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HomeMy WebLinkAboutNon Res Block Party - Kite Realty - ND Pep Rally1316 COUNTY-CITYBUILDING 227 W. JFYFERSON BoULENARI) SOUTH BFND. W)JANA 46601-1930 CITY OFSOUTHBEND PETS' BuTTIGIEG, MAYOR BOARD OF PUBLIC OR August 28, 2018 Taryn Ford Kite Realty Group 30: S. Meridian Street Indianapolis, IN 46204 RE: Event Narne: Notre Dame Pep Rally Street Closure: Eddy St. from Angela Blvd. to Napoleon St. Dear Ms. Ford: PHOW, 574/235-9251 FAX 574/ 235-9171 The Board of Public Works, at its meeting held on August 28, 2018, approved your request to close the above referenced street for your events scheduled for September 7, 2018 and September 28, 2018 from 10:00 a.m. to 7:00 p.m., subject to background checks of your security officers. For your information, the South Bend Police Department will monitor these events. Enclosed please find a copy of your approved permits. You will be responsible for the placement and removal of the barricades at the conclusion of the closing of various streets. Please note that a ten foot (10') clear and unobstructed lane must be maintained at either curb or down the center of the street for emergency purposes and that no fires are allowed in the street. If you have any further questions regarding this matter, please call this office at (574) 235- 9251. Sincerely, Linda M. Martin, Clerk Enclosure GMy A. Gii,o'r SUZANNA M. FRITZBEiz(i ELIZABE'rii A. MARADIK JAMEs A, W1EI-11.'JTi ir.,,'RESE J. DoRAU 1 0 L I i I G I I I 1111111*0TAMM91=01:14 I *,.L DATE SENT 8/712018 TO: d Gleckler, Traffic & Lighting r ene Eyster, Police Department 4, Matt Longfellow, Engineering Chris Dressel, Community Investment I Xederico Rodriguez, Fire Department 41 arcia Qualls, Engineering -Kara Wood, Park Department Kylie Carter, Downtown 9,outh Bend FROM: Linda M. Martin, Clerk SUBJECT: Non -Residential Block Party Notre Dame Pep Rally LOCATION: 1 RIUMW; SPOr%SOR: DATE DUE: Eddy St from Angela to Napoleon Sept 7 2018; 10:00 a.m. to 7:00 pm. Taryn Ford/Kite Realty August 21, 201 RECOMMENDATIONS AND COMMENTS: By Date APPLICATION FOR USE OF, AND BLOCKING OF ACCESS TO, THE PUBLIC RIGHT-OF-WAY FOR NON -RE, SIDENTIAL BLOCK PARTIES The Board of Public Works must have FOUR (4) weeks prior notice of the event. A NON-REFUNDABLE APPLICATION FEE OF $125.00, IN THE FORM OF A CERTIFIED CHECK OR MONEY ORDER, PAYABLE TO THE CITY OF SOUTH BEND, MUST BE INCLUDED WITH APPLICATION, P-ee Paid Applicant Name: t v V V I Address: Ir4100f(�ity: jn&&jaV1A 045State: Zip: 1 A) Email: 4-ffVd P kIA'OYM ( 'I I . O�M Phone: ft 1 &1 This application is made to the City of South Bend, Indiana, Board of Public Works, for the use of the specified public right-of-way by Applicant for the holding of the hereinafter described event: Event Name On Dame V"'q U119 Location Emd 00 Street Closure Narne of Street From To Date of Event 1901V '7 20 M a.m. Time: Registration/Setup ❑ P.M. Approximate Number of Attendees _ F-1 EIJIL Start 7P.m. End Answer the following appropriately: I , This event will have music (live or other). a. I understand the Noise Ordinance described in the Agreement/Permit 2. Required Information to Accompany Application a. Certified Check or Money Order in the Amount of $125.00, or: b. For Certified Nonprofit Organizations: Copies of the 501 (c)(3) Internal Revenue Exemption Status Document and a current copy of Form 990 of Form 990-E-Z are included with this application, and additionally filed with the Office of the City Clerk, 0' Floor, County - City Building, 227 W. Jefferson Blvd., South Bend , Indiana. c. Certificate of'Insurance d. Maps, drawings and setup plan of the area e. A copy of a flyer or door hanger that has been distributed to all affected property owners. 