 <br /> 1.98 <br /> 5.01 <br /> 5.45 <br /> .36 <br /> 3.47 4,530 157 <br /> <br />Net Deposit Premium <br /> <br />31,352 <br />.86 <br />26,963 <br />2,086 <br />24,g77 _ <br /> <br />74.~77 <br /> <br />Your final <br /> <br />The foregoing quotation is for a deposit premium based on your estimate of payroll. <br />actual premium will be computed after an audit of payroll subsequent to ti~e close of your policy <br />year and will be subject to revisions in 'rate or experience modification. While you are a <br />member of the LMCIT Workers' Compensation Plan, you will be eligible to participate in distri- <br />butions from tile Trust based upon claims experience and earnings of the Trust <br /> <br />EBA 441 (12/86) <br /> <br />Employee Bec/of it Administration Co. <br /> <br /> <br />