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'~ gq1PLATTE RIVER INSURANCE COMPAvvNY <br />1 /:_ ~ / 0 8 ,- A Psyc THIS 7S A CLAIMS MADE POL CY PLEA E READtC'?1REF~l11LLYy <br />*** RENEWAL *** <br />NOTI@I~-itt'~WER LIMIT OF LIABILITY APPLIES TO JUDGMENTS OR SETTLEMENTS WHEN THERE ARE ALLEGATIONS <br />OF SEXUAL MISCONDUCT (SEE THE SPECIAL PROVISION "SEXUAL MISCONDUCT" IN THE POLICY). <br />POLICY NO: 5 011- 013 7 <br />ITEM 1. (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 />~- -0200 3 - oP~17 -~/ <br />~- - O~Od ~' ®'~~ <br />TYPE OF ORG: PROFESSIONAL CORPORATION <br />ITEM 2. ADDITIONAL INSUREDS: <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 />Continued... <br />ITEM 3. POLICY PERIOD: 2801 A.M. STAND 0 3 0 ME ~ $ TIIE ADORES OOF THE INSURED A~ STATED HEREIN: <br />ITEM 4. LIMITS OF LIABILITY: (a) $ 2 , 0 0 0 , 0 0 0 EACH WRONGFUL ACT OR SERIES OF CONTINUOUS, REPEATED <br />OR INTERRELATED WRONGFUL ACTS OR OCCURRENCE <br />(b) $ <br />ITEM 5 <br />ITEM 6 <br />ITEM 7 <br />unt;r,~nn~,r crr~nrrr t;• <br />ACCOUNT NO: CA-SUSAl65-0 0427263C <br />ITEM 1. (b) ADDITIONAL NAMED INSUREDS: <br />SUAN SAXE-CLIFFORD, PH.D <br />7 5 , 0 0 0 COSTS RELATED TO ANY SINGLE PROCEEDING <br />(c) $ 4 , 0 0 0 , 0 0 0 AGGREGATE, FOR ALL CLAIMS AND ALL PROCEEDINGS <br />CLASSIFICATION NUMBER RATE ANNUAL PREMIUM <br />1ST PSYCHOLOGIST 1 1494.00 1,494.00 <br />INDEPENDENT CONTRACTORS 5 26.00 130.00 <br />DEFENSE LIMIT 140.00 <br />ADDITIONAL INSUREDS 9 250.00 <br />RETROACTIVE DATE: 0 3 / O l / 04 TOTAL PREMIUM: 2 , 014.0 0 <br />EXTENDED REPORTING PERIOD <br />ADDITIONAL PREMIUM (ifexercised):$ 3 , 525.00 NO DISCOUNT INCLUDED <br />ITEM 8. POLICY FORMS AND ENDORSEMENTS ATTACHED TO THIS POLICY <br />PRGE2000 (3/2006) PRGe1069 (1/2006) <br />THIS IS NOT A BILL. PREMIUM HAS BEEN PAID. / l AU RIZED COMPANY REPRESENTATIVE <br />PRGE2005 (3/2006) Americ Professional Agency' 95 Broadway, Amityville, NY 11701 <br />