Document - Historical information/data - Workers Compensation Policty - 12/11/1944
TitiA: Fi tz 4 T S nI Vr r: l 14 N h
OF ROSEMOLJNT
F A. RUHR, PRESIDENT
M. R. RUHR. VICE PRESIDENT
RALPH M TOOMBS. CASHIER
JOSEPH F. RUHR. ASSISTANT CASHIER
YOSEMMMOUNT, MINN.December 11, 1944
Mr. A. F. Rahn,
Eagan Township
Route 11
St. Paul 7, Minn.
Dear Mr. Rhhn:
Enclosed herewith find Anchor Casualty Company
Vorkmen's compensation Policy No. 42368 expiring December 11, 1945
in renewal of policy which expires today. You will also
find enclosed a statement for the premium due on the new
policy.
Thanking you for this business, we are
Yours truly,
First State BQk
By____.
FAR:LS
Standard Workmen's Compensation
and Employers' Liability Policy
A T T A T ir7 T A -XT - T
V1-3L UL~L 1 i V Vh"11 ill L
SAINT PAUL, MINNESOTA
"
A Stock Company
(HEREINAFTER CALLED THE COMPANY) ~OE$ elCtbp grit with this Employer, named and described as such in the Declarations form-
ing a part hereof, as respects personal injuries sustained by employees, including death at any time
* S; resulting therefrom as follows:
One (a) To Pay Promptly to any person entitled thereto, under the Workmen's Compensation Law and in the
manner therein provided, the entire amount of any sum due, and all instalments thereof as they become due,
Gti (1) To such person because of the obligation for compensation for any such injury imposed upon or accepted by this
Employer under such of certain statutes, as may be applicable thereto, cited and described in an endorsement
attached to this Policy, each of which statutes is herein referred to as the Workmen's Compensation Law, and
(2) For the benefit of such person the proper cost of whatever medical, surgical, nurse or hospital services, medical or
surgical apparatus or appliances and medicines, or, in the event of fatal injury, whatever funeral expenses are
required by the provisions of such Workmen's Compensation Law.
It is agreed that all of the provisions of each Workmen's Compensation Law covered hereby shall be and remain a part of
this contract as fully and completely as if written herein, so far as they apply to compensation or other benefits for any
personal injury or death covered by this Policy, while this Policy shall remain in force. Nothing herein contained shall
operate to so extend this Policy as to include within its terms any Workmen's Compensation Law, scheme or plan not
cited in an endorsement hereto attached. W
One (b) To Indemnify this Employer against loss by reason of the liability imposed upon him by law for damages
on account of such injuries to such of said employees as are legally employed wherever such injuries may be sustained with-
in the territorial limits of the United States of America or the Dominion of Canada. In the event of the bankruptcy or
insolvency of this Employer the Company shall not be relieved from the payment of such indemnity hereunder as would
have been payable but for such bankruptcy or insolvency. If, because of such bankruptcy or insolvency, an execution
against this Employer is returned unsatisfied in an action brought by the injured, or by another person claiming by,
through or under the injured, then an action may be maintained by the injured, or by such other person claiming by,
through or under the injured, against the Company under the terms of this Policy for the amount of the judgment in
said action not exceeding the amount of this Policy.
Two To Serve this Employer (a) by the inspection of work places covered by the Policy when and as deemed
desirable by the Company and thereupon to suggest to this Employer such changes or improvements as may operate to
reduce the number or severity of injuries during work, and, (b) upon notice of such injuries, by investigation thereof and
by settlement of any resulting claims in accordance with law. Three To Defend, in the name and on behalf of this Employer, any suits or other proceedings which may at any
time be instituted against him on account of such injuries, including suits or other proceedings alleging such injuries and
demanding damages or compensation therefor, although such suits, other proceedings, allegations or demands are wholly groundless, false or fraudulent.
Four To Pay all costs taxed against this Employer in any legal proceeding defended by the Company, all interest
accruing after entry of judgment and all expenses incurred by the Company for investigation, negotiation or defense, 1
Five This agreement shall apply to such injuries sustained by any person or persons employed by this
Employer whose entire remuneration shall be included in the total actual remuneration for which provision is hereinafter %
made, upon which remuneration the premium for this Policy is to be computed and adjusted, and, also to such injuries
so sustained by the President, any Vice-President, Secretary or Treasurer of this Employer, if a corporation. The
remuneration of any such designated officer shall not be subjected to a premium charge unless he is actually performing
such duties as are ordinarily undertaken by a superintendent, foreman or workman..
