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<br />-- CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MMIDD1YYYY)
<br />,,
<br />08/0312015
<br />THIS CERTIFICATE 15 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 I'NSU'RED, 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 Hou of such endorsement(s),
<br />PRODUCER
<br />CONTACT
<br />NAME: !Ilia Bush
<br />Brown & Brawn of Florida, Inc.
<br />P. 0. Box 173086
<br />dNraN o.. Extl; 813- 226 -1337 aid, Noy: 813 -226 -1313
<br />Tampa, FL 33672
<br />E -MAIL
<br />ADDRESS mbush obbtampa.com
<br />Joseph
<br />h W. LoPresti
<br />PRODUCER ._,. _..... ....... ._...._ _.,._,....
<br />usTpwfR IDta: HOLLA -4
<br />.. -..... ... _ ........_.. _..._...... _. .....
<br />_ ..... INSURER(S) AFrORDING COVERAGE NAIL Rf
<br />INSURED Holland &Knight ILLP
<br />_m. -. ... _.._.....
<br />INSURER A: Federal Insurance Company 2..0281
<br />Holland & Knight Charitable
<br />_. — _
<br />INSURER B: Sentry I nsurance 24988
<br />Inc
<br />10undath T
<br />100 North Tampa Street St 4100
<br />INSURERC Fed Ins Co /Libert Ins Und
<br />_. -- � -.�... .. .......... .....
<br />Tampa, FL 33602
<br />INSURER D. Great Northern Insurance 20303
<br />.. .......
<br />�...._ .....
<br />INSURER E
<br />I. ,.
<br />... CLAIMS -MADE OCCUR
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: RF=vISIrMCN NI Imprp•
<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 />_.
<br />INSR .....TYPE OF INSURANCE. .— _.. -., A�17F)L 99UBR ......POLICY EFE 'FbaR _E
<br />XP POLICYNUM..BER fMM0DffYYYJ JMM/DD[YYYY) LIMITS..
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />5 1,000,00
<br />D
<br />X COMMERCIAL GENERAL LIABILITY
<br />35798711
<br />0810112015
<br />08101/2016
<br />_UA—M—ATE—TO REWED
<br />PREMISESLEapc�urrence
<br />$ 1,000,00
<br />...__'
<br />�...._ .....
<br />I. ,.
<br />... CLAIMS -MADE OCCUR
<br />MIED EXP (Any one person)
<br />$ '10,000
<br />X Insured Contract
<br />PERSONAL. &ADV INJURY
<br />5 1,000,000
<br />.............
<br />_,..,.,........ ............._,,...
<br />GENERALAGGREGATE
<br />-..... -. ....-._
<br />.�.._...... 2,000,00
<br />GEN'LAGGREGATE LIMIT APPLIES PER"
<br />-
<br />$ Included
<br />POLICY X L 0 C
<br />Ij
<br />S
<br />AUTOMOBILE
<br />LIABILITY
<br />...74986036
<br />COMBINEDident) SINGLE LIMIT
<br />1,000,00
<br />D
<br />X
<br />ANY AUTO
<br />08101120'15
<br />0 810 112 0 1 6
<br />(Ea accident)
<br />BODILY INJURY (Per PeTSOn)
<br />$
<br />ALL OWNED AUTOS
<br />-
<br />.�
<br />BODILY INJURY (Per accident)
<br />$
<br />SCHEDULEDAUTOS
<br />X
<br />HIREDAUTOS
<br />(PER ACCIDENT)
<br />X
<br />NON- OWNEDAUTOS
<br />§
<br />X
<br />No Owned Autos
<br />$
<br />UMBRELLA LAS X OCCUR
<br />EACH OCCURRENCE
<br />-
<br />$ 49,000,000
<br />C
<br />EXCESS LIAR CLAIMS -MADE
<br />7981835511000053016 -03
<br />0810112015
<br />0810112016
<br />AGGREGATE
<br />w,
<br />$ 49,000,00:
<br />—.—
<br />DEDUCTIBLE
<br />s
<br />RETENTION S
<br />$
<br />WORKERSCOMPENSATION ..
<br />WCSTATU- OTH-
<br />TVP1GU,1LYFS ',.,..ER
<br />XL
<br />AND EMPLOYERS' LIABILITY YIN
<br />EACHACCaDENT
<br />_........
<br />s 1,000,00
<br />B
<br />ANY PROPRIETOR /PARTNERJEXECUTIVE
<br />N/A
<br />90149230119014920302
<br />0810112015
<br />0810112016
<br />(Mandatory In ER EXCLUDED?
<br />(Mandatory In NH)
<br />E.L. DISEASE -EA EMPLOYEE
<br />$....�__
<br />,0'. 0
<br />If yes, describe under
<br />...,..... -
<br />.,,1;000
<br />DESCRIPTION OF OPERATIONS below
<br />E L- DISEASE- POLICY LIMIT
<br />S 1,000,000
<br />D
<br />Personal Property
<br />35798711
<br />0810112015
<br />08/01/2016
<br />Spec.Form 116,079,000
<br />D
<br />Data Process.Equip
<br />35798711'
<br />0810112015
<br />0810112016
<br />Spec.Form 11,116,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 141, Additional Remarks Schedule, If more space is required)
<br />See "Certificate Attachment - Holland & Knight, LLP dated 8 -1 -1.51, attached.
<br />CITYSAN
<br />City of Santa Ana
<br />David Cavazos, City Manager
<br />20 Civic Center Plaza
<br />Santa Arta, CA 92701
<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 />T0..,_0, Y'�.cwfi,.I'
<br />1988 -2009 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD
<br />
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