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12-15-207 1:40PM FROM SAXE-CLIFFORD,PH_D_ 818 788 BS44 <br />gqPLATTE RIVER INSURANCE COMtPAAyNY <br />2 / 0 5 / 0 7 - A P syc THISS'[S A C S,A.IMS MAD,POL CYa PLEMI& AD CAREF U1LLYy <br />NOTICE- A LOWER LIMIT OF LIABILITY APPLIES TO JUDGMENTS OR SETTLEMENTS WHEN THERE ARE ALLEGATIONS <br />OF SEXUAL MISCONDUCT (SEF THF, SPECIAL PROVISION "SEXUAL MISCONDUCT" IN THE POLICY). <br />POLICY NO: 5 01- 0 01.013 7 <br />ITEM 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 />ENNCINO, CA 91436 <br />ACCOUNT NO: CA- SUSA165 - 0 <br />ITEM 1. (b) ADDITIONAL NAMED INSUREDS: <br />SUAN SAXE-CLIFFORD, <br />P_ 2 <br />0427263C <br />PH.D <br />TYPE OF ORG: PROFESSIONAL CORPORATION <br />ITEMS AnnTTInN A 1 IN.'ZT 1V nC- <br />ITEM 3_ POLICY PERIOD_ FROM: 0 3/ 01 0 7 TO- 0 3/ 01T 0 8 <br />I2:01A.M. STANDARD TIME AT THE ADDRESS OF THE INSURED AS STATED ME"IZEIN: <br />ITEM 4_ LIMITS OF L.IABILJTY: (a) $ 2,000,000 EACH WRONGFUL, ACT OR SERIES OF CONTINUOUS, REPEATLD <br />OR INTERRELATED WRONGFUL ACTS OR OCCURRENCE <br />(b) $ 75, 0 0 0 COSTS RELATED TO ANY SINGLE I'ROCEEDJNG <br />(C) $ 4,000,000 AGGREGATE, �OR ALL CLAIMS AND A* LL PROCEEDINGS <br />ITEM 5. PREMIUM SCHEDULF-- <br />CLASSIFJCATION NUMBER RATE ANNUAL PREMIUM <br />1ST PSYCHOLOGIST 1 1-130.00 1,330.00 <br />INDEPENDENT CONTRACTORS 4 26.00 104.00 <br />DEFENSE LIMIT 140.00 <br />ADDITIONAL INSUREDS 9 250.00 <br />ITT 6_ RETROACTIVE DATE: 0 3/ 01 / 0 4 TOTAL PREMIUM: L 1,824.00 <br />ITEM 7. EXTENDED REPORTING PERIOD <br />ADDITIONAI. PREK41UM (ifexercised)-$_ 3,192,00 NO DISCOUNT INCLUDED <br />ITEM 8. POLICY FORMS AND ENDORSEMENTS A7A JjZ: Bff PfMpCyo FORM <br />PRGE2000 (3/2006) PRGe1069 (1/2006) <br />Laura "-'i,f; <br />THIS IS NOT A BILL. PREMIUM HAS BEEN PAID. Assistant City <br />RJZED COMPANY REPRESENTATIVE <br />PRO)=.2005 (3/2006) Anreric roressiorial Agency * 95 Broadway, Amityville, NY 11701 <br />