The URL can be used to link to this page

Home My WebLink AboutGRUVER, ERIC 3A - 2002 INSURANCE ON FILE WORK"MAY PROCEED UNTIlIN~IJRAN E EXPJRES ..3 CLERK OF COU CIL DATE: ,.....,~L....,v'-- T--sr- " A-2002-143 '-' '-' AMENDMENT TO CONSULTANT AGREEMENT THIS AMENDMENT TO CONSULTANT AGREEMENT, is entered into on :):.1 \ ') , 2002, by and between ERlC GRUVER, Ph.D., a Professional~rporation, hereinafter referred to as "CONSULTANT," and the CITY OF SANTA ANA, a charter city and municipal corporation of the State of California, hereinafter referred to as "CITY." RECITALS A. The parties entered into that certain agreement entitled AGREEMENT FOR CONSULTANT SERVICES dated June 5, 2000, (hereinafter referred to as "said Agreement") by which CONSULTANT has provided psychological evaluation and counseling for the Santa Ana Police Department. B. The parties wish to amend the compensation term of said Agreement in order to compensate the CONSULTANT for his increased rate of services. WHEREFORE, in consideration of the mutual and respective covenants and promises hereinafter contained and made, and subject to all of the terms and conditions of said Agreement as hereby amended, the parties do hereby agree as follows. A. Section IV, the "Compensation" term of said agreement is amended to: IV. COMPENSATION In consideration for CONSULT ANT services, CITY shall pay CONSULTANT an hourly rate as follows: 1. For complete preemployment psychological evaluation, CITY agrees to pay CONSULTANT four hundred dollars ($400.00) per applicant. 2. For complete post-traumatic psychological incident review, fitness for duty review and crisis intervention, CITY agrees to pay CONSULTANT the hourly rate of one hundred and forty dollars ($140.00). 3. For testimony in court and court preparation, CITY agrees to pay CONSULTANT the hourly rate of two-hundred dollars ($200.00). 4. For SWAT consultation and training, CITY agrees to pay CONSULTANT the hourly rate of one hundred and forty dollars ($140.00). B. Except as hereinabove modified, the terms and conditions of said Agreement remain unchanged and in full force and effect. IN WITNESS WHEREOF, the parties hereto have executed this Amendment to Consultmlt Agreement on the date and year first written above. ATTEST: Q~~ PATRICIA E. HEALY Clerk of the Council '-' APPROVED AS TO FORM: JOSEPH W. FLETCHER City rrey BY~ Co~aff)_ Paula Coleman Assistant City Attorney APPROVED AS TO CONTENT: (l~'w ~ Paul M. Walters Chief of Police ..., CITY OF SANTA ANA CONSULTANT ;., ail -Sb1 ~~ ~.JiJ Tax ID # or Soc. Sec. # Account Number: CA GRUE 1440 Date: 1/08/0~ Initials: KK . CERTIF1CATE OF INSU~CE EXECUTIVE RISK INDEMNITY INC. C/o: American Professional Agency, Inc. 95 Broadway, Amityville, NY 11701 This is to certify that the insurance policies specified below have been issued by the company indicated above to the insured named herein and that, subject to their provisions and conditions, such policies