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EXECUTIVE RISK INDEMNITY INC. <br />4/04 - A PSYCHOLOGISTS PROFESSIONAL LIABILITY POLICY <br />THIS IS A CLAIMS MADE POLICY -PLEASE READ CAREFULLY <br />*** RENEWAL *** <br />:~ LO W'ER LIMIT OF LIABILITY APPLIES TO JUDGEMENTS OR SETTLEMENTS WHEN THERE ARE ALLEGATIONS <br />J.4L MISCONDUCT (SEE THE SPECIAL PROVISION "SEXUAL MISCONDUCT" IN THE POLICY). <br />Y NO: 0 08-1751708 <br />(e) NAME AND ADDRESS OF INSURED: <br />ERIC WAYNE <br />"'_7772 17TH <br />SCITE 106 <br />TUSTIN, CA <br />GRUVER,PH.D. <br />ST. <br />92780 <br />ACCOUNT NO: CA-GRUE144-0 0006288B <br />ITEM I. (b) ADDITIONAL NAMED INSUREDS: <br />~~~~~~~ <br />i~-ate' -`~~ <br />/~- -~~3- - 14 3 <br />TYPE OF ORG: INDIVIDUAL <br />'=TY OF ANAHEIM <br />'u'QAF.EIM, CA <br />POLICY PERIOD. <br />LIMI"fS OF LIABILITY, (a) $ <br />(b) S <br />CITY OF SANTA ANA <br />POLICE & PERSONNEL DEPT <br />24 CIVIC CENTER PLAZA <br />SANTA ANA, CA 92702 <br />FROM: 03/01/05 TO <br />12:OIA.M. STANDARD TIME AT THE ADDRESS i <br />ORANGE CO. SHERIFFS DE?T <br />.550 NORTH FLOWER <br />SANTA ANA, CA 92702 <br />03/01/06 <br />)F THE INSURED AS STATED HEREIN <br />2,000,000 EACH WRONGFUL ACT OR SERIES OF CONTINUOUS. REPf-::~lfiU <br />OR INTERRELATED WRONGFUL ACTS OR OCCURRENCE <br />50,000 DEFENSE REIMBURSEMENT <br />(c)g 4,000,000 AGGREGATE <br />PREMIUM SCHEDULE: <br />CLASSIFICATION NUMBER RATE ANNUAL PREMIUM <br />PART TIME PSYCHOLOGISTS 1 <br />DEFENSE LIMIT <br />ADDITIONAL INSUREDS 5 <br />I <br />RETROACTIVE DATE: 03/01/92 TOTAL PREMIUM: <br />`K~. <br />Ex I ~NU~u RErut<tINU rERfuu pp~ROVER AS TO FORM <br />ADDITIONAL PREMIUM (if exercised):S 1,696.00 NO DISCOUNT INCLU~EU- <br />~- <br />POLICY FORMS AND ENDORSEMENTS ATTACHED TO THIS POLICY ~IFL~ <br />29 (7/95 ED.) 022128 022092 EXE-99 Laura Stitt Sheedy <br />IS \O"f A BILL. PREMIUM HAS BEEN PAID. <br />'_(i0, )zJ <br />Assistant City Attornc~ <br />_~( <br />AUTJd RIZED COMPANY REPRE NTATIVE <br />Americ~ Professional Agency • 95 Broadway, Amityville, N Y 11701 <br />