01APM044398-02_Fitness_Superstore__Inc._COI__1_.pdf
PDF 68 KB Posted
- Attached to
- Master Agreement AZ|CTR079527
- Contract number
- CTR079527
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance issued by Kraft Lake Insurance Agency, Inc. for FITNESS SUPERSTORE, INC., with Berkshire Hathaway Homestate Companies and Redwood Fire and Casualty Insurance Company as the insurers. The certificate is specifically for the Arizona Department of Administration, located at 100 N 15th Avenue in Phoenix, AZ 85007, and covers automobile liability for a fleet of six vehicles manufactured between 2013 and 2017.
The insurance policy provides a combined single limit of $1,000,000 for automobile liability, with coverage effective from 02/28/2025 12:01 AM to 02/28/2026 12:01 AM. The vehicle schedule includes a 2013 Utility trailer, 2015 and 2014 Freightliner M2 106 trucks, a 2015 RAM 1500, a 2017 Isuzu NRR, and a 2014 Isuzu NPR-HD. Each vehicle has a collision coverage designation with varying stated amounts ranging from $4,000 to $30,000, and a consistent physical damage deductible of 500/500. The certificate holder (Arizona Department of Administration) is named as an Additional Insured on the policy.
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Text version
LIMITS
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.
PROPERTY DAMAGE
(Per accident)
TYPE OF INSURANCE
NAIC #INSURER(S) AFFORDING COVERAGE
X
1,000,000
01APM044398-02 02/28/2026
12:01 AM
N/A
N/A
N/A
Kraft Lake Insurance Agency, Inc.
5665 N Kraft Lk SE
Caledonia, MI 49316
586,043
A
Berkshire Hathaway Homestate Companies
02/28/2025
12:01 AM
FITNESS SUPERSTORE, INC.
537 STONE RD STE F
BENICIA, CA 94510
Y Y
03/20/2025 7:59 AM
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.
IIMPORTANT: 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).
CONTACT
NAME:
PHONE
(A/C. No. Ext):
FAX
(A/C. No):
ADDRESS:
INSURER A:
INSURER B:
INSURER C:
INSURER D:
INSURER E:
INSURER F:
PRODUCER
INSURED
CERTIFICATE OF LIABILITY INSURANCE
COVERAGES REVISION NUMBER:CERTIFICATE NUMBER:
INSR
LTR
ADDL
INSD
SUBR
WVD POLICY NUMBER
POLICY EFF
(MM/DD/YYYY)
POLICY EXP
(MM/DD/YYYY)
$COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE OCCUR
GEN’L AGGREGATE LIMIT APPLIES PER:
POLICY
PRO-J
ECT
LOC
EACH OCCURRENCE
DAMAGE TO RENTED
PREMISES (Ea occurrence)
MED EXP (Any one person)
PERSONAL & ADV INJURY
GENERAL AGGREGATE
PRODUCTS – COMP/OP AGG
$OTHER:
AUTOMOBILE LIABILITY
ANY AUTO
OWNED
AUTOS ONLY
HIRED AUTOS
ONLY
SCHEDULED
AUTOS
NON-OWNED
AUTOS ONLY
COMBINED SINGLE LIMIT
(Ea accident)
BODILY INJURY (Per person)
BODILY INJURY (Per accident)
UMBRELLA LIAB
EXCESS LIAB
OCCUR
CLAIMS-MADE
DED RETENTION $
EACH OCCURRENCE
AGGREGATE
WORKERS COMPENSATION
AND EMPLOYERS’ LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? Y / N
(Mandatory in NH)
If yes, describe under
N / A E. L. EACH ACCIDENT
E. L. DISEASE – EA EMPLOYEE
E. L. DISEASE – POLICY LIMIT
PER
STATUTE
OTH-
ER
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
11673REDWOOD FIRE AND CASUALTY INS. CO.
Certificate Holder is named as Additional Insured on this policy.
Vehicle Schedule: see attached
Vehicle Schedule
ARIZONA DEPARTMENT OF ADMINISTRATION
100 N 15TH AVENUE
PHOENIX, AZ 85007
M-5652 (10/2017) The ACORD name and logo are registered marks of ACORD
ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved.
AUTHORIZED REPRESENTATIVE
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
CANCELLATIONCERTIFICATE HOLDER
Cargo
Limit
In-Tow
Limit
Phys. Dam.
Deductible
Stated
Amount
Comp or
Spec. Caus.CollisionYear, Make, Model, VIN
500/500Covered C 2013 UTILITY UTILITY 4RACS2026CN083863 N/A N/A 4,000
500/500Covered C 2015 FREIGHTLINER M2 106 1FVACXDT0FHGP3963 N/A N/A 30,000
500/500Covered C 2014 FREIGHTLINER M2 106 3ALACXDTXEDFT1253 N/A N/A 30,000
500/500Covered C 2015 RAM 1500 1C6RR7TM3FS549670 N/A N/A 28,000
500/500Covered C 2017 ISUZU NRR JALE5W165H7303211 N/A N/A 20,000
500/500Covered C 2014 ISUZU NPR-HD JALC4W162E7004653 N/A N/A 25,000
ARIZONA DEPARTMENT OF ADMINISTRATION
100 N 15TH AVENUE
PHOENIX, AZ 85007
M-5652 (10/2017) The ACORD name and logo are registered marks of ACORD
ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved.
AUTHORIZED REPRESENTATIVE
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
CANCELLATIONCERTIFICATE HOLDER
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