afford the coverages indicated insofar as such coverages apply to the occupation or business of the Named insured(s) as stated. THIS CERTIFICATE OF INSURANCE NEITHER AFFIRMATIVELY NOR NEGATIVELY AMENDS. EXTENDS OR ALTERS THE COVERAGE(S) AFFORDED BY THE POLICY(IES) LISTED ON THIS CERTIFICATE. Name and Address of Insured: ERIC WAYNE GRUVER,PH.D. 17772 17TH ST. SUITE 106 TUSTIN CA 92780 Additional Named Insureds: Type of Work Covered: PROFESSIONAL PSYCHOLOGIST Location of Operations: {If different than address listed above} N/A Claim History: Policy Effective Expiration Limits of Coverages Number Date Date Liability ..~ PROFESSIONAL/ 2,000,000 LIABILITY 008-1751708 3/01/03 3/01/04 4,000,000 . NOTICE OF CANCELLATION WILL ONLY BE GIVEN TO THE FIRST NAMED INSURED ON THIS POLICY AND HE OR SHE SHALL ACT ON BEHALF OF AI~INS~EDS WITH RESPECT TO GIVING OR RECEIVING NOTICE OF CANCELLATION. APPROVED AS i u FORM Comments: _ ~ OJ P~_._-_.._--_. La ra ccdy Deputy City AttOf1H~Y This Certificate Issued to: Address: ERIC WAYNE GRUVER,PH.D. 17772 17TH ST. SUITE 106 TUSTIN CA 92780 Name: / Account Number: CA GRUE 1440 Date: 1/08/0~ Initials: KK . CERTIF1CATE OF INSU~CE EXECUTIVE RISK INDEMNITY INC. C/o: American Professional Agency, Inc. 95 Broadway, Amityville, NY 11701 This is to certify that the insurance policies specified below have been issued by the company indicated above to the insured named herein and that, subject to their provisions and conditions, such policies afford the coverages indicated insofar as such coverages apply to the occupation or business of the Named insured(s) as stated. THIS CERTIFICATE OF INSURANCE NEITHER AFFIRMATIVELY NOR NEGATIVELY AMENDS. EXTENDS OR ALTERS THE COVERAGE(S) AFFORDED BY THE POLICY(IES) LISTED ON THIS CERTIFICATE. Name and Address of Insured: ERIC WAYNE GRUVER,PH.D. 17772 17TH ST. SUITE 106 TUSTIN CA 92780 Additional Named Insureds: Type of Work Covered: PROFESSIONAL PSYCHOLOGIST Location of Operations: {If different than address listed above} N/A Claim History: Policy Effective Expiration Limits of Coverages Number Date Date Liability ..~ PROFESSIONAL/ 2,000,000 LIABILITY 008-1751708 3/01/03 3/01/04 4,000,000 . NOTICE OF CANCELLATION WILL ONLY BE GIVEN TO THE FIRST NAMED INSURED ON THIS POLICY AND HE OR SHE SHALL ACT ON BEHALF OF AI~INS~EDS WITH RESPECT TO GIVING OR RECEIVING NOTICE OF CANCELLATION. APPROVED AS i u FORM Comments: _ ~ OJ P~_._-_.._--_. La ra ccdy Deputy City AttOf1H~Y This Certificate Issued to: Address: ERIC WAYNE GRUVER,PH.D. 17772 17TH ST. SUITE 106 TUSTIN CA 92780 Name: / Account Number: CA GRUE 1440 Date: 1/11/02 Initials: KK CERTIF~CATE OF INSUR'i{NCE EXECUTIVE RISK INDEMNITY INC. C/o: American Professional Agency, Inc. 95 Broadway, Amityville, NY 11701 This is to ce~tlfy that the insurance policies specified below have been issued by the company indicated above to the insu~ed named he~ein and that, subject to their provisions and conditions, such