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31017B
<br />0
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MMIDDNYYYI
<br />2/27/2018
<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(€es) 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 ondorsement(s).
<br />PRODUCER
<br />Lines - (404) 923 3700
<br />Commercial L
<br />USI Insurance Services National, Inc.
<br />3475 Piedmont Road NE, Suite 800
<br />Atlanta, GA 30305-2886
<br />coNTACT Tim Baumann
<br />NAIVE:
<br />"ONE FAX
<br />:0610 537 1929
<br />EMAIL tim.baumann@usi.com
<br />anDREss;
<br />INSURER(S) AFFORDING COVERAGE
<br />,
<br />NAIC 4
<br />INSURERA: Endurance Assurance Corporation
<br />11551
<br />INSURED
<br />Kite Realty Group Trust
<br />30 S. Meridian St.,
<br />Suite 1100
<br />Indianapolis, IN 46204
<br />INSURER e : Allied World National Assurance Co,
<br />10690
<br />INSURER_ C : Sompo America Insurance Company _ _
<br />INSURER O :
<br />11126
<br />INSURER E ;
<br />INSURER F ;
<br />i,r_nwr+cr+ e-CDTIRt!'_A-rr: MHMME-0- 1277427"b REVISION NUM$EK: oee DeroW
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES ❑1=SCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />A SD
<br />WVO
<br />POLICY NUMBER
<br />MM nD YYY
<br />MMIDDIOL'ryYYYYe'p
<br />LIMITS
<br />A
<br />X
<br />COMM&RCIALGENERAL LIABILITY
<br />CLAIMS -MADE X OCCUR
<br />GGR10012604100
<br />031011201E
<br />03/01/2019
<br />EAC"OCCURRENCE
<br />S 1,1300,000
<br />-71
<br />PREMISES Ea occu nce}�
<br />S 1,0001000
<br />MEO EXP (Any one person)
<br />S Excluded
<br />PERSONAL &AOV INJURY
<br />5 1.000,000
<br />GEN'LAGGREGATE LIMIT APPLIES PER:
<br />GENERNLAOGREGATE
<br />S 2,000,000
<br />PRODUCTS -COMPIOPAGG
<br />$ 21000,000
<br />POLICY ❑ L_"J LOC
<br />5
<br />,fop
<br />A
<br />OTHER:
<br />AUTOMOBILE LIABILITY
<br />ACVS100BIO
<br />0310f12018
<br />03/01/2019
<br />EOMacelde tswyLELIMIT
<br />S 1,000,000
<br />BODILY INJURY (Per person)
<br />ANYAUTO
<br />BODILY INJURY (per eccldnntl
<br />S
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />X HIRED NON -OWNED
<br />AUTOS ONLY X AUTOS ONLY
<br />PROPERTYOAh1AGE
<br />Per accidan€
<br />$
<br />$
<br />B
<br />TXU1MBRE1kL-ALJAB"TIOx
<br />CESS LIAR
<br />OCCUR3088008
<br />CLAIMS -MADE
<br />03/01/2018
<br />03/01/2019
<br />EACHOCCURRENCE
<br />S 25,000,000
<br />AGGREGATEE
<br />$O
<br />X RETNS
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANYPROPRIETORIPARTNERIEXECUTIVE YIN
<br />OFFICERIMEMSEREXCLUDEO? C
<br />IMandatory in NH)
<br />If es, Jest ibe undo€
<br />D>�SCRIPTION UO OPERATIONS below
<br />X1 STA E ERH
<br />NIA
<br />WCN81015P0
<br />03/0112018
<br />03/01/2019
<br />E.L. EACH ACCIDENT
<br />S 1,y00,0g0
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ i'000,000
<br />E.L. DISEASE - POLICY HMiT
<br />S 1,000.000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS IVEHICLES (ACORD 101, Additional Remarks Schedule, maybe alfached If more space Is required)
<br />Re: KRG Eddy Street Commons, LLC , Eddy Street Commons 1044-1234 Eddy Street, South Bend, IN 46601
<br />r�r: Ft f-awr:F1 I l I111N
<br />City of South Bend
<br />Department of Public Works, Engineering Division
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION BATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />227 W Jefferson Blvd„ Suite 1316
<br />AUTHORIZEDREPRESENTATIVE
<br />South Bend, IN 46601
<br />The ACORD name and logo are registered marks of AGUKu lyt3ti-zV15 H�vreu �,�rcrvrcra I rely, ntI I1y€1w Iearlvcu,
<br />ACORN 25 (2016103)
<br />
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