COI Expires 12/17/2020 712/16/2019
E(MM/DD/YYYY)
ACOR" CERTIFICATE OF LIABILITY INSURANCE
'111
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT
NAME: Glen Mlron
CSIDZ, LLC PHONE FAX
225 South Sixth Street, Suite 1900 A/C No Ext: 612-322-6013 vc,No):
E-MMinneapolis MN 55401 ADDRESS: gmiron@csdz.com
INSURER(S)AFFORDING COVERAGE NAIC#
INSURERA:Travelers Indemnity Company 25658
INSURED INNOMASI INSURER B:Travelers Property Casualty 25674
Innovative Masonry Restoration, LLC INSURERC: Charter Oak Fire Insurance Company 25615
16264 Lakeside Ave
Prior Lake MN 55372 INSURER D7
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:1372593754 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS
LTR INSD WVD POLICY NUMBER MM/DD MM/DD
A X COMMERCIAL GENERAL LIABILITY Y Y DTC04P65049AIND19 12/17/2019 12/17/2020 EACH OCCURRENCE $1,000,000
DAMAGE S( RENTED
CLAIMS-MADE OCCUR
PREMISES Ea occurrence)
ccurrence) $300,000
X Cont Liab Per MED EXP(Any one person) $10,000
X Policy Form/XCU PERSONAL&ADV INJURY $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
POLICY� PE� LOC PRODUCTS-COMP/OP AGG $2,000,000
OTHER: $
B AUTOMOBILE LIABILITY Y Y 8104P1574341926G 12/17/2019 12/17/2020 COEaMBINED accidentSINGLELIMIT $1,000,000
X ANY AUTO BODILY INJURY(Per person) $
OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY Per accident
B X UMBRELLA LAB X OCCUR N Y CUP4P1580981926 12/17/2019 12/17/2020 EACH OCCURRENCE $5,000,000
EXCESS LAB CLAIMS-MADE AGGREGATE $5,000,000
DED X RETENTION$1 n nnn $
C WORKERS COMPENSATION Y UB4P1432691926G 12/17/2019 12/17/2020 X PER OTH-
AND EMPLOYERS'LIABILITY Y/N STATUTE ER
ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000
OFFICE R/M EMBER EXCLUDED? FN] N/A
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required)
The Certificate Holder is an Additional Insured under the Commercial General Liability and Auto Liability when required by written contract.
1ST
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A 3/30 020
CERTIFICATE HOLDER WAMF ,_ 4NCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Monroe County Board of County Commissioners
500 Whitehead Street AUTHORIZED REPRESENTATIVE
Key West FL 33040 IRA
@ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD