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KILEY COMPANY A-2011-068 & AGR # TBD REVIEWED BY. . EUNICE HEREDIA (PG 6 OF 9) <br />amonnom <br />d kkl� <br />LILA Administrators & Insurance Services <br />APPRAISAL AND VALUATION ASPEN <br />PROFESSIONAL LIABILITY INSURANCE POLICY <br />DECLARATIONS <br />ASPEN AMERICAN INSURANCE COMPANY <br />(A stock insurance company herein called the "Company") <br />175 Capitol Blvd. Shite 100 <br />Rocky Hitt, CT 06067 <br />Date Issued Policy Number Previous Policy Number <br />05/22/2015 AA1001251-01 <br />THIS IS A CLAIMS MADE AND REPORTED POLICY. COVERAGE IS LIMITED TO LIABILITY FOR ONLY THOSE <br />CLAIMS THAT ARE FIRST MADE AGAINST THE INSURED DURING THE POLICY PERIOD AND THEN REPORT- <br />ED TO THE COMPANY IN WRITING NO LATER THAN SIXTY (60) DAYS AFTER EXPIRATION OR TERMINATION <br />OF THIS POLICY, OR DURING THE EXTENDED REPORTING PERIOD, IF APPLICABLE, FOR A WRONGFUL <br />ACT COMMITTED ON OR AFTER THE RETROACTIVE DATE AND BEFORE THE END OF THE POLICY <br />PERIOD, PLEASE READ THE POLICY CAREFULLY. <br />Item <br />1. Customer ID: 141963 <br />Named Insured: <br />KILEY COMPANY <br />ELIZABETH M. KILEY INC. <br />Elizabeth M. Kiley <br />2681 Dow Avenue, Suite E <br />Tustin, CA 92780 <br />2. Policy Period: From: 06/20/2015 To: 06/20/2016 <br />02:01 A.M. Standard Time at the address stated in t above. <br />3. Deductible: $1,000 Each Claim <br />4. Retroactive Date: 06/20/1997 <br />S. Inception Date: 06/20/2015 <br />6. Limits of Liability: A. $ t,000,000 Eacb Claim <br />B. $1,000,000 Aggregate <br />7. Mail all notices, includin., notice of Claim, to: <br />L1A Administrators & Insurance Services <br />1600 Anacapa Street <br />Santa Barbara, Ca:tifouim 93101 <br />(800) 334-0652; Fax: (805) 962-0652 <br />8. Annual Premium: $3,187.00 <br />9. Forms attached at issue: LIA002 (12/14) ASPCO002 0110 LIA CA (11/14) LIA012 (12/14) <br />LIA013 (10/14) LIA025A (17./].4) LIA103 (10/14) <br />This Declarilmns Page, together with the completed and signed Policy Application including all anaclvnents and exhibits tbcrete, asid <br />the Policy shall constitute the contract beovem the Named hrsured add ¢Ire C on )any. <br />05/22/2015 By �C'�C.�_ . <br />Date Authorized Sig ature <br />UA -001 (12/t4) Aspen Amcrieau tasunuce Company <br />