|
2013 -Iq�-/
<br />OP ID: MB
<br />'AIR° CERTIFICATE OF LIABILITY INSURANCE
<br />DATE
<br />0111612014 Y)
<br />01/16/2014
<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 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 Phone:813- 226.1300
<br />CONTACT
<br />NAME: Mia Bush
<br />Brown &Brown of Florida, Inc. Fax: 873 - 226 -1313
<br />P. O. Box 173086
<br />Tampa, FL 33672
<br />Joseph W. LoPresti
<br />PNONE 813- 226 -1337 Fax
<br />AIC No Ext: A/C No 613-226.1313
<br />EMAIL
<br />ADDRESS: mbush @bbtampa.com
<br />C TOMERID#:HOLLA -4
<br />INSURER (S) AFFORDING COVERAGE
<br />NAIC A
<br />INSURED Holland & Knight LLP
<br />Holland & Knight Charitable
<br />Foundation Inc.
<br />100 North Tampa Street St 4100
<br />Tampa, FL 33602
<br />INSURER A: Federal Insurance Corn any
<br />20281
<br />INSURER B: Sentry Insurance
<br />24988
<br />INSURERC : Fed -Ins Co /Liberty Ins Und
<br />INSURER D: Great Northern Insurance
<br />20303
<br />INSURER E:
<br />TDAFKGE T RENTED
<br />PREMISES Ea occurrence
<br />$ 1+000,000
<br />INSURER F:
<br />$ 10,000
<br />PERSONAL &ADV INJURY
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<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 />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />SUER
<br />POLICYNUMBER
<br />MMIDDY�
<br />POLICY INYYPY
<br />LIMITS
<br />Santa Ana, CA 92701
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />D
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE I OCCUR
<br />35798711
<br />08/0112013
<br />08/0112014
<br />TDAFKGE T RENTED
<br />PREMISES Ea occurrence
<br />$ 1+000,000
<br />MED EXP (Any one person )
<br />$ 10,000
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />X Insured Contract
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GEN'L AGGREGATE
<br />LIMIT APPLIES PER
<br />PRODUCTS COMP /OP AGG
<br />$ Included
<br />POLICY
<br />PRO FX7 LOG
<br />JECT
<br />$
<br />D
<br />AUTOMOBILE
<br />X
<br />LIABILITY
<br />ANYAUTO
<br />74986035
<br />08/0112013
<br />08/0112014
<br />COMBINED SINGLE LIMIT
<br />(Ea accident)
<br />$ 1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />ALL OWNED AUTOS
<br />BODILY INJURY(Peraccident)
<br />$
<br />SCHEDULED AUTOS
<br />HIREDAUTOS
<br />PROPERTY DAMAGE
<br />(Per accident)
<br />$
<br />X
<br />X
<br />NONAWNEDAUTOS
<br />$
<br />X
<br />No Owned Autos
<br />$
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 49,000,000
<br />AGGREGATE
<br />$ 49,000,000
<br />C
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />7981835511000053076.02
<br />08/01/2013
<br />08/01/2014
<br />DEDUCTIBLE
<br />$
<br />$
<br />RETENTION S
<br />*
<br />B
<br />WORKERS COMPENSATION
<br />EMPLOYERS' LIABILITY
<br />ANYPRDPRIETOR/PARTNERIEXECUTIVE YIN
<br />OFFICER /MEMBER EXCLUDED?
<br />(Mandatory In NH)
<br />NIA
<br />901492301/9014920302
<br />08/01/2013
<br />08/01/2014
<br />X WC STATU- GET RI-
<br />ITS ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E. L. DISEASE EA EMPLOYEE
<br />$ 1,000,000
<br />If yes, describeunder
<br />DESCRI PTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />I $ 1,000,000
<br />D
<br />Personal Property
<br />35798711
<br />08/0112013
<br />08/01/2014
<br />Spec.Form 107,173,000
<br />D
<br />Data Process.Equip
<br />35798711
<br />08/01/2013
<br />08101/2014
<br />InclTheft Included
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
<br />See "Certificate Attachment - Holland & Knight, LLP dated 8 -1 -13" attached.
<br />CERTIFICATE HOLDER /If y I _ _n //_ CANCELLATION
<br />" CITYSAN
<br />La a Stitt SI]CEdy --
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />A,,gS( ant f It y Attorney
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City of Santa Ana
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />David Cavazos, City Manager
<br />AUTHORIZED REPRESENTATIVE
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701
<br />16w,, 14u. k)
<br />ACORD 25 (2009109)
<br />@ 1988 -2009 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
|