Six This agreement shall apply to such injuries so sustained by reason of the business operations described
in said Declarations which, for the purpose of this insurance, shall include all operations necessary, incident or appurte-
nant thereto, or connected therewith, whether such operations are conducted at the work places defined and described in
said Declarations or elsewhere in connection with, or in relation to, such work places.
Seven This agreement shall apply only to such injuries so sustained b reason of accidents
by occurring during
3 the Policy Period limited and defined as such in Item 2 of said Declarations.
(For Conditions see Second Page)
This space is intended for the attachment of such endorsements as may be executed as in the Policy provided, and,
when so executed and attached, they are to be construed as a part of the Policy.
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THIS AGREEMENT IS SUBJECT TO THE FOLLOWING CONDITIONS:
A. The premium is based upon the entire remuneration Board or other state agency for the benefit of such em-
earned, during the Policy Period, by all employees of this ployees or such dependents, then the provisions of such law
Employer engaged in the business operations described in are made a part hereof, as respects any matter subject
said Declarations together with all operations necessary, thereto, as fully as if written herein. The obligations and
incident or appurtenant thereto, or connected therewith promises of the Company as set forth in this paragraph
whether conducted at such work places or elsewhere in con- shall not be affected by the failure of this Employer to do
nection therewith or in relation thereto; excepting however or refrain from doing any act required by the Pohcy; nor
the remuneration of the President, any Vice-President, by any default of this Employer after the accident in the
Secretary or Treasurer of this Employer, if a corporation, payment of premiums or in the giving of any notice re-
but including the remuneration of any one or more of such quired by the Policy or otherwise; nor by the death, insol-
designated officers who are actually performing such duties vency, bankruptcy, legal incapacity or inability of this Em-
as are ordinarily undertaken by a superintendent, foreman ployer, nor by any proceeding against him as a result of
or workman. If any operations as above defined are under- which the conduct of this Employer's business may be and
taken by this Employer but are not described or rated in continue to be in charge of an executor, administrator, re-
said Declarations, this Employer agrees to pay the pre- ceiver, trustee, assignee, or other person.
mium thereon, at the time of the final adjustment of the E. As between the employee and the Company, notice to
premium in accordance with Condition C hereof, at the or knowledge of this Employer of an injury or death cover-
rates and in compliance with the rules, of the Manual of ed hereby shall be notice or knowledge, as the case may be,
Rates in use by the Company upon the date of issue of of the Company; the jurisdiction of this Employer, for the
this Policy. purposes of any Workmen's Compensation Law covered
At the end of the Policy Period the actual amount of the re- hereby, shall be jurisdiction of the Company and the Com-
muneration earned by employees during such Period shall pany shall in all things be bound by and subject to the find-
be exhibited to the Company, as provided in Condition C rags, judgments, awards, decrees, orders or decisions reri-
hereof, and the earned premium adjusted in accordance there- dered against this Employer in the form and manner pro-
with at the rates and under the conditions herein specified. vided by such laws and within the terms, limitations and
If the earned premium, thus computed, is greater than the provisions of this Policy not inconsistent with such laws.
advance premium paid, this Employer shall immediately F. This n Employer, upon the occurrence of an accident,
pay the additional amount to the Company, if less, the shall give immediate written notice thereof to the Company
Company shall return to this Employer the unearned por- with the fullest information obtainable. He shall give like
tion, but in any event the Company shall retain the Mini- notice with full particulars of any claim made on account
muin Premium stated in said Declarations. All premiums of such accident. If, thereafter, any suit or other proceed-
provided by this Policy, or by any endorsement hereon, ing is instituted against this Employer, he shall immediate-
shall be fully earned whether any such Workmen's Com- ly forward to the Company every summons, notice or other
pensation Law, or any part of such, is now or shall here- process served upon him. Nothing elsewhere contained in
after be declared invalid or unconstitutional. this Policy shall relieve this Employer of his obligations to
B. This Policy may be canceled at any time by either of the Company with respect to notice as herein imposed
the parties upon written notice to the other party stating upon him.
