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EXECUTIVE RISK INDEMNITY INC. <br />5/30/06 - 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 />OF SEXUAL MISCONDUCT (SEE THE SPECIAL PROVISION "SEXUAL MISCONDUCT" IN THE POLICY). <br />POLICY"NO: 008-1741807 <br />77'EM I. (a) NAME AND ADDRESS OF INSURED: <br />SUSAN SAXE-CLIFFORD,PH.D <br />A PROFESSIONAL CORP. <br />16530 VENTURA BLVD. <br />SUITE 203 <br />ENCINO, CA 91436 <br />ACCOUNT NO: CA-SUSA165-0 <br />ITEM I. (b) ADDITIONAL NAMED INSUREDS: <br />SUAN SAXE-CLIFFORD, <br />~}-aGb7-oho <br />~~3_~`f7'o~ <br />.~ - a-oo 3 - a-~7 <br />0427263B <br />PH.D <br />TYPE OFORG: PROFESSIONAL CORPORATION <br /> <br />ITEM 3. <br />ITEM 4. <br />POLICY PERIOD: FROM: 03/01/06 TOE 03/01/07 <br />]2:OIA.M. STANDARD TTME AT THE ADDRESS OF THE INSURED AS STATED HEREIN: <br />LIMITS OF LIABILITY: (a) $ <br />(b) $ <br />1, 0 0 0 , 0 0 0 EACH WRONGFUL ACT OR SERIES OF CONTINUOUS, REPEATED <br />OR INTERRELATED WRONGFUL ACTS OR OCCURRENCE <br />75, 000 DEFENSE <br />(c) $ 3, 0 0 0, 0 0 0 AGGREGATE <br />SCHEDULE: <br />ITEM 6. <br />ITEM 7. <br />CLASSIFICATION NUMBER RATE ANNUAL PREMIUM <br />1ST PSYCHOLOGIST 1 978.00 978.00 <br />INDEPENDE;1`7T CONTRACTORS 4 14.00 56.00 <br />DEFENSE LIMIT 65.00 <br />ADDITIONAL INSUREDS 9 250.00 <br />RETROACTIVE DATE: 03/01/04 TOTAL PREMIUM: 1,349.00 <br />~ 1\V ! L:1VVL <br />ADDTTIONAL PREMIUM (if exercised):$ 2,361.00 NO DISCOUNT INCLUDED. <br />ITEM 8. POLICY FORMS AND ENDORSEMENTS ATTACHED TO THIS POLICY <br />C22129 (7/95 ED.) C22128 C22092 ,. <br />Y <br />THIS IS NOT A BILL. PREMIUM HAS BEEN PAID. ZED COMPANY REPRE NTATIVE <br />APA22(10/95) American Professional Agrncy' 95 Broadway, Amityville, NY ] 1701 <br />