3. a. This event involves City streets b. This event involves County roads c. This event involves State highways Updated 8/2017 e Yes Yes / Yes El M. ❑ No El No F-1 No Yes ❑ No Yes No Yes F-1 No ❑ Yes No El Yes No I d, This event involves the use of the sidewalk 2� Yes F] No e. This event is aQl/regional/national event (Please circle the Yes No appropriate event type) f. Affected property/business owners have been notified of this event. Yes F] No g. There is/are resident(s) affected by the event that may need ADA Yes E] No transportation assistance to their residence. h. I understand that I must arrange a meeting with all affected governmental agencies to organize the above event (Call Marcia Yes F] No Qualls, Customer Service Manager, 235-5939 to organize meeting), IF ALCOHOL IS TO BE SERVED OR SOLD Alcoholic beverages will be servedE] Alcoholic beverages will be sold Certified Check or Money Order for $400.00 must be submitted with application. Id • Application cannot be processed without deposit. • Deposit will be: returned upon inspection of event area by the Board of Public Works. Names and phone numbers of THREE Security guards • To monitor underage drinking. • Qualifications must be listed (e.g. Off -duty police officer, professional security guard, or event APPLICANT), A drawing must be submitted showing: • Fencing around serving area • Trash receptacles. o Ample trash receptacles must be provided to ensure proper disposal of refuse. Temporary liquor license. • Call the Alcohol & Tobacco Commission at (317) 234-4315 for more information. • Application cannot be processed Without a copy of this license. 4- pvovi 4'9'� to 0 KOUrl��,O RAWfC City of South Bend, Indiana e Board of Public Works The Non-residential Block Party will be permitted to take place Linder the following terms and conditions: I. Pursuant to Local Ordinance No. 10224-13, there is a $125.00 non-refundable fee for non- residential Block Parties. Non-profit organizations meeting Section 50 1 (c)(3) of the Internal Revenue Code: are exempt from the fee provided copies of the 501 (c)(3) Internal Revenue Exemption Status Document and a current copy of Form 990 of I",orm 990-EZ are filed with this application and with the Office of the City Clerk, 4th Floor, County -City Building, 227 W. Jefferson Blvd., South Bend , Indiana. 2, The APPLICANT Must Comply With all terms and conditions of this Permit and Agreement, 3. All residents and businesses within the affected area must be notified of this event. The APPLICANT must obtain signatures frorn and/or has made an attempt to notify all residents that reside on the block. A copy of a brochure or door hanger distributed to all affected residents/businesses describing the event purpose, date, and time must be included with the application. 4. The applicant is responsible, prior to the event, for determining if there are any residents or business owners affected that could potentially need assistance in accessing their property. The applicant is responsible for providing said resident/business owner transportation to their. property. 5. The APPLICANT shall reimburse the Board for the actual cost to the City for the event, if deemed necessary. 6. APPLICANT shall include a flyer or letter describing the details of the event. 7. Notification of approval/denial of this request will be issued by return of this form, upon signed authorization by the Board of Public Works. 8. The APPLICANT shall provide to the Board a Certificate of Insurance showing a liability policy in full force and effect with limits of $300,000.00 per occurrence and $5,000,000.00 aggregate and the City of South Bend listed as an additional named insured for this event. 9. The APPLICANT assumes full responsibility for providing ample disposal containers for refuse/recycling and assures the area will be cleaned up upon the Conclusion of the event. 10. Barricades will be delivered and picked up at the event location. The APPLICANT is responsible for seeing that all cones arc maintained and returned undamaged. 11. The APPLICANT will follow the City of South Bend Noise Ordinance, which is in effect at all hours. Between the hours of 11:00 p.m. and 7:00 a.m. certain noises are particularly prohibited. These include operating radio receiving sets, musical instruments, phonographs and other sound reproduction devices if audible fifty (50) feet away, as well as shouting, yelling, hooting, whistling, or singing in the streets in a rnanner to disturb the peace (Municipal Code 13-57). 