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I <br />LEAGUE OF MINNESOTA CITIES INSURANCE TRUST <br />Self- Insured Workers' Compensation Quotation <br />Plan Administrators: <br />Employee Benefit Administration Co. <br />6950 Wayzata Blvd., Suite 430 <br />Minneapolis, Minnesota 55426 <br />Telephone (612) 544 -0311 <br />RENEWAL <br />Name of City: Ramsey <br />Policy Period: From <br />Estimated Annual Premium: <br />Code <br />I <br />I <br />Street and Road Construction <br />Waterworks <br />Electric Power Co. & Steam Heating <br />Sewage Plant <br />Firemen (Not Volunteer) <br />Firemen (Volunteer) <br />Policemen <br />Store Risks Retail <br />Clerical Office <br />Building Operations <br />Restaurants and Bars <br />Pa rks <br />Street& Sewer Clean ing,Snow Removal <br />Municipal Employees <br />5506 <br />7520 <br />7539 <br />7580 <br />7706 <br />7708 <br />7720 <br />8017 <br />8810 <br />9015 <br />9079 <br />9102 <br />9402 <br />9410 <br />0.J <br />To 10 -1 -86 <br />Rate <br />$9.35 <br />6.68 <br />4.36 <br />4.68 <br />12.93 <br />31.53 <br />5.63 <br />1.60 <br />.24 <br />6.34 <br />2.89 <br />5.60 <br />11.78 <br />2.53 <br />Estimated <br />Payroll <br />47,475 <br />Deposit <br />Premium <br />4,439 <br />1 <br />pop. <br />_269,815 15,191 <br />69,630 <br />27.430 <br />193,800 <br />167 <br />_1.536 <br />4.903 <br />1 <br />Manual <br />Experience Modification Factor 89 <br />Standard Premium __73 -.3r0_ <br />' Premium Discount 2,921 <br />Discounted Standard Premium <br />LMCIT Discount 10 <br />2,043 <br />t Net Deposit Premium 18,386 <br />The foregoing quotation is for a deposit premium based on your estimate of payroll. Your final, <br />actual premium will be computed after an audit of payroll subsequent to the close of your policy <br />year and will be subject to revisions in rate or experience modification. While you are a member <br />' of the LMCIT Workers' Compensation Plan, you will be eligible to participate in distributions <br />from the Trust based upon claims experience and earnings of the Trust. <br />i <br />10 -1 -85 <br />Employee Benefit Administratrgn Co. <br />IBA 441 <br />