policies afford the coverages indicated insofar as such coverages apply to the occupation or business of the Named insured(s) THIS CERTIFICATE OF INSURANCE NEITHER AFFIRMATIVELY NOR NEGATIVELY AMENDS, EXTENDS OR ALTERS THE COVERAGE(S) AFFORDED BY THE POLICY(IES) LISTED O~ THIS CERTIFICATE. as stated. Name and Address of Insured: ERIC WAYNE GRUVER,PH.D. 17772 17TH ST. SUITE 106 TUSTIN CA 92780 Additional Named Insureds: Type of Work Covered: PROFESSIONAL PSYCHOLOGIST Location of Operations: (If different than address listed above) NIA Claim History: Policy Effective Expiration Limits of Coverages Number Date Date Liability PROFESSIONALI 2,000,000 LIABILITY 008-1751708 3/01/02 3/01/03 4,000,000 NOTICE OF CANCELLATION WILL ONLY BE GIVEN TO THE FIRST NAMED INSURED ON THIS POLICY AND HE OR SHE SHALL ACT ON BEHALF OF ALL INSUREDS WITH RESPECT TO GIVING OR RECEIVING NOTICE OF CANCELLATION. Comments: APPROVED AS TO FORM ~~AOO ~ aura Sheedy Deputy City Attorney This Certificate Issued to: Address: ERIC WAYNE GRUVER, PH.D. 17772 17TH ST. SUITE 106 TUSTIN CA 92780 Name: / \.00' ERIC W. GRUVER, PH.D. I'SYc,~c1(i '-'l , l'SYC/JOU)(! V November 17,2001 City of Santa Ana Office of the City Attorney 20 Civic Center Plaza M-29 Santa Ana, CA 92702 Eric W. Gruver, Ph.D. 17772 17'h Street, Ste. 106 Tustin, CA 92780 To the City of Santa Ana I, Eric W. Gruver, Ph.D., am under a contractual relationship with the City of Santa Ana to provide psychological service and understand the City's insurance requirements. While I have the necessary insurance coverage plus the Additional Insured Endorsement, as required, my insurance carrier, Farmer's Insurance Exchange, will not agree to the cross-outs in the cancellation clause (bottom right comer). Therefore, I, Eric W. Gruver, Ph.D., agree and promise that I will personally provide the City with the required 30 days notice should my coverage be cancelled or materially reduced in amounts. ~~MI~J~~' flC W. G ve Ph.D. Diplomate oft e American Board of Law Enforcement Experts Fellow and Diplomate of American College of Forensic Psychology EWG/ch Enclosure ~ASTOr~BM c E LEE SHAW Deputy City Attorney 17772 SEVENTEENTH STREET / SUTE Ion / TUSTIN, CALIFORNIA 92780-1944 OFFICE (714) 544-44:34 / FAX (714) 544-4996 ,'E:J.LOW-AMERICAJ\ COLJ.E(;r; OF FOHEJ\SIC PSYCIlOLO(;Y FELL< )\V-fllPLOMATE THE INTERNxnONAL A( '.ADEM'l' (W MEDICU\'E AM) PS)'( 'HOI,OGY NOV-.3-2001 10:11 FROM:ERIC W Sont By: DAVIS INSURANCE; I> "JERPH D 7145444996 ~' i4i ea7 0709 TO'~'A 647 6515 NOV-9-0~':10PM; 1/-",,"OO''''nv P.002/005"()~ Page 2 .- ".., - ACORD~ CERTIFICATE OF LIABILITY INSURANCE ?lR:i:'.n :l'II . Ilium All " IIATTIII llf 1_....'_ ~~= NO liGHT! UPON Tl5 CEIlT1Re,a'l'll C:fRI1RllATIi ~ NOT A119Il UmNIl OR N.:r", 'PIE E AFI'ORDIi:D III THE P IELClW. .; !1NSIi_ AI'I'ORDING COVERAIlIE ......~. iuw__~ - 0_- 13~" r.... All_ 11ft. iod.w 241 Ni.ooJ."" ""_'0, t'A ...11 - l'OIlJO-'OO~ P7-15-320 Ida lift...... IIID ..... 