when, not less than ten days thereafter, cancelation shall be G. No action shall lie against the Company to recover
effective. The effective date of such cancelation shall then upon any claim or for any loss under Paragraph One (b)
be the end of the Policy Period. The law of any state, in foregoing unless brought after the amount of such claim or
which this Policy applies, which requires that notice of can- loss shall have been fixed and rendered certain either by
celation shall be given to any Board, Commission or other final judgment against this Employer after trial of the issue
state agency is hereby made a part of this Policy and can- or by agreement between the parties with the written con-
celation in such state shall not be effective except in com- sent of the Company, nor in any event unless brought
pliance with such law. The remuneration of employees within two years thereafter.
for the Policy Period stated in said Declarations shall be H. If the method of serving notice of cancelation, or the
computed upon the basis of the actual remuneration to the limit of time for notice of accident or for any legal proceed-
date of cancelation determined as herein provided. If such ing herein contained is at variance with any specific stat-
cancelation is at the Company's request, the earned pre- utory provision in relation thereto, in force in the state in
mium shall be adjusted pro rata as provided in Condition A. which any of the business operations herein described are
If such cancelation is at this Employer's request, the conducted, such specific statutory provision shall super-
earned premium shall be computed and adjusted at short sede any such condition in this contract inconsistent there-
rates, in accordance with the table printed hereon, but such with.
short rate premium shall not be less than the Minimum I. No assignment of interest under this Policy shall
Premium stated in said Declarations. If this Employer, bind the Company unless the consent of the Company shall
when requesting cancelation, is actually retiring from the be endorsed hereon.
business herein described, then the earned premium shall J. If this Employer carries any other insurance covering
be computed and adjusted pro rata. Notice of cancelation a claim covered by this Policy, he shall not recover from the
shall be served upon this Employer as the law requires, but, Company a larger proportion of any such claim than the
if no different requirement, notice mailed to the address of sum hereby insured bears to the whole amount of valid and
this Employer herein given shall be a sufficient notice, and collectible insurance.
the check of the Company, similarly mailed, a sufficient K. The Company shall be subrogated, in case of any pay-
tender of any unearned premium. ment under this Policy, to the extent of such payment, to
C. The Company shall be permitted, at all reasonable all rights of recovery therefor vested by law either in this
times during the Policy Period, to inspect the plants, works, Employer, or in any employee or his dependents claiming
machinery and appliances covered by this Policy, and to hereunder, against persons, corporations, associations or
examine this Employer's books at any time during the estates.
Policy Period, and any extension thereof, and within one L. No condition or provision of this Policy shall be
year after its final expiration, so far as they relate to the re- waived or altered except by endorsement attached hereto
muneration earned by any employees of this Employer signed by the President, a Vice-President or Secretary; nor
while this Policy was in force. shall notice to any agent, nor shall knowledge possessed by
D. The obligations of Paragraph One (a) foregoing are any agent, or by any other person, be held to effect a
hereby declared to be the direct obligations and promises of waiver or change in any part of this contract. Changes in
the Company to any injured employee covered hereby, or, the written. portion of the Declarations forming part hereof
in the event of his death, to his dependents; and to each (except Items 2, 3 and 4) may be made by the agent
such employee or such dependent the Company is hereby countersigning this Policy, such changes to bind the Com-
made directly and primarily liable under said obligations pany when initialed by such agent. The personal pronoun
and promises. This contract is made for the benefit of herein used to refer to this Employer or to an injured
such employees or such dependents and is enforceable employee or dependents, shall apply regardless of number
against the Company, by any such employee or such de- or gender.
pendent in his name or on his behalf, at any time and in M. The statements in Items 1 to 6, inclusive, in the
any manner permitted by law, whether claims or proceed- Declarations hereinafter contained, are true; those stated
ings are brought against the Company alone or jointly with as estimates only are believed to be true. This Policy is
this Employer. If the law of any state in which the Policy issued upon such statements and in consideration of the
is applicable provides for the enforcement of the rights of provisions of the Policy respecting its premium and the
such employees or such dependents by any Commission, payment of the premium in such Declarations expressed.
In (Uitnea Whereof, The ANCHOR CASUALTY COMPANY has caused this Policy to be signed by its President
and Secretary, but the same shall not be binding upon the COMPANY unless countersigned by a duly authorized rep-
resentative of the Company.
(RA4~w
Secretary. President.
nosemount, ,~.i.nnesota ljth ~ovT~=n'~^r
Countersigned at - this day of--- - 19
Authorized Representative.
