01APM044398-02_Fitness_Superstore__Inc._COI__1_.pdf

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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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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):

E-MAIL

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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