1II'lI"" 117?2 --tI> '_1:. 11d.1:.o _U... ClIo 81m 101 .- CO\IIlIbOlll, .I TllE PCLJaIiS OP IeJIWICl! 1.11_ ....-HA... 8EEllliSUEll10lHE lIIIIlREIl_'IIIlM _ _ -.cY~_ NIICATED. N01\M1HSl'MOINCl AK'Ia!D\llllEMENT, 1EIlMOR Cl>>IlI1lOlI Of AN'/'lXlIfT1UIll'OROTHER ~.-'__ REIIPIC'l'10WlllCH 'ItIIS CIII'I1FICllTE....., "&IDCIfI I0Io\1 ''''''AIM. TllII_lu.eelD....1NEI'eYC~ IlE8CRII;O H_II0uaa;r10.w. TH! _'Iil111IIONe ""0 COIClI OF 5UQI POUCIell. AGGREG\1E UMfl'S _ MAY HAIIIl_ 11000111 IV .~O IllMlIl , _R ""~~ !; --- " r~"""",GitUAL~ ......._~- 01501 10 07 Il/Ufzaal I ! ".5/1D0I .............- ~ EWIIG&CNl!r .._ -......,.. . ~.... "AblRun' .il!lI!!!!o.....- i ...xJJCJ1I.~!!JO I 'JI,OOO,O I,'JS;~ . ~.OOO- ,l,aOD;amr '. l,aOr,no l',OOOr . , -" 1....._GCAft--"'" .' -: .!I.OC ~ ~UIaIT'f' j_""'O 1"'-_."""'" i... ! ~EIIJ;:'AUTm ~ W~bNJIIIDI ~SINGl..l""" ,..- . Iilla.T_ ....- " j n_1 :="-..:.=r' >--- I-- I . ""auTO .~.r- ~om.T.M~ I cmtIl""'N ~. l Aln'O ON.'t: MJG : _UOltt'll'h~ ..1 .- -......... I ~ ...... ~ c""""...... ' ,- "- ~fI CI!RTlIlleAT ClI..D8( _-I CAau"'Ct I Io.l1CIN :: .....1IIt.,.~.. - I'IILICI:I.P_lmlI r JIll......" .11 MaIOP. 111 +--a ..... ~ UIU\UI '18 .... ..!... UVI ...,. ..".. 'Ie 1tII -.,a-...... ...... 'lie 'ftII ....-r. -n...... "V IIID tv tMI.I. ..... _ a....M..... CIlIJMILIn' QlII' MlIIQIG IPDIN 1tS ...-. m ........ .. .If""''' -: ~._._-~..,.- RaMr 1... D"~. ~ ICl~AI....-; ~ .. .ACORD COIlJlOIlATlON ,", !_- ...1- 1'--" . ; t u.. UOtMrilt:ItM . I U.~'l' .~1.MI'1 ~ .onu -- FIIIIIIDII--.c. I .W",_4I1-'.-. .... ......<111 eu.. DW .....too lIRa a. iC1..1a CeaUlt .1__ 10 .0Il 1111 ........ _, CA. .270a ~ aM (7I17J NOV-,15-2001 13: 03 FROM: ERIC W r,c'IVERPH 0 7145444996 .~ Se,!;! 6y,. DAVIS lNSUHANC~j "-' ~4~ 0." UIU:r TO'714 647 6515 J t..",.. '''' ,"~~' ..., .I '" . P.002/002 . --oJ 111~"ia" NFM Nnd Add... . ~ f'llIiCY Nl,nIIler " 15 120 U~ .1 17 d the CamllMY dl!&igrGlltdln 111& OIclerallollS ~and . ~ 171Z2 Iu.: iT",",' . IT! ..,5 'nISTlN CA 92'''' \lilIllI-- --.... . . El!tCM DD I-Ir of LiN ClI Lilbilly " 1.I>>IMI.GGa tlIG!1~nce . , ADDlnOHAL INSURED ENtlORSEMENT (SPEcw.. SENTlNILl . I,. Clllllidellllon ot 1I1e premUn we agIllIl MIl yOU to \he follOWIng: - ~ ,. TI1e il'lSlJf8/1Ce pmvIded II)' l/1isllollc:yfor IloIIlIv ....., ilIlllily end ~ 1IliIMg. WIlY uncflr ClMIlge t)-i\l"" uablllly inIU,1IraI shall aleo apply 10 1M IlClClitIDnII itllRJf8di>omaa belOW, but only w\1h rteped to .. _rrt!liOt arllilg OIA Ollh. oWllalllhip,'mlimenanc. or uae iii m. pilr1. !II tile Inlll..... IIlc8IIoII occupied by you, . ~ Thill ifllll.lrance (lOa noI APllIr to; (a) Ally ClCQI_& wt\I(;h tikII plad' .r \'OIl __ 10 IICOUPV a1t IftRNII 10011I0Il. lb) Any III\Ic:Wfe,I &llendlMl. II8W CO/lIINCIian 0' ~Ion opcmtio~ r;leIIOnMC by or lor I\IIY altdltional InIUrllO named bIIIllW. ' i. 