QC~A~Ation Number 4` t
Item 1. Name of this Employer TOti:NSHIP OF EAGAPN
P. O. Address 11. Y. L. fill, SA i T PAUL, 7, MINNESOTA
For the purpose of serving notice, as in the Policy provided, this Employer agrees that this address may be
considered as both the residence and business address of this Employer or any representative upon whom notice
may be served.
Individual, co-partnership, corporation or estate? Muniei.nF•lity
Item 2. The period during which the Policy shall remain in force, unless canceled as in the Policy provided (herein
called the Policy Period) shall be from a_!ecember 11, 19W4 , to December 11, 19LL5
at twelve and one minute o'clock A. M., standard time, as to each of said dates at the place where any operation
covered hereby is conducted, as respects that operation, or at the place where any injury covered hereby is
sustained, as respects that injury.
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~ cdara €on Number 4 231
Item 1. Name of this Employer TG.'~iISHIP OF EAGAN
P. O. Address R. D. #11, SAINT PAUL, 7, MI1Tt%:_SOTA
For the purpose of serving notice, as in the Policy provided, this Employer agrees that this address may be
considered as both the residence and business address of this Employer or any representative upon whom notice
may be served.
Individual, co-partnership, corporation or estate? Municipality
Item 2. The period during which the Policy shall remain in force, unless canceled as in the Policy provided (herein
called the Policy Period) shall be from ece fiber 11, 19)4 , to December 11, 19I15
at twelve and one minute o'clock A. M., standard time, as to each of said dates at the place where any operation
covered hereby is conducted, as respects that operation, or at the place where any injury covered hereby is
sustained, as respects that injury.
Item 3. Locations of all factories, shops, yards, buildings, premises or other work places of this Employer, by Town
or City, with Street and Number. R.F.D. #11, Saint Paul 7, Minnesota and
elsewhere in the State of Minnesota.
All business operations, including the operative management and superintendence thereof, conducted at or
from the locations and premises defined above as declared in each instance by a disclosure of estimated remunera-
tion of employees under such of the following Divisions as are undertaken by this Employer. 1 All industrial
operations upon the premises. 2 All office forces. 3 Operations not on the premises.
CLASSIFICATION OF OPERATIONS Estimated Rate per Estimated
Total Annual $100 of Re-
NOTE: If more than one classification indicate each other by (b), (c), (d), etc. (Remuneration muneration Premium
1 (a.) Street or Road Construction or Reconstruction,
Paving or Repaving, Surfacing or Resurfacing or
Scraping- all kinds-including airport runways or
warming aprons; Drivers, Chauffeurs and their
He1-oers.-(Cleari.ng of right of way; earth or rock
excavation; filling or grading; tunneling; bridge
or culvert building; quarrying; stone crushing to
be sevara,tely rated.) (5506) 1,000 '.16
(b) Constables - including Drivers, Chauffeurs
mnd their Helpers. (7720) 100 1 1.57 1.57
Min Ch~.
2 (a) Clerical Office Employees 8810
3 (a) Outside Salesmen, collectors and messengers (wherever engaged)
who do not deliver merchandise 8742
(b) Drivers and their Helpers, including stablemen-if not specifically
included in Division 1 7205
(c) Chauffeurs and their Helpers-Commercial, including incidental
garage employees-if not specifically included in Division 1 7380
Minimum Premium for this Policy shall be $ 39 -CO Estimated Advance Premium 39.00
Item 4. The foregoing enumeration and description of employees include all persons employed in the service of this
Employer in connection with the business operations above described to whom remuneration of any nature in
consideration of service is paid, allowed or due together with an estimate for the Policy Period of all such remunera-
tion. This enumeration and description with the estimated remuneration shall also include the President, any
Vice-President, Secretary or Treasurer of this Employer if a corporation if actually performing such duties as
are ordinarily undertaken by a superintendent, foreman or workman, but any such designated officer not so
engaged shall not be included in such enumeration, description or estimated remuneration. The foregoing
estimates of remuneration are offered for the purpose of computing the advance premium. The Company
shall be permitted to examine the books of this Employer at any time during the Policy Period and any extension
thereof and within one year after its final termination so far as they relate to the remuneration earned by any
employees of this Employer while the Policy was in force.
