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310178
<br />Ate.-.^ "
<br />L(�(-"J'R CERTIFICATE OF LIABILITY INSURANCE
<br />IQ[]IYYYY)
<br />=51912017
<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 endorsemeni(s).
<br />PRODUCER -
<br />Commercial Lines - (404) 923-3700
<br />Wells Fargo Insurance Services USA, Inc.
<br />CONTACT Kimberlee Koili
<br />NAME:
<br />HAX
<br />!aAICAC o404 923 3532 877 362-9069
<br />AE-MAtL kimberlee.m.kofli wellsfar O.COm
<br />DDRESS' @ g
<br />INSURER S AFFORDING COVERAGE
<br />NAIC p
<br />3475 Piedmont Road NE, Suite 800
<br />INSURERA: LM Insurance Corporation
<br />33600
<br />Atlanta, GA 30305-2886
<br />INSURED
<br />INSURER a ; Allied World National Assurance CO.
<br />10690
<br />Kite Realty Group Trust
<br />W
<br />INSURER C
<br />INSURER D.
<br />30 S. Meridian St., Ste. 1100
<br />INSURER E
<br />INSURERF:
<br />Indianapolis IN 46204
<br />COVERAGES CERTIFICATE NUMBER: 11760500 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 />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADOL
<br />SUBR
<br />D
<br />__
<br />POLICY NUMBER
<br />POLICY EFF�
<br />MMIDDIYYYY
<br />POLICY EXP
<br />MMlDOIYYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE X OCCUR
<br />TB6Z91453740077
<br />No Deductible/Retention
<br />03/01/2017
<br />03/01/2018
<br />EACH OCCURRENCE
<br />S 1,000,000
<br />DAIA11 TO RENTED
<br />PREMISES Ea occurrence
<br />S 800.000
<br />MED EXP (Any one person)
<br />$ Excluded
<br />Applies to GL
<br />PERSONAL & AOV INJURY
<br />S 1,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />POLICY E] JE� I LOC
<br />PRODUCTS-COMPlOPAGG
<br />$ 2,000,000
<br />S
<br />OTHER:
<br />A
<br />AUTOMOBILE LIABILITY
<br />AS5Z91453740067
<br />03/01/2017
<br />03/01/2018
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 1.000,000
<br />BODILY INJURY (Per person)
<br />$
<br />X ANY AUTO
<br />No deductible
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />on Auto Liability
<br />y
<br />BODILY INJURY (Per accident)
<br />S
<br />PROPERTYDAMAGE
<br />fper accident
<br />$
<br />X HIRED X NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />B
<br />X
<br />UMBRELLALIAB
<br />X
<br />OCCUR
<br />3088008
<br />03/0112017
<br />03/01/2018
<br />EACH OCCURRENCE
<br />$ 26,000,000
<br />AGGREGATF
<br />$ 25,00g000
<br />EXCESS UAa
<br />CLAIMS -MADE
<br />D£D I X RETENTIONS 5,000
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS` LIABILITY YIN
<br />ANYPROPRIETORIPARTNERlEXECUTiVE
<br />OFFICERIMEMBEREXCLUDED? E
<br />(Mandatory in NH)
<br />NIA
<br />WC5Z914537400a7
<br />03101I2017
<br />0310112D18
<br />X STATUTE ORH
<br />E.L. EACH ACCIDENT
<br />1,000,000
<br />$
<br />E.L. DISEASE -EA EMPLOYEE
<br />$ 1,000'am
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES fACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Re: KRG Eddy Street Commons, LLC , Eddy Street Commons 1044-1234 Eddy Street, South Bend, IN 46601
<br />CERTIFICATE HOLDER CANCELLATION
<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 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 Bend, IN 46601
<br />((�
<br />yC +o lr,
<br />The ACORD name and logo are registered marks of ACORD @ 1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016103)
<br />{rhig ,gNrWlB ,epleres raN(Iralek 117fi64351ssuetl an 51Bl2017)
<br />
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