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IPl -9019-bP
<br />HOLLA-4 OP ID: MB
<br />, 6. o CERTIFICATE OF LIABILITY INSURANCE
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<br />MTE(MMI07!30122Y018
<br />8
<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), AUTHORED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: U the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WANED, subject to
<br />the terns 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 />MO i� Mia Bush
<br />PHONE .
<br />U,,m-Em; 813-226-1337 F= Na): 813-2264313
<br />Tampa, FL 33672
<br />Tony Leavme
<br />meq` s; mbush@bbtampa.com
<br />IN9URERIBIAFFORDING COVERAGE
<br />X
<br />DJSURmA: SENTRY INSURANCE
<br />_NAID9
<br />24988
<br />E 10,000
<br />DJ$URED Holland&Knight LLP
<br />Holland&Knight Charitable
<br />Foundation, Inc.
<br />INSURER B: Great Northern Insurance
<br />20303
<br />wsumc: Federal Insurance Company
<br />20281
<br />INSURER D:
<br />524 Grand Regency Blvd
<br />_.
<br />INsuaaRE: -
<br />Brandon,FL33510
<br />INSURBRF:
<br />5 2,000,000
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAKED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REOUREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES- LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />ILNTSRR TYPEOFINSURANCE A00 POLICYNUMEei MPoucr6 MMOL LIMnb
<br />B
<br />XCOMMERCIALGENERALUAe1LITY
<br />CLAIMS -MALE ® OCCUR
<br />Insured Contract
<br />35798711
<br />0810112018
<br />081/1112019
<br />EACHOCCURRENCE
<br />DA MAOETORENTED
<br />_PHW1$E$JEa9uum,nm
<br />E 1,060,000
<br />X
<br />S 1,666,000
<br />MEDEVIAa-, oaeoenwn)
<br />E 10,000
<br />PERSONAL&ADV INJURY
<br />S 1,000_000
<br />_
<br />GENLAGGREGATE LIMITAPPLIES PER:
<br />POUCY[:1jE,TFk] LOC
<br />GENERALAGGREGATE
<br />5 2,000,000
<br />PRODUCTS-COMPJOPAGO
<br />E Included GA
<br />$
<br />OTHER
<br />AIROMMLE
<br />HASILRY
<br />_
<br />COMBINEDSINGLEUMR
<br />_IEa :cclda
<br />$ 1,000,00_0
<br />B
<br />X
<br />ANY AUTO
<br />74986035
<br />0810112018
<br />0810112019
<br />BODILY INJURY(Perpemm)
<br />_
<br />$
<br />ALLOWNED SCHEDULED
<br />AUTOS _ AUTOS
<br />BODILY INJURY(PereccidenO
<br />E
<br />X
<br />X
<br />�( NON-0WNED
<br />HIRED AUTOS _ AUTOS
<br />No Owned Autm
<br />PROPERTY DAMAGE
<br />Lrdy,SIR@BO
<br />$
<br />E
<br />X
<br />UMBRa1AUAS
<br />X
<br />OCCUR
<br />EACHOCCURRENCE
<br />E 50,000,00
<br />AGGREGATE
<br />$ 50,000,60
<br />C
<br />EXCESS UAB
<br />DLAIMS-MADE
<br />79818355
<br />0810112018
<br />0810112019
<br />DED I I RETENTION 5
<br />$
<br />-
<br />A
<br />WORI03MCOMPEN"TION
<br />AND MPLOYatS' UAetU ,f
<br />ANYICREOOPPRIETOF AENSER AR NEOWEHBCUTNE YIN
<br />CFF(Mendetoryln NH)
<br />NIA
<br />901492301
<br />0810112D16
<br />0810112019
<br />X PER OTH-
<br />'- TVTE_
<br />E.L.EACHACCIOENT
<br />$ 11000,000
<br />E.L.DISEASE-EAEMPLOYE
<br />$
<br />ffypp SC escdbe under c h
<br />EL DISEASE -POLICY UNIT
<br />_ _1,000,060
<br />5 1,000.00
<br />B
<br />Personal Property
<br />357QB711
<br />0810112018
<br />08101/2019
<br />Spec Form 144,513,60
<br />B
<br />Data Process Equip
<br />3579B711
<br />0810112018
<br />08101/2019
<br />Spec Form 21,366,00
<br />OI30RPnON OF OPERATIDNS I LOCATIONS I Ve0CLF9 (ACORD 101, Mnl Remarke Schedule, may be attached a mora space Is mqulmd)
<br />See "Certificate Attachment -Holland & Knight, LLP" attached
<br />CMC)
<br />CITYSAN
<br />City of Santa Ana
<br />David Cavazos, City Manager
<br />20 Civic Center Plaza
<br />Santa Ana, 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 NTH THE POLICY PROVISIONS.
<br />AUIHGRR® REPRESENTATIVE
<br />,ju
<br />©1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD25(2014101) The ACORD name and logo are registered marks of ACORD
<br />
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