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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 />PREMIUM DUE DATE ENDORSEMENT <br /> <br />WCIP Policy Number: WC-22-()4.159728-03 <br />Association File Number: 3201395 <br /> <br />ti>rae <br /> <br />BorIcIoyRi&l.__~.LlC <br /> <br />GNAW INC <br />dba; Centerville Liquor Barrel <br />7093 20th Ave <br />Centerville, MN 55038 <br /> <br />Tax 10#: F 830385468 <br />ule #: 068701550000 <br />Policy Period: From: 1/812008 <br />To: 1/8/2009 <br />Endorsement Eft. Date: 1/8/2008 <br />Date of Mailing: 111212007 <br /> <br />This endorsement is used to amend: <br />Section D. of Part Five of the policy is replaced by this provision. <br /> <br />PART FIVE <br />PREMIUM <br /> <br />D. Premium is amended to read: <br /> <br />You will pay all premium when due. You will pay the premium even if <br />part or all of a workers compensation law is not valid. The due date <br />for audit and retrospective premium is the date of the billing. <br /> <br />All other terms and conditions of this policy remain unchanged. <br /> <br />Aaencv Name and Address <br />Ross Nesbit Agencies Inc <br />Paulet Slater Agency <br />2610 University Ave W <br />St Paul, MN 55114 <br /> <br />we 00-04-19 <br />3836 639064 <br />