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03919/2013 12:08 17145500344 KATALIN BASSETT MD PAGE 03/06 <br />A CLAIMS-MADE PROFESSIONAL <br />T H E Qd CTO RS C 0 M PANY LIABILITY POLICY <br />COVERAGE SUMMARY <br />Effective bate expiration Date <br />Policy Number Policy Period from 01/01/2013 to 0110112014 <br />0421028 (12:0) A.M. Standard Time at the Principal Address of the First Named Insured) <br />First Named Insured <br />Katalln Bassett MD <br />Principal Address Mailing Address <br />1401 N Tustin Ave Suite 120 1409 N Tustin Ave Suite 120 <br />Santa Ana, CA 92706 Santa Ana, CA 92706 <br />First Named Insurees coverage <br />LIMITS OF LIABILITY <br />Claim Limit Aggregate Limit <br />Coverage A-tndividuai Professional Uability $1,000,000 $3,000,000 <br />Coverage S Entity Professional Liability (optional) <br />Policy Aggregate (if any) -- <br />Specialty PSY01 Psychiatry <br />Retroactive Date 07101 11 9 9 0 Rating Territory California Area B <br />Rating and Coverage information for any other Protected Party is shown In the Endorsements. <br />Coverage under your policy is subject to the terms and conditions of the Endorsements fisted below: <br />MPL10011/04 Business Associate MPL21911/04 MediGuaM Coverage <br /> Agreement (HIPAA) MPL240 01169 IRB-Approved Clinical Trials <br />MPLIDICA 11104 California Changes MPL293 90109 Extended Reporting <br />MPL20811/04 Sexual Misconduct 5ublimit Provision <br />MPL20911104 Additional Coverage - MPL31101/09 Limited Claims-Mada <br /> Psychiatrists Premises Liability Cov <br />WARNING: A SMALLER LIMIT OF LIABILITY APPLIES TO JUDGMENTS OR <br />SE"iTLIEMENT$ WHEN THERE ARE ANY ALLEGATIONS OF SEXUAL MISCONDUCT. <br />(SEE ENDORSEMENT MPL208 "SEXUAL MISCONDUCT SUBLIMIr') <br /> <br />S <br />Continued <br />MPL002(1%4) 208 Page tof2 MDO02 $079939-00 insured