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<br />139/23/21303 13:12 <br /> <br />5512870995 <br /> <br />UNITED CHECK CASHING <br /> <br />PAGE 134/05 <br /> <br />_rac <br /> <br />1l<!I.l!lj'!ooI.J!!ltrtklo.".".tdml"'f.lJ1l <br /> <br />MlnnMoIa Workers" Compensatlon Ati5igned Rielk plan <br />Standard Workers' CompensaUon and Emproy~rs' Liability Policy <br />. Contract Admlnlslrafor <br />Berkley ~Ist AdministfatQf'$ Company, LlC <br />P.O. Box S9143 Minneapolis, Minnesota 55459-0143 <br />Phone (S12) 7es.3000 Neel CartferCode 21<lee <br />~~R.TIFICATr:; tlf INSURANCE <br /> <br />1. The InsLlred: <br />Global FlrumclQI Qub;ource Sel"li(;~~ Ine; <br />dba; Uflnad Check C!U)hlt!~ <br />2216 Wust County Road D Suite C <br />RCluwllllil, MN $51'" <br /> <br />POlicy Number: WC.U.Q4-12n81-Q1 <br />AsSQdatlon Fill! NI,IJ'rlber: 31/57580 <br /> <br />T<I;( 10#: F 450.464428 <br />UIO f; EXEMPT <br />F!lllcy PerJl:ld: From: 411:U~QC3 <br />To: 4J1W'20i'J4 <br /> <br />The Certificate is issued :,as :;J mlltter Qf Information only and COnfers no righb upon the gertificate Hordar, <br />this Certificate doel:l not arnehd, exlend or eHElf the cov~rage afforded by the PofiO)! H$ted below. <br /> <br />This is to certify that the Policy of lnsuFl'lnoe ~Qscrib&d herein has been issued 10 the Insured named above for <br />the polieI' period indicated. Notwlthslal'ldlng ~ny requirement, term or condition 'of any contract or other docurnal'lt <br />wttn respeet to which this Certificate may be Issued or may pertain I tfle lnsul'llnee afforded by the PC'lIey described <br />herein is 5ubjer;;t to all the term~. ~uslans ~l'Iti gondltlons of such Policy, <br /> <br /> , <br />TYPE OF IttSUAANeE! LlIiIITS OF LIABIUTY , <br />Part One <br />Workel"5' COh'ipensaUol'I Slalutory <br />Part Two a~jlY Injury tI)I' AC(;ldent 1100.000 each acddenl. <br />Employers' llallltlty 6~"y Injury by DiMliH ;seC,goo policy limit. <br /> Bcdlly InJuly t:'I Ojlll!l:l/!$ $100,000 GaCf'l employee. <br /> <br />Should the above ~oUcy be canceled ~I'oro IhQ e,q')iratlon dat1;l thereof, th'J Plan Wilt <br />mail 30 days written notice to the berow named Certificate Helder, <br /> <br />Certif!cra(e Holders Narne and AdClress: <br />MIMOBOtlil Dept Qf Commerce Licensing Division OfFICERS hlOT COVERED. <br />6$ nh PIiCt> eliililt $~ ~ <br />st Paul, MN S51C1 <br /> <br />Agency Name aill'ld Addf@9~ Daw l:J;li\l((ld; ~f2i!&CO:li <br /> <br />a~!;1Qi;;R1tTI Ct;jI<l'iBr, ~i\l s..~~Wi1~i <br /> <br /> <br />~S!lll':hllt!!;jd lli1$lYlrillW'iC€ll A~el'l~ <br /> <br />~:ee~ fr:?a~\q;~J fJ~J'~ <br /> <br />M.~-""'.1/"r-. <br />t.';1~~~"ifW <br /> <br />~o 'd <br /> <br />66vE99L219 'ON Xijj <br /> <br />QijH8 Wd B1:20 NOW SDOZ-Z,-d3S <br />