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Insurance Information <br /> Professional Liability Insurance (Required for All Salons)—General Liability will not be accepted <br /> Name of Insurance Company , i <br /> ���!�� �/�� �....�,� - <br /> Policy Number � � ., , � f ,� <br /> ��� �� <br /> Attach a Certificate of Insurance to the Application that indicates: <br /> • Certificate Must Show: <br /> o $25,000 coverage/each claim <br /> o $50,000 coverage/each policy per operator <br /> • Certificate Holder Must Be: <br /> o Minnesota Board of Cosmetologist Examiners, 2829 University Ave SE,Suite 710, Minneapolis, <br /> MN 55414. <br /> o Name of Insured must be the owner and DBA of the salon and assigned to the salon's address. <br /> Workers Comnensation Questions <br /> 1. Will this salon employ individuals? �Yes � No <br /> 2. Will this salon have only independent contractors with MN Manager Licenses? oYes Q No <br /> You must complete the following Workers Compensation Insurance section if you answered: <br /> • Yes,to Question Number One or <br /> • No,to Question Number Two <br /> Workers Compensation Insurance (Required for All Salons Employing Individuals) <br /> Name of Insurance Company v /)„ ` <br /> , � l <br /> Policy Number ; ,�� ��, s � <br /> � -tl1 <br /> Required documentation to be submitted to the BCE <br /> • Certificate Must Show: <br /> o Workers Compensation Coverage <br /> • Certificate Holder Must Be: <br /> o Minnesota Board of Cosmetologist Examiners, 2829 University Ave SE,Suite 710, Minneapolis, <br /> MN 55414. <br /> • Contact the Minnesota Department of Labor and Industry regarding workers compensation questions <br /> at 651-284-5005. <br /> 4 <br />