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League of Minnesota Cities Insurance Trust <br /> Group Self- Insured Workers' Compensation Plan <br /> 145 University Avenue West <br /> St. Paul, MN 55103 -2044 <br /> APPLICATION FOR: City of Centerville <br /> County: Anoka Mailing Address: 1880 Main St Ne <br /> Phone: 651 -429 -3232 City, State, Zip: Centerville, MN 55038 <br /> Contact Person: Mike Jeziorski Title: Finance Director <br /> 2000 Census Population: 3202 Current Estimated Population: 3821 <br /> Agency: Farmers Insurance - Paul Steffel <br /> Address: 1709 Main St <br /> City, State, Zip: Centerville, MN 55038 <br /> Telephone: ( 651) 762 - 7801 Facsimile; ( ) 651 <br /> Agency Contact: Email Address: psteffel @farmersagent.com <br /> AGENT COMPENSATION: ❑ 2% © City Will Compensate the Agent Directly <br /> ❑ Other please specify: <br /> 1 Please complete and return with Renewal Data Information. Any questions please call <br /> 651- 215 -4173. <br /> 21 <br />