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WORKERS COMPENSATION AND EMPLOYER <br />INFORMATION PAGE <br />POLICY N0; 92-D3-2316-6 COVERAGE IS PR <br />REPLACES N0. 92-EV-1341-9 STATE FARM FI <br />900 OLD RIVER RD. <br />1. NgMEO INSURED g MAIILL NG ADpRESgg NCCI C <br />SUSAN SAXE CLI~FORD PHD INC FEIN 9 <br />16530 VENTURA BLVD STE 203 }LO5C3ATI <br />ENCINO CA 91436-4535 ENCINO <br />INSURE <br />COPYRIGHT 1987 NATIONAL COUNCIL ON COMPENSATION <br />----------------------------- <br />2. THE POLICY PERIOD IS FROM 07/01/2006 TO 07/0 <br />AT THE INSURED'S MAILING ADDRESS. <br />3A, WORKERS^COMPENSATION INSURANCE PART^ONE OF~ <br />WORpRKERS COMPENSATION LAW OF THE STATES lISTE <br />B ~D~tKOINREACHASTgTEYLiSTEDAINNEITREMRg3ATpWCOCT,I~pEENL <br />UNUUEER PART Two ARE. 80DILyYy IIINJURY BY DISEEASE <br />C. OTHER STATES INSURANC0D1PAR7N7NREEBWFDAHEASO <br />EXCEPT ME, MT. ND, OH, RI, WA, WWVV YY nNIE ''TT <br />D. THISSq POLL7ICY INCLUUgDES THESE ENDDRSEMt=NTS ANO <br />W0000422*0000113*W0000404/0484 WC040360A <br />4__REQUIF~EDLBEL(~~RIS~S~BJECRATOSVER~FICATNONPAND <br />CODE NOS AND PIgR~Mj~~ <br />CLASSIFICATIONS NUALttRE <br />--------------------------------- <br />o --- ------- <br />CLERICALggORRFCCFIppCE EMPLOYEES - NOC <br />EMPLOYERSULIABTGfTYOLIMNT5EA5ED <br /> _, ~ <br />~. <br /> <br /> <br />a <br />N <br />J <br />d FOREIGN TERRORISM PREMIUM 9740 <br />a MINIMUM PREMIUM S 250 CALIFORNIA TOTAL ESTIMA <br /> <br />EMIUM ---- <br />ADUUSTMENT PERIOD SHALL BE ------------- <br />A <br />N <br />N <br />UAL <br /> <br /> PREPARED 04/24/2006 S <br />E <br />E <br />CdUNTERSIGNE <br />=' WC UO 00 01 04 64 ~-z 80 2151 6738 BY gGENi <br />Gopyr:pM 2006 Na[ional Coundl on Compensation Insurance., Inc. <br />LIABILITY POLICY "~~°°~ <br />IOED gy 23-1308-F412 U <br />AND CASUALTY COMPANY <br />KERSFIELD CA 93311-6000 <br />RIER CODE N0. 14842 <br />Oi2886 <br />atURA BLVD STE 203 <br />I$ A CORPORATION <br />SWRANCE <br />-=--------------------------- <br />2~07 12:01 A.M. STANDARD TIME <br />.1-------------------------- <br />E~POLICY APPLIES TO THE <br />HHRE: CA <br />POLICY APPLIES 1'0 <br />ITSSOF OUR LIABILITY <br />~', 550o g0g LL, 00 p0p EPPpA IHI EMCLLIppDENE <br />~S `IST~~SINS3AALl. STA~ES <br />~~8~~~0~ W~o4a6°°A <br />+EFFECTIVE 07/01/06 <br />!Y OUR MANUALS OF <br />ALL INFORMATION <br />1 INgGErBY RRAgqUDI//T <br />~ ED AN REMUNERA~^ANNUA~TED <br />I~RATION TION PREMIUM <br />7,29 1.33 522 <br />75 <br />229 I 03 I 12 <br />';ANNUAL PREMIUM S 6o0g9 <br />F;~AUDISURCHARGE $ 1600 <br />~- d DD58 88L 818 ~O ~Hd ~OaOddl~O~li~X~'S W02id Wd80`81 90Z-£Z-S <br />