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OP ID: MB
<br />'46,.'�..°ROA CERTIFICATE OF LIABILITY INSURANCE
<br />DATE
<br />07/MM/2014 "'
<br />07/29/2014
<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 Phone: 813- 226 -1300
<br />CONTACT
<br />NAME: Mia Bush
<br />Brown & Brown of Florida, Inc.
<br />P. 0. Box 173086 Fax: 813 - 226 -1313
<br />Tampa, Tam FL 33672
<br />p
<br />Joseph W. LoPresti
<br />a °NN E.t 813- 226 -1337 arc, No): 813- 226 -1313
<br />EMAIL
<br />ADDRESS:
<br />mbush@bbtampa.com
<br />PRODUCER
<br />CUSTOMER
<br />ID p: HOLLA -4
<br />INSURERS AFFORDING COVERAGE
<br />NAIC4
<br />$ 1,000,000
<br />INSURED Holland & Knight LLP
<br />Holland& Knight Charitable
<br />Foundation Inc.
<br />100 North Tampa Street St 4100
<br />Tampa, FL 33602
<br />INSURER A: Federal Insurance Company
<br />20281
<br />INSURER B: Sentry Insurance
<br />24988
<br />INSURERC: Fed.lns Co /Liberty Ins Und
<br />GENERAL AGGREGATE
<br />INSURER D:Great Northern Insurance
<br />20303
<br />INSURER E
<br />$ Included
<br />NSURPRE:
<br />D
<br />AUTOMOBILE
<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 />SUER
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDDIYVVY
<br />POLICY EXP
<br />MMIDDIVVVV
<br />LIMITS
<br />D
<br />GENERAL LIABILITY
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE I ^ OCCUR
<br />X Insured Contract
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701
<br />35798711
<br />0810112014
<br />08/0112015
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />E TED
<br />PREMISES (Ea occurrence)
<br />$ 1,000,000
<br />MED EXP(Any one person)
<br />$ 10,000
<br />PERSONAL$ ADV INJURY
<br />$ 1,000,000
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER'.
<br />POLICY PRO X LOC
<br />PRODUCTS - COMPIOP AGO
<br />$ Included
<br />$
<br />D
<br />AUTOMOBILE
<br />LIABILITY
<br />ANY AUTO
<br />ALLOWNEDAUTOS
<br />SCHEDULED AUTOS
<br />HIREDAUTOS
<br />NON- OWNEDAUTOS
<br />No Owned Autos
<br />74986035 /� FORM
<br />ri�l,..��V ED AS TO l'
<br />�^.
<br />�l�M
<br />'
<br />08/0112015
<br />COMBINED SINGLE LIMIT
<br />(Ea accidenp
<br />$ 1,000,000
<br />X
<br />BODILY INJURY (Per person)
<br />$
<br />BODILY INJURY (Per accident)
<br />$
<br />PROPERTY DAMAGE
<br />(Peraccldent)
<br />$
<br />X
<br />X
<br />Laura A. Rossini
<br />—d I r /usklaul City Attorney
<br />$
<br />X
<br />$
<br />C
<br />UMBRELLA LIAR
<br />EXCESS LIAB
<br />X
<br />OCCUR
<br />CLAIMS -MADE
<br />7981835511000053016 -03
<br />08/01/2014
<br />0810112015
<br />EACH OCCURRENCE
<br />$ 49,000,000
<br />AGGREGATE
<br />$ 49,000,000
<br />DEDUCTIBLE
<br />RETENTION $
<br />$
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />ANDEMPLOYERS'LIABILITV
<br />ANY PROPRIETOR /PARTNER /EXECUTIVE VIN
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />901492301/9014920302
<br />0010112014
<br />08/0112015
<br />X WC STATU- OTH-
<br />TORY LIMITS OF
<br />E L. EACH ACCIDENT
<br />$ 1,000,000
<br />E. L. DISEASE - EA EMPLOYFE1
<br />$ 1,000,000
<br />EL DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />D
<br />D
<br />Personal Property
<br />Data Process.Equip
<br />35798711
<br />35798711
<br />08/01/2014
<br />0810112014
<br />08/01/2015
<br />08101/2015
<br />Spec.Form 115,892,000
<br />InclTheft Included
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />See "Certificate Attachment - Holland & Knight, LLP dated 8 -1 -14" 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 />City of Santa Ana
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />David Cavazos, City Manager
<br />AUTHORIZED REPRESENTATIVE
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701
<br />1'iMa,� hu,I,J
<br />ACORD 25 (2009109)
<br />© 1988 -2009 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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