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EXECUTIVE RISK INDEMNITY INC. <br />1/;2%05 - A PSYCHOLOGISTS PROFESSIONAL LIABILITY POLICY <br />THIS IS A CLAIMS MADE POLICY -PLEASE READ CAREFULLY <br />*** RENEWAL *** <br />NOTICE: A LOWER L[M(T OF LIABILITY APPLIES TO JUDGEMENTS OR SETTLEMENTS WNEN THERE ARE ALLEGATIONS <br />)F 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 />ACCOUNTNO: CA-SUSA165-0 0427263B <br />ITEM I. (b) ADDITIONAL NAMED INSUREDS: <br />SUAN SAXE-CLIFFORD, PH.D <br /> <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 />fEM3. POLICY PERIOD: FROM: 03/01/05 TG~ 03/01/06 <br />12:0 l A.M. STANDARD TIME AT THE ADDRESS OF THE INSURED AS STATED HEREIN: <br />fEM d. LIMITS OF LIABILITY: (a) S 1 , 0 0 0 , 0 0 0 EACH WRONGFUL ACTOR 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 />'EM i. PREMIUM SCHEDULE: <br />EM 6. <br />EM 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: 03x01/04 TOTAL PREMIUM: 1,009.00 <br />tx fnrvutu xErORI irv0 rERluu <br />ADDITIONAL PREMIUM (if exercised):S 1 , 7 66.00 NO DISCOUNT I~i~'hTR~ED AS TU r ~- - <br />EM 8. POLICY FORMS AND ENDORSEMENTS ATTACHED TO THIS POLICY ~~~'~~ ~! ~/ <br />22129 (7/95 ED.) C22128 C22092 _1`-'.~-Lt <br />LauYa :+Ilu Sheedy <br />nt 1.;:~ ;',borne)' <br />THIS IS NOT A BILL. PREMIUM HAS BEEN PAID. A RIZED COMPANY REPRE NTATIVE <br />4 Pd J>l,ry+p 51 Amen Professional Aerncv • 95 Bmadwsv. Amitwille. NY 11701 <br />