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<br />tT>rac <br /> <br />Minnesota Workers' Compensation Assigned Risk Plan <br />Standard Workers' Compensation and Employers' Liability Policy <br /> <br />Contract Administrator <br />Berkley Risk Administrators Company, LLC <br />P.O. Box 59143 Minneapolis, Minnesota 55459-0143 <br />Phone (612) 766-3000 NCCI Carrier Code 21466 <br /> <br />Minnesota Amendantorv Endorsement <br /> <br />Beo1<Iey Posk MmiAslraiofs COmpany. LLC <br /> <br />1. The Insured: <br /> <br />WCIP <br /> <br />Policy Number: WC-22-C4-159728-03 <br />Association File Number: 3201395 <br /> <br />Tax 10#: F 830385468 <br />UIC #: 068707550000 <br />Policy Period: From: 1/6/2008 <br />To: 1/6/2009 <br />Endorsement Eff. Date: 1/6/2008 <br />Date of Mailing: 1112/2007 <br /> <br />This endorsement applies only to the insurance provided because Minnesota is shown in Item 3A of the information page. <br /> <br />GNAW INC <br />dba: Centerville Liquor Barrel <br />7093 20th Ave <br />Centervil/e, MN 55038 <br /> <br />PART TWO - EMPLOYERS LIABILITY INSURANCE <br /> <br />E. We will Also Pay is amended to read: <br /> <br />We will also pay these costs, in addition to other amounts payable under this insurance, as part of any claim, <br />proceeding, or suit we defend: <br /> <br />1. reasonable expenses incurred at our request, but not loss of earnings; <br />2. premiums for bonds to release attachments and for appeal bonds in bond amounts up to the limit of our <br />liability under this insurance; <br /> <br />3. litigation costs taxed against you; <br />4. your share of pre- or post-judqment interest assuminq that the principal amount of that iudoment is within <br />the applicable policy limits under this insurance: and <br /> <br />5. expenses we incur. <br /> <br />H. Recovery From Others is amended to read: <br />Our ability to exercise your rights to recover our payment from anyone liable for an injury covered by this <br />~__. ........._............ ...1__... __4. ___I.. ;. "'1-.._' _..""...... ....._.._...._ ;.... :......, ,......-11-... "'''''.... ...._..-..... I............ 1...... ..... T....:.... 1:.-:......4.;-..... _...._1:-..... ........1., :& <br />II I;:'Uldl II...I:: UUI::;:' 'IUL d!JfJlY II LlldL ULIII::I !-'I::I;:'UIII;:' III;:'UII::U IVI LlII:: ;:'dllll:: IV;:';:' uy U;:'. III';:' IIl1l1LdLlUIJ dfJfJIIO:;;:> VII'Y II <br />the loss was caused by the non-intentional acts of the person against whom subrogation is sought. <br /> <br />PART FIVE - PREMIUM <br /> <br />G. Audit is amended to read: <br /> <br />You will let us examine and audit all your records that relate to this policy. These records include ledgers, <br />journals, registers, vouchers, contracts, tax reports, payroll and disbursement records, and programs for storing <br />and retrieving data. <br /> <br />We may conduct the audits during regular business hours during the policy period and within three years after the <br />policy period ends, except as it pertains to Part Two - Employer's Liability rnsurance which shall be one vear. <br />Information developed by audit will be used to determine final premium. Insurance rate service organizations <br />have the same rights we have under this provision. <br /> <br />All other terms and conditions of this policy remain unchanged. <br /> <br />Aqency Name and Address <br />Ross Nesbit Agencies Inc <br />Paulet Slater Agency <br />2610 University Ave W <br />St Paul, MN 55114 <br /> <br />WC 22-00-00 <br />3836 639064 <br />