12. The APPLICANT assures the City that the area will be closed during the times indicated on the application only. Event end times are pursuant to the recommendations of the South Bend Police Department. 13. IF ALCOHOL IS TO BE SERVED OR SOLD a Certified Check or Money Order for $400.00 must be submitted with application. The application cannot be processed without a deposit. The deposit will be returned by the Board of Public Works upon inspection of the event area after the event, and provided there is no damage to the area. Names, phone numbers, and qualifications (e.g. Off -duty police officer, professional security guard, or event APPLICANT) of THREE security guards to monitor underage drinking, must be submitted with the application. A drawing must be submitted showing fencing around serving area, and trash receptacles. For a temporary liquor license call the Alcohol and Tobacco Commission at (317) 234-4315 for more information. Application cannot be processed without a copy of this license. 14. APPLICANT agrees to indemnify, defend and hold harmless the Civil City of South Bend, Indiana, from any liability, loss, costs, damages or expenses, including attorney fees, which the Civil City of South Bend, may suffer or incur as a result of any claims or actions which may be made by any person, including a participant in the activity, arising out of the approval of this request by the Board of Public Works to close a portion of the public right-of-way for the event described above. I have read the Application and Permit and the Agreement for the "Use of Right -of -Way for Special Events" and I understand and agree to the above rules and regulations. I also understand that this application may be denied based on any false or incomplete information. Dated this 6 {'Vl day of 20 APPLICANT Signature Printed Name 1 ........................ -- BOARD OF PUBLIC WORKS APPROVAL President M tuber M ber lmbe� tv Member Date RETURN FORM TO: Board of Public Works 1316 County -City Building 227 West Jefferson Boulevard South Bend, IN 46601 Phone: (574) 235-9251 142' 10 14AMMrmS BOOKSTORE ON BODY STPKSV Fd1'01 0,154 SF 310178 0 acoRo CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 212712018 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. IMPORTANT: 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). PRODUCER Commercial Lines - (404) 923-3700 US] Insurance Services National, Inc. 3475 Piedmont Road NE, Suite 800 Atlanta, GA 30305-2886 CONTACT NAME: Tim Baumann PHONE FAX c.No-WC 470.875.0517 AIc No; 610-537-1929 E-MAIL ADDRESS: tim.baumannQusi.com INSURERIS)AFFOROINGCOVERAGE NAICIt INSURERA: Endurance Assurance Corporation 11551 INSURED _ Kite Realty Group Trust 30 S. Meridian St., Suite 1100 Indianapolis, IN46204 INSURER : Allied World National Assurance Co. 10690 INSURER : Sompo America Insurance Company 11126 -- --- INSURER D ; INSURERE: INSURERF: mm rnVFRAGFS CERTIFICATE NUMBER: 12774275 REVISION NUMBER: See below 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. ADDL SUER POLICY EFF POLICY EXP- INSR TYPE OP INSURANCE LIMITS LTR IN50 WVD POLICY NUMBER MMIDDIYYYY MMlDOIYYYY A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 1-fl OCCUR GGR10012604100 03/01/2018 03/01/2019 EACHOCCURRENCE S 1,000,000 GE TO RENTED PREMISES Ea occurrence $ 1,000,000 MED EXP (Any one person) $ Excluded PERSONAL & AOV INJURY S 1,000,000 AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 GEN'L PRODUCTS - COMPIOP AGG $ 2,000,000 POLICY PRO- JECT LOC S OTHER: /5, AUTOMOBILE LIABILITY ACVS100810 03/01/2018 0310112019 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY BODILY INJURY (Per accfdenl) S PROPERTYDAMAGE Per accident S $ S X UMBRELLALIAB X OCCUR 3088008 03/01/2018 03/01/2019 EACHOCCURRENCL S 25,000,000 AGGREGATE $ 25,000,000 EXCESS LIAR CLAIMS -MADE DEO I X RETENTION$ 5,000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETORIPARTNERIEXECUTIVE OFFICERlMEMBEREXCLUCED? N (Mandatory In NH) NIA WONS1015P0 03/01/2018 03/01/2019 X STATUTE ER" E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1.000.000 E.L. DISEASE -POLICY LIMIT S 1.000,000 If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS f LOCATIONS f VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: KRG Eddy Street Commons, LLC , Eddy Street Gammons 1044-1234 Eddy Street, South Bend, IN 46601 r`Fr7TlRIrATF I-Inl nFR CANCELLATION City of South Send Department of Public Works, Engineering Division SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 227 W Jefferson Blvd., Suite 1316 AUTHORIZED REPRESENTATIVE South Send, IN 46601 The ACORD name and logo are registered marks of ACORD (P1988.2015 ACORD CORPORATION. An rights reserved. ACORD 25 (2016103) I I ki, 0 , A . 0 01"-ill A 0 1 DATE SENT 8/712018 TO: �Fd Gleckler, Traffic & Lighting g'Gene Eyster, Police Department Matt Longfellow, Engineering �KChris Dressel, Community Investment )(Federico Rodriguez, Fire Department Marcia Qualls, Engineering Kara Wood, Park Department Kylie Carter, Downtown South Bend FROM: Linda M. Martin, Clerk. , '" SUBJECT: Non -Residential Block Party Notre Dame Pep Rally AXAM If] Ll SPONSOR: DATE DUE: FAX OR E-MAIL TO: EddV St from Angela to Napoleon September 28, 2018; 10:00 a.m. to 7:00 p,mu. Taryn Ford/Kite Realty August 21, 2018 RECOMMENDATIONS AND COMMENTS: By Date APPLICATION FOR USE OF, AND BLOCKING OF ACCESS TO, THE PUBLIC RIGHT -,OF -WAY FOR NON-RESIDENTIAL BLOCK PARTIES The Board of Public Works must have FOUR (4) weeks prior notice of the event, A NON-REFUNDABLE APPLICATION FEE OF $125.00, IN THE FORM OF A CERTIFIED CHECK OR MONEY ORDER, PAYABLE TO THE CITY OF SOUTH BEND, MUST BE INCLUDED WITH APPLICATION. Applicant Name:v) f�rd Vee�Paid If Address: pity: Zip: dPhone: 7 0 Email: -e This application is made to the City Of South Bend, Indiana, Board of Public Works, for the use of the specified public right-of-way by Applicant for the holding of the hereinafter described event: t A Event Name N Pelv KNA 11 V I Location "— I ST. (Des4ribe Area/Route) Street Closure Marne of Street From MR To 0 fcAn Witaw0 Date of Event y 1� �71. r a.m. F] a.m. Time: Registration/Setup 0- F-1 p.rn. Start p.m. End Approximate Number of Attendees Answer the following appropriately: I , This event will have music (live or other). Yes F-1 No a. I understand the Noise Ordinance described in the Agreement/Permit Yes ❑ No 2. Required Information to Accompany Application a. Certified Check or Money Order in the Amount of $125.00, or: b. For Certified Nonprofit Organizations: Copies of the 501 (c)(3) Internal Revenue Exemption Status Document and a current copy of Form 990 of Form 990-EZ are included with this application, and Yes ❑ No additionally filed with the Office of the City Clerk, 4"' Floor, County - City Building, 227 W. Jefferson Blvd,, South Bend , Indiana. c. Certificate of Insurance d, Maps, drawings and setup plan of the area Yes No e. A copy of a flyer or door hanger that has been distributed to all Yes ❑ No affected property owners. 3. a. This event involves City streets [R( Yes E] No b. This event involves County roads E] Yes No c. This event involves State highways ❑ Yes No Updated 8/2017 1 d. This event involves the use of the sidewalk 10, Yes F1 No e. This event is a local/regional/national event (Please circle the Yes ❑ No appropriate event type) f. Affected property/business owners have been notified of this event. Yes ❑ No g. There is/are resident(s) affected by the event that may need ADA lid Yes ❑ No transportation assistance to their residence, h. I understand that I must arrange a meeting with all affected 0 11 A A govei umental agencies to organize the above even ( a as era Yes F—I No Qualls, Customer Service Manager, 235-5939 to organize meeting). IF ALCOHOL IS TO BE SERVED OR SOLD [/0 Alcoholic beverages will be served [:] Alcoholic beverages will be sold Certified Check or Money Order for $400.00 must be submitted with application. • Application cannot be processed without deposit. • Deposit will be returned upon inspection of event area by the Board Of Public Works. Names and phone numbers of THREE security guards ❑ • To rnonitOl' underage drinking. • Qualifications Must be listed (e.g. Off -duty police