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HOLLA-4 OP ID: MB
<br />,d►coRO CERTIFICATE OF LIABILITY INSURANCE
<br />�- --''�
<br />DATE
<br />1 2/0088 /DD//20116 6
<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
<br />Brown & Brown of Florida, Inc.
<br />P. O. Box 173086
<br />NAME: Mia Bush
<br />PHONE FAX
<br />A/C No. : 813- 226 -1337 'C' No): 813- 226 -1313
<br />aI oRless: mbush bbtam a.com
<br />Tampa, FL 33672
<br />Joseph W. LoPresti
<br />COMMERCIAL GENERAL LIABILITY
<br />INSURERS AFFORDING COVERAGE
<br />NAIC #
<br />INSURERA: SENTRY INSURANCE
<br />24988
<br />$ 1,000,000
<br />INSURED Holland & Knight LLP
<br />Holland & Knight Charitable
<br />Foundation, Inc.
<br />INSURER B: Great Northern Insurance
<br />20303
<br />INSURER C: Federal Insurance Company
<br />20281
<br />08/01/2016
<br />08/01/2017
<br />524 Grand Regency Blvd
<br />INSURER D:
<br />$ 1,000,000
<br />INSURER E:
<br />MED EXP (Anyone person)
<br />Brandon, FL 33510
<br />INSURER F:
<br />Insured Contract
<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 />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />WVD
<br />POLICY NUMBER
<br />MM /DDY EFF
<br />MM /DD EXP
<br />LIMITS
<br />B
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACHOCCURRENCE
<br />$ 1,000,000
<br />CLAIMS -MADE � OCCUR
<br />35798711
<br />08/01/2016
<br />08/01/2017
<br />AMAGE TO
<br />PREM SES Eaolccu RENTED
<br />$ 1,000,000
<br />X
<br />MED EXP (Anyone person)
<br />$ 10,000
<br />Insured Contract
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />GEN'L AGGREGATE LIM ITAPPLIES PER
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />POLICY ❑ PRO JECT Fx LOC
<br />PRODUCTS - COMP /OPAGG
<br />$ Included
<br />$
<br />OTHER
<br />AUTOMOBILE LIABILITY
<br />COM Ea accident S BINED INGLE LIMIT
<br />$ 1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />B
<br />X ANY AUTO
<br />74986035
<br />08/01/2016
<br />08/01/2017
<br />BODILY INJURY (Per accident)
<br />$
<br />ALLOWNED SCHEDULED
<br />AUTOS AUTOS
<br />PROPERTYDAMAGE
<br />Peraccident
<br />$
<br />X X NON -OWNED
<br />HIRED AUTOS AUTOS
<br />X No Owned Autos
<br />$
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACHOCCURRENCE
<br />$ 50,000,00
<br />AGGREGATE
<br />$ 50,000,00
<br />C
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />79818355
<br />08/01/2016
<br />08/01/2017
<br />DED I I RETENTION
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR /PARTNER /EXECUTIVE Y�
<br />901492301/901492301
<br />08/01/2016
<br />08/01/2017
<br />X PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />OFFICER /MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />N /A
<br />E.L. DISEASE -EA EMPLOYE
<br />$ 1,000,000
<br />Ifyes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />1,000,000
<br />B
<br />Personal Property
<br />35798711
<br />08/01/2016
<br />08/01/2017
<br />Spec Form 125,664,000
<br />B
<br />Data Process Equip
<br />35798711
<br />08/01/2016
<br />08/01/2017
<br />Spec Form 13,589,00
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />See "Certificate Attachment- Holland & Knight, LLP dated 8 -1 -16" attached
<br />CERTIFICATE HOLDER CANCELLATION
<br />CITYSAN
<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 />City of Santa Ana
<br />David Cavazos, City Manager
<br />20 Civic Center Plaza
<br />AUTHORIZED REPRESENTATIVE
<br />Santa Ana, CA 92701A..,r�m...�"
<br />©1988- 2014ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
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