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<br />1. The Insured: <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 CANCELLATION AND NONRENEWAL ENDORSEMENT <br /> <br />Page 2 of2 <br /> <br />WCIP Policy Number: WC.22-04-159728-03 <br />Association File Number: 3201395 <br /> <br />&rac <br /> <br />llorkIoy Risk Ildmill8ln1lln OInpony. LLC <br /> <br />GNAW INC <br />dba: Centerville Liquor Barrel <br />7093 20th Ave <br />CenterviJIe, MN 55038 <br /> <br />TaxlD#:F830385468 <br />UIC #: 088707550000 <br />Policy Period: From: 1/612008 <br />To: 1/612009 <br />Endorsement Eff. Date: 1/612008 <br />Date of Mailing: 11/212007 <br /> <br />REFUNDS DUE YOU <br />If this policy is cancelled, we will send you any premium refund due. If we cancel, the refund will be pro rata. If you cancel, <br />the refund may be less than pro rata. The cancellation will be effective even if we have not made or offered a refund. <br /> <br />NONRENEWAL OF YOUR POLICY <br />Any notice of non renewal shall be in writing and shall be sent by first class mail, or delivered to you and any agent. to the <br />last mailing addresses known to us, at least 60 days before the expiralion dale. <br />We need not mail or deliver this nonrenewal notice if you have: <br />(1) Insured elsewhere; <br />(2) Accepted replacement coverage; or <br />(3) Requested or agreed not to renew this policy. <br /> <br />This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. <br /> <br />All other terms and conditions of this policy remain unchanged. <br /> <br />AQencv Name and Address <br />Ross NesbIt Agencies Ine <br />Paulet Slater Agency <br />2610 University Ave W <br />SI Paul, MN 55114 <br /> <br />we 22-06-01 D <br />3836 639064 <br />