officer, professional security guard, or event APPLICANT). A drawing must be submitted showing: • Fencing around serving area • Trash receptacles. o Arnple trash receptacles must be provided to ensure proper disposal of refuse. Temporary liquor license. Ej • Call the Alcohol & Tobacco Commission at (317) 234-4315 for more information. • Application cannot be processed without a copy of this license. VV I ill top pv0vided 10� 0, fzcw(Ke� I-h 6 rt V1, V) City of South Bend, Indiana e Board of Public Works DK41 a The Non-residential Block Party will be permitted to take place under the following terms and conditions: 1. Pursuant to Local Ordinance No. 10224-13, there is a $125.00 non-refundable fee for non- residential Block Parties. Non-profit organizations meeting Section 501(c)(3) of the Internal Revenue Code are exempt from the fee provided copies of the 501(c)(3) Internal Revenue Exemption Status Document and a current copy of Form 990 of I'-0orm 990-EZ are filed with this application and with the Office of' the City Clerk, 4th Floor, County -City Building, 227 W. Jefferson Blvd., South Bend , Indiana. 2. The APPLICANT must comply with all terms and conditions of this Permit and Agreement. 3. All residents and businesses within the affected area must be notified of this event, The APPLICANT must obtain signatures from and/or has made an attempt to notify all residents that reside on the block. A copy of a brochure or door hanger distributed to all affected residents/businesses describing the event purpose, date, and time must be included with the application. 4. The applicant is responsible, prior to the event, for determining if there are any residents or business owners affected that could potentially need assistance in accessing their property. The applicant is responsible for providing said resident/business owner transportation to their property. 5. The APPLICANT shall reimburse the Board for the actual cost to the City for the event, if deemed necessary. 6. APPLICANT shal I include a flyer or letter describing the details of the event. 7. Notification of approval/denial of this request will be issued by return of this form, upon signed authorization by the Board of Public Works. 8. The APPLICANT shall provide to the Board a Certificate of Insurance showing a liability policy in full force and effect with limits of $300,000.00 p6r occurrence and $5,000,000.00 aggregate and the City of South Bend listed as an additional named insured for this event. 9. The APPLICANT assumes full responsibility for providing arnple disposal containers for refuse/recycling and assures the area will be cleaned up upon the conclusion of the event. 10. Barricades will be delivered and picked up at the event location. The APPLICANT is responsible for seeing that all cones are maintained and returned undamaged. I I . The APPLICANT will follow the City of South Bend Noise Ordinance, which is in effect at all hours. Between the hours Of 11:00 p.m. and 7:00 a.rn. certain noises are particularly prohibited. These include operating radio receiving sets, musical instruments, phonographs and other sound reproduction devices if audible fifty (50) feet away, as well as shouting, yelling, hooting, whistling, or singing in the streets in a manner to disturb the peace (Municipal Code 13-57), 12, The APPLICANT assures the City that the area will be closed during the times indicated on the application only. Event end times are pursuant to the recommendations of the South Bend Police Department, 13. IF ALCOHOL IS TO BE SERVED OR SOLD a Certified Check or Money Order for $400.00 must be submitted with application. The application cannot be processed without a deposit. The deposit wi 11 be returned by the Board of Public Works upon inspection of the event area after the event, and provided there is no damage to the area. Names, phone numbers, and qualifications (e,g. Off -duty police officer, professional security guard, or event APPLICANT) of THREE security guards to monitor underage drinking, must be submitted with the application. A drawing must be submitted showing fencing around serving area, and trash receptacles. For a temporary liquor license call the Alcohol and Tobacco Commission at (317) 234-4315 for more information. Application cannot be processed without a copy of this license. 