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310178 <br />ACCORD® CERTIFICATE OF LIABILITY INSURANCE <br />DAens/20 6 <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 pollcy(ies) must be Endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />Commercial Lines - (404) 923-3700 <br />Wells Fargo Insurance Services USA, Inc. <br />3475 Piedmont Road NE, Suite 800 <br />Atlanta, GA 30305-2886 <br />CONTACT Kimberlee Kolli <br />PHONE <br />FAX <br />Alq a .404-923-3532 A/q Rol, 877-362-9069 <br />ADDRESS: Kimberlee.m.kolli@wellsfargo.com <br />INSURER S AFFORDING COVERAGE <br />NAIC Y <br />INSURER A: LM Insurance Corporation <br />33600 <br />INSURED <br />Kite Realty Group Trust <br />30 S. Meridian St., Ste. 1100 <br />INSURER e: Allied World Assurance CO US <br />19469 <br />INSURER C <br />INSURER O: <br />INSURER E : <br />Indianapolis IN 46204 <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: 10580924 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 />ILTR <br />I TYPE OF INSURANCE <br />Jm B <br />POLICY NUMBER <br />MMIOD,Y y <br />MMIDIDIYYYY <br />LIMITS <br />A <br />X COMMERCUILGENERALLIIIBILITY <br />CLAIMS -MADE � OCCUR <br />TB5Z91453740076 <br />No Deductible/Retention <br />Applies to GL <br />3/01/2016 <br />3/01/2017 <br />� <br />EACH OCCURRENCE <br />$ 1,000,000 <br />A O RENTED <br />PREMISES Ea omurrence <br />$ 300.000 <br />MED EXP(Any one person) <br />$ Excluded <br />PERSONAL A ADV INJURY <br />$ 1,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRO <br />POLICY JECT X LOC <br />OTHER: <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />PRODUCTS-COMP/OP AGG <br />$ 2,000,000 <br />$ <br />A <br />AUTOMOBILE LIABILITY <br />MANY AUTO <br />B ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />% HIRED AUTOS X NON-Ol <br />AUTOS <br />AS5Z91453740066 <br />No deductible <br />On AUTO Liability <br />Y <br />03/01/2016 <br />3/01/2017 <br />j <br />OMBINEDi SINGLE LIMIT <br />fee% <br />$ 1,000,000 <br />BODILY INJURY (Per person) <br />$ <br />BODILVINJURY(Peraccidelt ) <br />$ <br />PROPERTY DAMAGE <br />Per amident <br />$ <br />B <br />X UMBRELLA LUIB <br />EXOESSLIAB <br />% <br />OCCUR <br />CLAIM_MADE <br />0308-8008 <br />3/01/2016 <br />j <br />3/01/2017 <br />EACH OCCURRENCE <br />$ 25,000,000 <br />AGGREGATE <br />$ 25,000,000 <br />DIED % RETENTION$ 5,000 <br />$ <br />A <br />WORKERS COMPENSATION <br />ANDEMPLOYERS'LIABILITY YIN <br />OFFICER/MEMBERMY /EXCUDED RTNECUTIVE <br />(Mandatory in NH) <br />If yea, describe under <br />DESCRIPTION OF OPERATIONS bebw <br />NIA <br />WC5Z91453740086 <br />3/01/2016 <br />3/01/2017 <br />X PER OTH- <br />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 />$ 1,000,000 <br />DESCRIPTION OFOPERATIONS I LOCATIONS I VEHICLES (ACORD ID1,Addltiond Remarks Schedule, maybe aeaered it more space is required) <br />Board Of Public Works SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />1316 County -City Building THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />227 West Jefferson Boulevard <br />South Bend, IN 46601 AUTHORIZED REPRESENTATIVE <br />The ACORD name and logo are registered marks of ACORD ©1888-2014 ACORD CORPORATION. All rlahts reserved <br />ACORD 25 (2014/01) <br />(rxs amm�u revia�• ssnmrasa mmarze iss�eecn s,aoral <br />