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PPLATTE RIVER INSURANCE COMPAAvNY <br />1 /:_ / 08 A Psyc THIS 7S A CLAIMS MADE POL CY PLEA E READtCAREFoUlLLV <br />*** RENEWAL *** <br />NOTI@IE?-7tMWER 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 />ACCOUNT NO: CA-SUSA165-0 0427263C <br />ITEM 1. (b) ADDITIONAL NAMED INSUREDS: <br />SUAN SAXE—CLIFFORD, PH.D <br />,4 , o?pd3 -On 7 <br />- 0206 3 — ON 7 -C)/ <br />eo6 7®-/"d <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: 2:01 A.M. STAND RD 0 3 0 ME A T THE ADDRESS OOF THE INSURED AS STATED HEREIN: <br />ITEM 4. LIMITS OF LIABILITY: (a) $ 2,000,000 EACH WRONGFUL ACT OR SERIES OF CONTINUOUS, REPEATED <br />OR INTERRELATED WRONGFUL ACTS OR OCCURRENCE <br />ITEM 5 <br />ITEM 6 <br />ITEM 7 <br />(b) $ <br />75,000 COSTS RELATED TO ANY SINGLE PROCEEDING <br />(c) $ 4, 0 0 0, 0 0 0 AGGREGATE, FOR ALL CLAIMS AND ALL PROCEEDINGS <br />DDFAATTTTA CCLWTITTI F- <br />CLASSIFICATION <br />NUMBERI <br />RATE I <br />ANNUAL PREMIUM <br />1ST PSYCHOLOGIST <br />1 <br />1494.00 1 <br />1,494.00 <br />INDEPENDENT CONTRACTORS <br />5 <br />26.00 <br />130.00 <br />DEFENSE LIMIT <br />140.00 <br />ADDITIONAL INSUREDS <br />9 <br />250.00 <br />RETROACTIVE DATE: 0 3 / 01 / 04 TOTAL PREMIUM: <br />2,014.00 <br />EXTENDED REPORTING PERIOD <br />ADDITIONAL PREMIUM (if exercised):$ 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..p6RIZED COMPANY REPRESENTATIVE <br />PRGE2005 (3/2006) AmericatfProfessional Agency' 95 Broadway, Amityville, NY 11701 <br />