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31017B
<br />A -1r �®
<br />l�('r(✓j=�LJ CERTIFICATE OF LIABILITY INSURANCE
<br />DATE1YYYY1
<br />zr27120271zo1a
<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 />Insurance Services National, Inc.
<br />CONTACT Tim Baumann
<br />NAME:
<br />HO No Ext : 470.875.0517 FAX
<br />Noy 610-537-1929
<br />(AJCUSI
<br />E-MAIL ADDRESS: tim.baumann@usi.com
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />3475 Piedmont Road NE, Suite 800
<br />INSURERA: Endurance Assurance Corporation
<br />11551
<br />Atlanta, GA 30305-2886
<br />INSURED
<br />INSURER B : Allied World National Assurance Co.
<br />10690
<br />INSURERC: Sompo America Insurance Company
<br />11126
<br />Kite Realty Group Trust
<br />30 S. Meridian St.,
<br />INSURER O:
<br />INSURER E :
<br />Suite 1100
<br />INSURER F :
<br />Indianapolis, IN 46204
<br />r•nWC0Ar_Cc rFQTIFrr'A-rP wimmr m. 12774275 RFVIStON 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 />ISO
<br />BURR
<br />WVO
<br />POLICY NUMBER
<br />POLICY EFFm
<br />MMIDDIYYYY
<br />POLICY EXP
<br />MMIDDIYYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE OCCUR
<br />GGR10012604100
<br />o3/01/2018
<br />03/01/2019
<br />EACHOCCURRENCE
<br />S 1,000,000
<br />DAMAGOENTED
<br />PREMISES (Ea occurrence]
<br />, S 1,000,000
<br />MFO EXP (Any one person}
<br />$ Excluded
<br />PERSONAL&ADVINJURY
<br />S 1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER
<br />GENERAL AGGREGATE
<br />S 2,000,000
<br />PRODUCTS- COMPIOP AGG
<br />S 2,000,000
<br />POLICY PRO_ JECT • p LOG
<br />f
<br />S
<br />OTHER:
<br />A
<br />AUTOMOBILE LIABILITY
<br />ACVS100810
<br />03/01/2018
<br />03/01/2019
<br />COarcldepntSINGLE LIMIT
<br />S 1,000,000
<br />BODILY INJURY (Per person)
<br />S
<br />ANY AUTO
<br />S
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />HIRED X NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />IX
<br />BODILY INJURY (Per accident)
<br />PROPE"' OAMAGE
<br />Pan er a.,dl
<br />$
<br />$
<br />B
<br />X
<br />UMBRELLALIAB
<br />X
<br />OCCUR
<br />3088008
<br />0310112018
<br />03/01/2019
<br />EACH OCCURRENCE
<br />S 25,000,000
<br />AGGREGATE
<br />$ 25,000.000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED X RETENTION $ 5,000
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS'LIABILITY YIN
<br />ANYPROPRIETORIPARTNERIEXECUTIVE j-'
<br />OFFICERfMEMSERFXCLUDEO?
<br />(Mandatary in NH)
<br />N ! A
<br />WCNS1015P0
<br />031D1l2018
<br />03101l2019
<br />X STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$ 1.000,000
<br />E.L. DISEASE - EA EMPLOYFE
<br />$ 1,000,000
<br />E.L. DISEASE - POLICY LIMIT
<br />S 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />DESCRIPTION OF OPERATIONS! LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is required)
<br />Re: KRG Eddy Street Commons, LLC , Eddy Street Commons 1044-1234 Eddy Street, South Bend, IN 46601
<br />r CaTICIr ATt= Mnl DER r:ANr:FI..I... ATION
<br />City Of South Bond
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Department of Public Works, Engineering Division
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />227 W Jefferson Blvd., Suite 1316
<br />AUTHORIZED REPRESENTATIVES
<br />South Bend, IN 46601
<br />The ACORD name and logo are registered marks of ACORD ©1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016103)
<br />
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