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<br />ti>rac <br /> <br />Minnesota Workers' Compensation Assigned Risk Plan <br />Standard Workers' Compensation and Employers' Liability Policy <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 />CERTIFICATE OF INSURANCE <br /> <br />Be<t.1eyRi;.M~ ~......,..llC <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 />Policy Number: WC-22-04-129287-00 <br />Association File Number: 3157590 <br /> <br />Tax 10#: F 450464425 <br />UIC #: EXEMPT <br />Policy Period: From: 4/18/2002 <br />To: 4/18/2003 <br /> <br />Date of Mailing: 9/27/2002 <br /> <br />The Certificate is issued as a matter of information only and confers no rights upon the Certificate Holder. <br />This Certificate does not amend, extend or alter the coverage afforded by the Policy listed below. <br /> <br />This is to certify that the Policy of Insurance descdbed herein ilas been issued to the Insured named above for <br />the policy period indicated. Notwithstanding any requirement term or condition of any contract or other document <br />with respect to which this Certificate may be issued or may pertain, the insurance afforded by the Policy described <br />herein is subject to all the terms, exclusions and conditions of such Policy. <br /> <br />TYPE OF INSURANCE LIMITS OF LIABILITY <br />Part One <br />Workers' Compensation Statutory <br />Part Two Bodily Injury by Accident $100,000 each accident. <br />Employers' Liability Bodily Injury by Disease $500,000 policy limit. <br /> Bodily Injury by Disease $100,000 each employee. <br /> <br />Should the above Policy be canceled before the expiration date thereof, the Company <br />will endeavor to mail 30 days written notice to the below named Certificate Holder, but <br />failure to mail such notice shall impose no obligation or liability of any kind upon the Company. <br /> <br />Certificate Holder's Name and Address: <br />Minnesota Dept of Commerce Licensing Division <br />85 7th Place East Ste 600 <br />St Paul, MN 55101 <br /> <br />OFFICERS NOT COVERED. <br /> <br />Aqency Name and Address <br />Associated Insurance Agents <br />2800 Freeway Blvd <br />Brooklyn Center, MN 55430-1751 <br /> <br />Date Issued: 9/27/2002 <br /> <br />~~" <br /> <br />BA3140 <br />