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310178
<br />AC ROB CERTIFICATE OF LIABILITY INSURANCE
<br />GATE 1lYYYY)
<br />5/912019/2017
<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 />Wells Fargo Insurance Services USA, Inc.
<br />CONTACT NAME: KDlli
<br />PHONE 404-923-3532 FAX AIG No ; 877-362-9069
<br />A1C o E t :
<br />EMAIL kimberlee.m.kolli@wellsfargo.com
<br />ADDRESS; o.com Gay g
<br />INSURERS AFFORDINGGOVERALiE
<br />NAIL#
<br />3475 Piedmont Road NE, Suite 800
<br />INSURERA: LM Insurance Corporation
<br />33600
<br />Atlanta, GA 30305-2888
<br />INSURED
<br />INSURER B: Allied World National Assurance Co.
<br />10690
<br />Kite Realty Group Trust
<br />INSURER C
<br />30 S. Meridian St., Ste. 1100
<br />INSURER D:
<br />INSURER E :
<br />INSURER F :
<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 />ADDL
<br />I O
<br />SU13R
<br />V
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMfDDJYYYY
<br />POLICY EXP
<br />MWDDIYYYY
<br />LIMITS
<br />q
<br />XCOMMERCIALGENERAL
<br />LIABILITY
<br />CLAIMS -MADE [�] OCCUR
<br />TB5Z91453740077
<br />No Deduc#iblelRetention
<br />03/01/2017
<br />03/01/2018
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />PAM
<br />PREM SES Ea oceur, nce
<br />$ 500,000
<br />MED EXP (Any one person)
<br />$ Excluded
<br />Applies t0 GL
<br />PERSONAL&ADVINJURY
<br />5 1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />POLICY ❑ PROJECT LOC
<br />PRODUCTS • COMP/OP AGG
<br />5 2.000,000
<br />5
<br />OTHER:
<br />I
<br />I
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />AS5Z91453740067
<br />03/01/2017
<br />03/01/2018
<br />E° ac,QeDn€SINGLE LIMIT
<br />S 1,000,0o0
<br />BODILY INJURY (Per person)
<br />5
<br />X
<br />ANY AUTO
<br />No deductible
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />on Auto Liability
<br />y
<br />BODILY INJURY (Per accident)
<br />5
<br />X
<br />HIRED X NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />PROPERTYDAMAGE
<br />Per accident
<br />5
<br />5
<br />B
<br />X
<br />UMBRELLALIAB
<br />X
<br />OCCUR
<br />3088008
<br />03/01/2017
<br />03/01/2018
<br />EACH OCCURRENCE
<br />S 25,000,000
<br />AGGREGATE
<br />$ 25,000,000
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />DED I X RETENTIONS 5.000
<br />$
<br />A
<br />AND KERS EMPLOYECOMPENSATION' LIIT
<br />AND EMPLOYERS' LIABILITY
<br />ANYPROPRtE~TOPJPARTNERfEXECUT€VE Y f N
<br />OFFIC6RIMEMBEREXGLUDE07
<br />(Mandatory in NH)
<br />NIA
<br />WC5Z91453740087
<br />03/01/2017
<br />03101 /2018
<br />X 5 ATPEN UTE FIR
<br />E.L. EACH ACCIDENT
<br />f,000,000
<br />$
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,0w
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />- 1,ODD,D00
<br />$
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 1011, Additional Remarira Schedule, maybe 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 />lmMI:41I;1L",\1;in iLai 411121 tlGleL";qAW_\ILei ►
<br />City of South Bend
<br />Department of Public Works, Engineering Division
<br />227 W Jefferson Blvd., Suite 1316
<br />South Bend, IN 46601
<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 />AUTHORIZED REPRESENTATIVE
<br />The ACORD name and logo are registered marks of ACORD ©1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016103)
<br />(rhia ce,t1k.te p1 ces cerff.teq 11760495 issued ae M20171
<br />
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