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2004_1122_Packet
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2004_1122_Packet
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5/12/2014 9:11:41 AM
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12/14/2009 1:46:00 PM
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� <br />ra� <br />� Ry1c Jdwri11710-� Company, LLC <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 />�ialf�� Irrforn�tlon Pa�� EtudaKa�t�t� <br />Thelnsured: O�i�,N b w�•x��#•1xa�6�.�x <br />Global Financial Outsource Services Inc �I� AssociationFi IVumber: �i5�3�a <br />dba: United Check Cashing <br />2216 West County Road D Suite C Tax ID#: F 450464425 <br />St Paul, MN 55112 UIC#: EXEMPT <br />Policy Period: From: o4tts12oo4 <br />To: o4tt8/2005 <br />Endorsement Eff. Date: o4tt212oo4 <br />Date Of Mailing: 51412004 <br />The following item: <br />3. C State <br />Is changed to read: <br />Delete Wording & "See WC-00-03-26(A)" <br />All other terms and conditions of this policy remain unchanged. <br />Aaencv Name and Address <br />Associated InsuranceAgents Inc <br />2800 Freeway Blvd <br />Brooklyn Center, MN 55430-1751 <br />�+3d��+i�� <br />1 �� 32��2� <br />
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