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310178
<br />0
<br />acoRo CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MMIDDIYYYY)
<br />212712018
<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
<br />Commercial Lines - (404) 923-3700
<br />US] Insurance Services National, Inc.
<br />3475 Piedmont Road NE, Suite 800
<br />Atlanta, GA 30305-2886
<br />CONTACT NAME: Tim Baumann
<br />PHONE FAX
<br />c.No-WC 470.875.0517 AIc No; 610-537-1929
<br />E-MAIL ADDRESS: tim.baumannQusi.com
<br />INSURERIS)AFFOROINGCOVERAGE
<br />NAICIt
<br />INSURERA: Endurance Assurance Corporation
<br />11551
<br />INSURED _
<br />Kite Realty Group Trust
<br />30 S. Meridian St.,
<br />Suite 1100
<br />Indianapolis, IN46204
<br />INSURER : Allied World National Assurance Co.
<br />10690
<br />INSURER : Sompo America Insurance Company
<br />11126
<br />-- ---
<br />INSURER D ;
<br />INSURERE:
<br />INSURERF: mm
<br />rnVFRAGFS CERTIFICATE NUMBER: 12774275 REVISION NUMBER: See below
<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 CONTRACT OR 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 />ADDL SUER POLICY EFF POLICY EXP-
<br />INSR TYPE OP INSURANCE LIMITS
<br />LTR IN50 WVD POLICY NUMBER MMIDDIYYYY MMlDOIYYYY
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE 1-fl OCCUR
<br />GGR10012604100
<br />03/01/2018
<br />03/01/2019
<br />EACHOCCURRENCE
<br />S 1,000,000
<br />GE TO RENTED
<br />PREMISES Ea occurrence
<br />$ 1,000,000
<br />MED EXP (Any one person)
<br />$ Excluded
<br />PERSONAL & AOV INJURY
<br />S 1,000,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />S 2,000,000
<br />GEN'L
<br />PRODUCTS - COMPIOP AGG
<br />$ 2,000,000
<br />POLICY PRO-
<br />JECT LOC
<br />S
<br />OTHER:
<br />/5,
<br />AUTOMOBILE LIABILITY
<br />ACVS100810
<br />03/01/2018
<br />0310112019
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />X HIRED X NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />BODILY INJURY (Per accfdenl)
<br />S
<br />PROPERTYDAMAGE
<br />Per accident
<br />S
<br />$
<br />S
<br />X
<br />UMBRELLALIAB
<br />X
<br />OCCUR
<br />3088008
<br />03/01/2018
<br />03/01/2019
<br />EACHOCCURRENCL
<br />S 25,000,000
<br />AGGREGATE
<br />$ 25,000,000
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />DEO I X RETENTION$ 5,000
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANYPROPRIETORIPARTNERIEXECUTIVE
<br />OFFICERlMEMBEREXCLUCED? N
<br />(Mandatory In NH)
<br />NIA
<br />WONS1015P0
<br />03/01/2018
<br />03/01/2019
<br />X STATUTE ER"
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1.000.000
<br />E.L. DISEASE -POLICY LIMIT
<br />S 1.000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />DESCRIPTION OF OPERATIONS f LOCATIONS f VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Re: KRG Eddy Street Commons, LLC , Eddy Street Gammons 1044-1234 Eddy Street, South Bend, IN 46601
<br />r`Fr7TlRIrATF I-Inl nFR CANCELLATION
<br />City of South Send
<br />Department of Public Works, Engineering Division
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />227 W Jefferson Blvd., Suite 1316
<br />AUTHORIZED REPRESENTATIVE
<br />South Send, IN 46601
<br />The ACORD name and logo are registered marks of ACORD (P1988.2015 ACORD CORPORATION. An rights reserved.
<br />ACORD 25 (2016103)
<br />
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