14. APPLICANT agrees to indemnify, defend and hold harmless the Civil City of South Bend, Indiana, from any liability, loss, costs, damages or expenses, including attorney fees, which the Civil City of South Bend, may suffer or incur as a result of any claims or actions which may be made by any person, including a participant in the activity, arising out of the approval of this request by the Board of Public Works to close a portion of the public right-of-way for the event described above. I have read the Application and Permit and the Agreement for the "Use of Right -of -Way for Special Events" and I understand and agree to the above rules and regulations. I also understand that this application may be denied based on any false or incomplete information. Dated this day of 1.1A 1 (4 —_ 20 APPLICANT Signature Printed Name BOARD OF PUBLIC WORKS APPROVAL A -��- President Me ber Member ember Member RETURN FORM TO: Board of Public Works 1316 County -City Building 227 West Jefferson Boulevard South Bend, IN 46601 Phone: (574) 235-9251 Date 142' 14 0 BOOKSTORE cKrE. ON BODY STPUR T 8101 2'0,154 SF 340478 ACORN 0 CERTIFICATE OF LIABILITY INSURANCE DATE (MMlDDIYYYY) 2/27/2018 THIS CERTIFICATE fS 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. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION 15 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). PRODUCER Commercial Lines - (404) 923-3700 CONTACT Tim Baumann NAME: TPHONE 470.875.0517 FAX 610-537-1929 _EMAIL°Kt): Arc No ; USI Insurance Services National, Inc. ADDRESS: tlm.baumann@us1.Com INSURER(S)AFFORDING COVERAGE NAICP 3475 Piedmont Road NE, Suite 800 INSURER A: Endurance Assurance Corporation 11551 Atlanta, GA 30305-2886 INSURED INSURER El: Allied World National Assurance Co. 10690 Kite Realty Group Trust tNSURER C : Sompo America Insurance Company 11126 30S. Meridian St., --- INSURERD: INSURER E Suite 1100 INSURERF: Indianapolis, IN 46204 COVERAGES CERTIFICATE NUMBER: 12774275 REVISION NUMBER: See below 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 WH$CH 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. INSR LTR TYPE OF INSURANCE ADDS INSD SUHR W D _ POLiCYNUMBER POLICY EFV MMIDDIYYYY POLICY EXP MMlDOIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 1�1 OCCUR GGR10012604100 03/01/2018 03/01/2019 EACH OCCURRENCE s 1,000,000 DAMAGE D PREMISES Ea occurrence $ 1,000,000 MED EXP (Any one Person) $ Excluded PERSON AL&ADVINJURY $ 1,000,000 GENT AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE S 2,000,000 PRO-X 1 LOC POLICY..mm� JECT u PRODUCTS -COMPIOPAGG $ 2,000,000 S OTHERr A AUTOMOBILE LIABILITY ACVS 100810 03101 /2018 03/01/2019 (Ea acB.clNdeD SINGLE LIMIT S 1,000,000 BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED X AUTOS ONLY X AUTOS ONLY BODILY INJURY (Per accidenl) $ PROPERTYDAMAGE Per accident $ $ B X UMBRELLALIAB X OCCUR 3088008 03/01/2018 03/01/2019 EACH OCCURRENCE S 25,000.000 AGGREGATE $ 25,000,000 EXCESS LIAO CLAIMS -MADE DED X RETENTION$ 5,000 $ G WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y r N ANYPROPRIETORIPARTNERIEXECUTIVE � OFFICEPJMEMBEREXCLUDED? 1 ". (Mandatory in NH) NIA WGNS1015P0 03/01/2018 03/01/2019 X STATUTE ERH £.L.EACH ACCIDENT g 1,000,000 F.L. DISEASE -EA EMPLOYEE S 1,000,000 F L DISEASE - POLCY LIMIT $ 1.00000 If yes. describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS f LOCATIONS f VEHICLES (ACORD 101, Addirional Remarks Schedule, may be attached it more space is required) Re: KRG Eddy Street Commons, LLC , Eddy Street Commons 1044-1234 Eddy Street, South Bend, IN 46601 City of South Bond SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Department of Public Works, Engineering Division ACCORDANCE WITH THE POLICY PROVISIONS. 227 W Jefferson Blvd., Suite 1316 South Bend, IN 46601 AUTHORIZED REPRESENTATIVE The ACORD name and logo are registered marks of ACORD O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103)