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DIREFIT-01 PVOSS
<br />ACOR®" CERTIFICATE OF LIABILITY INSURANCE DATE (M:vvDDmYY)05/1512018
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER €-CNONMEACT-PBUI VOSS
<br />GIS Cornerstone, LLC ` A
<br />_.
<br />22333 Classic Court E-MAIL
<br />HCNNo_ ExtJ (224) 655- 2494 315 VAX,
<br />No):(224) 241 3000
<br />Lake Barrington, IL 60010 a o ESS_, PoSs@giscornerstone com
<br />I - INSURERtS) AFFORDING COVERAGE _ NAIC I!_
<br />INSURER A_ Travelers CaSUal�I.I'1SU,rance
<br />INSURED I iNSURER6
<br />Direct Fitness Solutions LLC INSURER c
<br />& Tag Fitness LLC -- — - - —
<br />600 Tower Road INSURER.6 __--
<br />Mundelein, IL60060 INSURERS: _
<br />INSURER F .
<br />r,wr�co r�roTrcrnA rc kl� I�ao�o. ©GtllCinki Ail IRRIPLI=O-
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR €AOOL SUER POLICY EFF POLICY EXP
<br />LTR TYPE OF INSURANCE I N yyylp POLICY NUMBER Mp�pp LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL. LIABILITY
<br />_--
<br />]CLAIMS -MADE L X� OCCUR
<br />f
<br />I
<br />;630-6G27679A
<br />01116I2018
<br />0111612019
<br />EACH OCCURRENCE i
<br />DAMAGE TO RENTED
<br />PREMISES (Ea occurrence)
<br />$ 1,000,000
<br />-
<br />1oa,aoa
<br />$ ..-
<br />MEO EXP �ny_ane person)__;$
<br />_._ - -
<br />�,a0a
<br />-- _ _....
<br />PERSONAL_& ADV INJURY -
<br />$ 1,000,000
<br />!
<br />$ 2 ---- 0
<br />2,000,000
<br />$
<br />I GEN'L AGGREGATE LIMIT APPLIES PER:
<br />I POLICY PRO LOC
<br />!
<br />,GENERAL AGGREGATE
<br />PRODUCTS
<br />OTHER:
<br />$
<br />A
<br />AUTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT
<br />1,,000,000
<br />X ANY AUTO
<br />810-6G27679A
<br />0111612018,
<br />01/16/2019
<br />BODILY INJURY (Per p_ersanT
<br />$ __ __ __
<br />_ _
<br />OWNED SCHEDULED
<br />AUTOS ONLY - AUTOS
<br />X X p 9T
<br />AUTOS ONLY _.._....... AUTOS ONLY
<br />BODILY INJURY SPeracadent)
<br />rr
<br />$ -
<br />PROPERTY
<br />eer a dden} DAMAGE
<br />-(-- --
<br />$
<br />UMBRELLA LIAR
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />EXCESS L€AB
<br />CLAIMS -MADE
<br />CUP-9J181679
<br />01/1612018
<br />01/16/2019
<br />I 2,000,000
<br />TX
<br />AGGREGATE
<br />j
<br />$
<br />DEG X RETENTION $ 0:
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPR€FTORIPARTNERIEXECUTIVE YIN
<br />OF `.%=tR MEMBER EXCLUDED?
<br />{Mandatory in NH)
<br />NIA
<br />UB9J162180-18-14-G
<br />01116/2018
<br />01/16/2019
<br />I X I STATI,fTE �RH
<br />_
<br />_E.L EACH ACCIDENT,,,,._ __.__
<br />E.L. DISEASE -FA EMPLOYE
<br />1,000,000
<br />$ _
<br />1 ppp ppp
<br />$
<br />I If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />I $ 1,a0a,aaa
<br />I
<br />E
<br />I
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD iOl, Additional Remarks Schedule, may be attached if more space is required)
<br />RE: Charles Black Exercise Equipment, Project #1056-2018
<br />The City of South Bend Indiana is named as an Additional Insured on the General Liability per written contract on a primary and noncontributory basis for
<br />work performed by the Named Insured.
<br />rAAircr I A'rinkl
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of South Bend
<br />tY
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />3419 W Washington St
<br />South Bend, IN 46619
<br />AUTHORIZED REPRESENTATIVE
<br />i�L V00-
<br />ACORD 25 (2016103) U 198U-ZU15 A(:UKU L:UKPUKAI IUN. An rights reservea.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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