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EXECUTIVE RISK INDEMNITY INC. <br />*1/12%O5 - A PSYCHOLOGISTS PROFESSIONAL LIABILITY POLICY <br />THIS IS A CLAIMS MADE POLICY -PLEASE READ CAREFULLY <br />*** RENEWAL *** <br />NOTICE: A LOWER LIMIT OF LIABILITY APPLIES TO JUDGEMENTS OR SETTLEMENTS WHEN THERE ARE ALLEGATIONS <br />OE SEXUAL MISCONDUCT (SEE THE SPECIAL PROVISION "SEXUAL MISCONDUCT" IN THE POLICY). <br />POLICY NO: 008-1741807 <br />ITEM ]. (a) NAME AND ADDRESS OF INSURED: <br />ACCOUNT NO: CA-SUSA165-0 0427263B <br />ITEM L (b) ADDITIONAL NAMED INSUREDS: <br />SUAN SAXE-CLIFFORD, PH.D <br />~}; - ~ C-U3 _ ~ ~f 7 <br />SUSAN SAXE-CLIFFORD,PH.D <br />A PROFESSIONAL CORP. <br />16530 VENTURA BLVD. <br />SUITE 203 <br />ENCINO, CA 91436 <br />TYPE OFORG: PROFESSIONAL CORPORATION <br />CITY OF BEVERLY HILLS CITY OF INGLEWOOD LOS ANGELES COUNTY <br />HUMAN SERVICES ONE MANCHESTER BLVD. METROPOLITAN TRANS. AUTH <br />455 N. REXFORD DR. #210 INGLEWOOD, CA 90303 1 GATEWAY PLAZA FL. 9 <br />BEVERLY HILLS, CA 90210 LOS ANGELES, CA 90012 <br />ITEM 3. POLICY PERIOD: FROM: 03/01/05 TDB 03/01/06 <br />12:OIA.M. STANDARD TIME AT THE ADDRESS OF THE INSURED AS STATED HEREIN: <br />ITEM d. LIMITS OF LIABILITY: (a) S 1 , 0 0 0 , 0 0 0 EACH WRONGFUL ACT OR SERIES OF CONTINUOUS, REPEATED <br />OR INTERRELATED WRONGFUL ACTS OR OCCURRENCE <br />(b) S <br />75,000 DEFENSE REIMBURSEMENT <br />(c)S 3, 000, 000 AGGREGATE <br />ITEM ~. PREMIUM <br />ITEM 6 <br />ITEM 7 <br />CLASSIFICATION NUMBER RATE ~ .ANNUAL PREMIUM <br /> <br />PSYCHOLOGIST <br />1 <br />552.00 i <br />I 652.00 <br />INDEPENDENT CONTRACTORS 3 14.00 42.00 <br />FIRST ADDITIONAL INSURED 1 50.00 50.00 <br />OTHER ADDITIONAL INSUREDS 8 25.00 200.00 <br />DEFENSE LIMIT 65.00 <br />RETROACTIVE DATE: 03/01/04 TOTAL PREMIUM: 1,009.00 <br />EXTENDED REPORTING PERIOD <br />ADDITIONAL PREMIUM (ifexercised):S 1, 766.00 NO DISCOUNT I~f1"~~$D AS TU s v .. <br />ITEM 8. POLICY FORMS AND ENDORSEMENTS ATTACHED TO THIS POLICY ~" 7.^ p / ~/ <br />C22129 (7/95 ED.) C22128 C22092 ~~ ~ ~ `'~t'i' <br />'~'`~~~ a Sheedy <br />LauAa .,u <br />ni L;n i=,uorney <br />THIS IS NOT A BILL. PREMIUM HAS BEEN PAID. A RIZED COMPANY REPRE NTATIVE <br />APA221I0/95) Amen Professional Agency • 95 Broadway, Arttityville, NY 11701 <br />