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<br />9rac <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 />Schedule for MN <br /> <br />8erkley Risk Administrators Company. lLC <br /> <br />Renewal Of No. WC-22-04-129287-00 <br /> <br />1. The Insured: <br />Global Financial Outsource Services Inc <br />dba: United Check Cashing <br />2509 Pearson Pkwy <br />Brooklyn Park, MN 55444 <br /> <br />WCIP <br /> <br />Policy Number: WC-22-04-129287-01 <br />Association File Number: 3157590 <br /> <br />Tax 10#: F 450464425 <br />UIC #: EXEMPT <br />Policy Period: From: 4/18/2003 <br />To: 4/18/2004 <br />Endorsement Eft. Date: 4/18/2003 <br />Date of Mailing: 4/4/2003 <br /> <br />PREMIUM BASIS RATES ENTRIES IN THIS ITEM, EXCEPT AS SPECIFICALLY PROVIDED ESTIMATED <br />ESTIMATED TOTAL PER $100 OF CLASS ELSEWHERE IN THIS CONTRACT; DO NOT MODIFY ANY OF ANNUAL <br />ANNUAL REMUNERATION CODE THE OTHER PROVISIONS OF THIS POLICY. PREMIUM <br />DC..' <br /> 2509 Pearson Pkwy <br /> Brooklyn Park MN, 55444 <br />If Any 0.35 8810 CLERICAL OFFICE EMPLOYEES - NOC $0 <br /> <br />Agency Name and Address <br />Associated insurance Agents <br />2800 Freeway Blvd <br />BrookJyn Center1 rv1t~J 55430..1751 <br /> <br />WC990001A <br />