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HOLLA-4 OP ID: MB
<br />CERTIFICATE OF LIABILITY INSURANCE DATEjMMDWYYYY)
<br />07/28/2017
<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(los) 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-I
<br />SECT Mia Bush
<br />PHONE813-226-1337 aIc Nor 813.226.1313
<br />pplL,s• mbush(cbbbtampa.Com
<br />Tampa, FL 33672
<br />Joseph W. LoPresti
<br />IIIISURER;S}AFFORDING COV ERAGE
<br />MAID #
<br />INSURERA: SENTRY INSURANCE
<br />24988
<br />CLAIMS -MADE OCCUR
<br />INSURED Holland & Knight LLP
<br />Holland& KnightCharitable
<br />Foundation, Inc.
<br />INSURER B: Great Northern Insurance
<br />20303
<br />INSURER c: FederaUnsuranceCompany
<br />20281
<br />X Insured Contract
<br />524 Grand Regency Blvd
<br />INSURER D:
<br />PERSONALBADV INJURY $ 1,000 00_0
<br />Brandon, FL 33510
<br />NsuRER E:
<br />INSURER F:
<br />GEN'LAGGREGATE LIMITAPPLIES PER
<br />GENERALAGGREGATE S 2,000,000
<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 />MSR Lm
<br />TYPEOFINSURANCE
<br />Ah L SUB
<br />POLICYNUMBER
<br />POLICY EFF POLICYEXP
<br />LIMITS
<br />B
<br />X COMMERCIALGENERALLIABILITY
<br />20 Civic Center Plaza
<br />AU Howzm REPRESEc aTlvE
<br />Santa Ana, CA 92701
<br />EACHOCCURRENCE $ 1,060,000
<br />CLAIMS -MADE OCCUR
<br />35798711
<br />0810112017 0810112016
<br />TO
<br />GTO RELATED
<br />DAMAGE
<br />EBEMI E SM..1,000,000
<br />MED EW (Any one porsonI $ 10000
<br />X Insured Contract
<br />PERSONALBADV INJURY $ 1,000 00_0
<br />GEN'LAGGREGATE LIMITAPPLIES PER
<br />GENERALAGGREGATE S 2,000,000
<br />PRODUCTS-COMPIOPAGG $ Included
<br />POLICY JECT F—X] LOC
<br />AUTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT $ 1,000,000
<br />E,11-Reil/_�1
<br />BODILY INJURY(Parparson) $
<br />B
<br />X ANY AUTO
<br />74986035
<br />08/01/2017 08/01/2018
<br />BODILY INJURY(PeracedwC $
<br />ALLOWNED SCHEDULED
<br />AUTOSAUTOS
<br />X X NOWOWNED
<br />HIRED AUTOS AUTOS
<br />X No Owned Autos
<br />PROPERTY DAMAGE $
<br />eraccident)
<br />,
<br />$
<br />X UMBRBLLAIJAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE $ 50,000,00
<br />AGGREGATE $ 50,00000
<br />C
<br />EXCESS uaa
<br />oLAIMs-MAGE
<br />79518355
<br />08101/2017 08101/2018
<br />DEORETENTON
<br />S$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETORIPARTNER/EXECOI-VE YO
<br />901492301
<br />08/0112017 0810112018
<br />X FEgT OTH-
<br />E.L. EACH ACCIDENT $ 1,0001000
<br />OFFICERNEMSER EXCLUDED?
<br />(Mandawryln NH)
<br />NIA
<br />E.L.DISEASE-EAEMPLOYE $ 1,000,000
<br />E.1 Lt;BEA2E-POUQyLIM7I 1000000
<br />IFyes, describe under
<br />D7RCR�PTQNQEQ0�RA7RQNSJoe�m
<br />B
<br />Personal Property
<br />35798711
<br />08/0112017 08101/2018
<br />Spoc Form 128,940,125
<br />B
<br />Data Process Equip
<br />35798711
<br />08/01/2017 08/01/2018
<br />Spec Form 17,679,00
<br />DESCRIPTION OF OPERATIONS t LOCATIONS t VEHICLES (ACOftD 101, AckWUHai Remarks Schedule, may Ise attached R mora apace is requi,ed)
<br />See "Certificate Attachment - Holland & Knight, LLP dated 8-1-17" attached
<br />RFRTIEIn ATF Nnl EFR 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 />AU Howzm REPRESEc aTlvE
<br />Santa Ana, CA 92701
<br />©1988.2014ACORD CORPORATION. All rights reserved.
<br />ACORD25(2014101) The ACORD name and logo ars registered marks ofACORD
<br />
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