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1.101 4 OP ID: MB
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />°ATEIMM,DNV
<br />0712812017
<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 pollcy(ies) must be endorsed. If SUBROGATION IS WANED, subJact 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 sndoraement(s).
<br />PRODUCER
<br />Brown & Brown of Florida, Inc.
<br />CONTACT
<br />_NAME Mia BDSh
<br />- -
<br />P. O. Bon 173086
<br />PHONE7
<br />-EMa i° — 813-226-133 -- aC_Nal; 813 226.1313.
<br />Tampa, FL 33672
<br />Joseph W. LGPresti
<br />_
<br />nDDness.. mbush@bbtampa tom
<br />INSUREBBAFFORDING COVERAGE NAICq
<br />—__
<br />IlusuRaxA. SENTRY INSURANCE ___24988
<br />INSURED Holland &Kni ht LLP
<br />9
<br />-----
<br />20303
<br />INsuREne GreatNortherollnsurrrip
<br />Holland & Knight Charitable
<br />_
<br />— — ---- _______
<br />Foundatlon,lnc,
<br />INSURERC:_FederallnsuranceCompany _ 20281
<br />524 Grand Regency Blvd
<br />Brandon, FL 33510-
<br />_
<br />INSURER E:
<br />INSURER F:
<br />rwsvn L'MOCK:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE
<br />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 />MSR _...._—ADGL SUB' ..-_..__._ _.
<br />LTR TYPE OF INSURANCE
<br />luau �,yp, POLICYNUMBB2 ANN MNVO LIMITS
<br />B
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />-0
<br />_
<br />- I
<br />CLAIMS -MADE ® OCCUR
<br />35798791
<br />08/01/2017
<br />08101/2016
<br />DAMAGET RRENCE
<br />DAMAGE TO RENTEp
<br />$ 11600,060
<br />1,000+666
<br />X
<br />_1
<br />Insured Contract
<br />312€MISEg !til star+telt@:__
<br />$
<br />--------------- -----
<br />MEDE%P An waf,Iraero
<br />$ 16,600
<br />------------ -----
<br />PERSONAL& ADV INJURY
<br />$ 1,000,000
<br />GEN'IAGGREGATE
<br />LIMITAPPLIE9 PER:
<br />POLICY PRO-
<br />X LOC
<br />GENERALAGGREGATE
<br />$ 2,000,00
<br />ECT
<br />PRODUCTS-COMP/OPAGG
<br />S Included
<br />AUTOMOBILE
<br />LIABNTY
<br />COMBINED SI NOLELIMIT
<br />1
<br />�"ILY
<br />$ 1,_0_00,00_0_
<br />B
<br />it
<br />ANY
<br />7 966035
<br />08109!2017
<br />08101/2098
<br />.. _
<br />INJURY
<br />BODILY INJURY (Per perecn)
<br />_
<br />$
<br />ALLOWNEO ACHEDULEO
<br />AUTOS — AUTO&
<br />BODILY
<br />BODILY INJURY IPereccltlenl)
<br />$
<br />)(
<br />...
<br />)( NON -OWNED
<br />HIRED AUTOS _ qul�g
<br />PROPERTY DAMAQE
<br />ergDl49n11
<br />$
<br />X
<br />No Owned A
<br />____.
<br />- --
<br />X _ OCCUR
<br />aB B X
<br />EACH OCCURRENCE 3 50,090,06
<br />Q
<br />FACESS CLAIMSMADE79616355
<br />.__ _— _
<br />0610112017
<br />0810112018—
<br />._-
<br />AGGREGATE $_ 50,000,00
<br />OED RETENTION c
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />PER OTI-
<br />X 01
<br />A
<br />NJYPROPRIETEUPARTNDED? UTIVE YIN
<br />❑NIA
<br />901492301
<br />06/0112017
<br />06101/2018
<br />.,.iATIJTE _ _ __.
<br />E L EACH ACCIDENT $ 1,666,666
<br />OFFICERIMEMBER EXCLUDED?
<br />(Mendatcryin
<br />yNn dsr
<br />If es, desctlbe un
<br />-_ _
<br />E_L_DISEASE-EA EMPLOYE $ 1,000,000
<br />____... _ --_
<br />.Dr
<br />c�:r:P*iijN nrnPcl.:,-�:ras rW -.
<br />E.L. DIEEA$E- POLICY LIMIT t 1,000,000
<br />B
<br />Personal Property
<br />35798711
<br />0810112017
<br />08101/2018
<br />SpeCForm 128,9403125
<br />B
<br />Data Process Equip
<br />35798711
<br />08/0112017
<br />08101/2018
<br />Spec Form 17,679,60
<br />OEORIPTON OF OPFRARONS! LOCATION& I VEHICLE (ACORD 101, Mditional Ramarks Schedule, may ha adaehed'rf more space la rsquiredl
<br />See "Certificate Attachment- Holland & Knight, LLP dated 8-1-17" attached
<br />t
<br />J
<br />VVV
<br />CITYSAN
<br />City of Santa Ana
<br />Davld Cavazos, City Manager
<br />20 Civic Center Plaza
<br />Santa Ana,CA92701
<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 />AUTHORRED REPRESENTATIVE
<br />©1988.2014ACORD CORPORATION. All HOME raaervp—,i
<br />AL.UKLI 40 tLO1141UT) I ne ACURD name and logo are registered m arks of ACORD
<br />
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