Item 5. This Employer is conducting no other business operations at this or any other location not herein disclosed-
except as herein stated:
Item 6. No similar insurance has been canceled by any insurance carrier during the past year-except as herein stated:
For Attachment to
SIANDARD WORKMEN'S COMPENSATION AND EMPLOYERS' LIABILITY POLICY
ichen applicable in the STATE OF MINNESOTA to complete the contract as provided in the Policy
1. The obligations of Paragraph One (a) of the Policy to which this endorsement is attached include
such Workmen's Compensation Laws as are herein cited and described and none other;
Chapter 23A, General Statutes of Minnesota, 1923,
and all laws amendatory thereof or supplementary thereto which are or may become effective while this
Policy is in force.
2. This Employer agrees that he will not create or carry into operation any fraudulent scheme, artifice,
or device to enable him to execute work without himself being responsible to the workmen for the provisions
of such Workmen's Compensation Law.
3. If this Employer is a general contractor, intermediate contractor or subcontractor, as defined and
limited by Section 4290 of the above cited Workmen's Compensation Law and this Employer contracts with
another (herein called Subseqent Subcontractor) for the performance of all or any part of the Business Oper-
ations covered by this Policy, it is agreed that the remuneration of all employees of any Subsequent Subcon-
tractors shall be included in the return of remuneration upon which the premium for this Policy is computed
in the same manner as is required by the Policy for the remuneration of the direct employees of this Em-
ployer. The remuneration of the employees of any Subsequent Subcontractor shall be subject to the manual
rates for each classification of operations undertaken by the Subsequent Subcontractor, such manual rates to
be adjusted to reflect the experience modification of the general contractor. This Employer named as such in
the Policy shall pay to the Company the amount of premium so computed on the operations of any Subse-
quent Subcontractor as hereinbefore provided. This paragraph shall not apply to any Subsequent Sucon-
tractor who has provided security for compensation for his employees in full compliance with Section 4288 of
said Law and maintains such security during the performance of the subcontracted operations.
4. It is agreed that the Policy of which this endorsement forms a part does not afford insurance under
Paragraph One (b) with respect to the liability imposed upon this Employer by law for damages on account
of any disease caused or aggravated by periodic, frequent or continual exposure over a period of days,
weeks, months or longer to conditions in the course of employment, or any occupational disease, and that the
provisions of Paragraph Two, Three and Four shall not apply with respect to any disease for which no in-
surance is afforded under Paragraph One (b).
5. If this Employer is a corporation, the entire remuneration of the President, any Vice-President,
Secretary, Treasurer and other executive officers elected or appointed in accordance with the charter and
by-laws of such corporation shall be disclosed and premium shall be paid thereon, subject to a minimum
individual remuneration of $30 per week, if the actual remuneration is less than such amount, and to a max-
in.iutn individual remuneration of $100 per week, if the actual remuneration is greater than such amount.
The remuneration so determined of each executive shall be assigned without division to the classification
which is applicable to the actual operations in which such executive officer is primarily engaged, provided
the remuneration so determined of each executive officer who performs such duties as are ordinarily under-
taken by a superintendent, foreman or workman, or whose duties include direct charge of the actual perform-
ance of any operations of this Employer, shall be assigned without division to the highest rated classification
which is applicable to any such duties undertaken by such executive officer for any part of his time.
6. The Company's liability under Paragraph One (b) shall be limited to $25,000 as the result of one
or more claims arising from a single accident.
7. This Policy is issued by the Company and accepted by this Employer with the agreement that
premium rates are subject to changes to the extent that such changes are approved or required by the Com-
pensation Insurance Board of Minnesota in accordance with law by reason of (1) any change in the benefit
provisions of the above cited compensation law effective during the Policy Period, or (2) any revision of
manual rates which becomes effective and applicable during the Policy Period, or (3) the promulgation of
adjusted rates by the Minnesota Compensation Rating Bureau in accordance with the rating plans as approv-
ed. Such change shall become applicable from and after the date specified by the rate making authority. The
provisions of this paragraph shall apply to rates expressed in this Policy or any endorsement attached thereto.
Such changes, if any, are to be expressed by further endorsement naming the effective date thereof.
8. This Policy as written is amended as herein specifically stated but not otherwise.
ANCHOR CASUALTY COMPANY
(RA4a-aw -
Form 538A 5M dp 9-44 President
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