'n,uldio'lIIlnlured 9haII nal btcorllllUed or dMm8lI to bill UllIlIl*1O the ComJl.lllly issuing tlilOOIicY, 4. The adddlll1lli il'llllrlCllhal nClt be Qr bIeom& ~ tor IIIV 1lf8IT'lu'" Plvmenlt 0J8 upon lhia pOliCy. IS. n lhiII ~ Is \en'l'll~MIId lor any "lIOII .... ....11 !JlIe in wrllil'iO "" lh. IlddilianaJ Il>IUlacl namod tleIow. If' daY' ~ TIlIImd......,llri ill p.n 01 \'OIl' poli;)'. ~ 11\1,.-. &Nl ClllltraIB ~ng III UIII CClI1Ir8IY. 1111 alhelwlllB !N~ II> allIIh&r lI!rma of me policy. i Adoibvll . city t}ffI I0Il<<' .. Itllured . 20\ I;IVII; C6Nt'O DII . SAHtA 1M c:A It7DI ~ TO FOBM . I E LEE<;t~ . ~Uty City Attorney CW~V~'.! ~1i2~- - .....116 ......~ iJoll I/f2/01 . A 11"1:11 FROM:ERIC W GF""JERPH D 7145444996 1'0,7'4 647 6515 E~UTIVE RISK INDEMNITY INC, '-' rSYCBOLOGISTS PROFSSSIONAL LIABILITY pOLICY THIS is 1\ CLAIMS I\'IA01: POLICY. pLI::ASe lIe"o CARI::,ULLY P.00Y1"I1"I5 NOl)-~3-21"11"11 * * * RENEWAL . U '0 Iln ~ LOWER LIMIT Or LIABILITY APPLIES TO JUDGEMENTS OR sm'LEMENTS WHEN THeR. ARE ALLEGATIO'S 01' >E\I:'\I, MISCONDUCT (SEE THE SPECIAL PROVISION "SEXU"L MISCONDUCT" IN THE POLICY], DECI.^RATION~ I'OLIO NO 008- ~ 751708 ACCOUNT NO; CA.GRUE1~4-0 00062663 J'l "" I IJI ,,"'IE AND ,WORIESS Or INSURED: ITEM I (b) ADDITIONAL NAMED INSUREDS ERIC WAYNE GRUVER.~H-D, 17772 11TH ST. 5UITE lOG TUSTIN, c:"" 92nO l'YPE OF ORG: INDIVIDU""L J'l EM 2 ADDITIONAL IN 'UREOS: CITY Of SANTA ANA ORANCE co, SHER!PFS OEPT POLICE & PERSONNEL DEPT.SSO NORTH FLOWER 24 CIVIC CENTER PLAZA S~T"" ANA, c"" ~2702 SANTA ANA, CA 92702 fROM' 03/01/01 TO 03/01/02 Il:OIAM STANDARD TIME ATTlio ADDRESS OF -I HE I'ISURED I\S SlATED HeR.I\ cITY OF' AN""HEIM !l.NlI'IEIM. ClJ-. I [fll ,1 !'OLICY' PERIO!) 2,000,000 Ei\CH WRONGFUL ACT OR SERI E> OF CONTINUOUS I\.~i: '\ T ED OR INTEIIRr.lATED WRONGfUL "CTS OR OC (lIRRE\lt I-rEM J LIMITS OF LIABILITY (0) S (b)S 50.000 DErENSEI\EIMBURSEMENT (el S 4.000. 000 AGORr.CAT~ --.,-.. ITE\1 S L. I PREMIUM SCI.IEDULE- ClAS IfKA.-tION NUM ";;R ' I{A TE "'NNUAL 1'1\ ~lIU 1[1 PART TIME PSYCHOLOGISTS DEFENSE LIMIT ADDITIONAL INSUREDS 1 3 .. ITf;11 (I n(\17 RfTRO.\CTIVE DATE 03/01/92 D;TI;NDW RE~ORTING rERlutJ ADDITIONAL PREMIUM (,I e'crm,d),~ CRIIIoTINE LEE s'i\i ' Dep\l~ ~ AtW' ll"~ - ITEII. C22129 PULlCY fORMS AND ENDORSEMENTS ATTACHBD TO THIS POLICY (7/95 ED.) C22128 C22092 EXE-99 TfilS I., ~()T A ~llL PREMiUM HAS I:lE"N P"'ID .d' ~ ~'II(H)~\ AUT RIZED tOMPANy-il(PR~; NI A'i\[ - ArmHn: PlOlb~l1"Jnal"~.!:ll\;.,..!):\.H(')\l.J....;l.y,..l,ml'~' 1"- ..., II.':, ND~-13-2001 10:11 FROM:ERIC W ~oUUERPH 0 , '- 7145444996 TO: ~1.4 547 5515 P.004/005 ~ "-' PSYC~GISTS' PIlOFfSSIONAL UABIUTY .QRANCE ~ I Executive Risk A "ll~ I'UII';Y ';UIILil.lns.all me agreements between You an nrst named Insured In the Declarations is authorized to I ,nly be ehenged by a written endorsement We issue an '5.~jonmAnt: You cannot assign or tl'3Nfilr Your interest in this polle} "Vou dl~ or are d6clar&d I&gally incompetent. Your righ Nhlle acting within the scope of his or her duties as such ~emporary custody of VOl!!'J!!QPertY wiltb.tl..Wyerlllills.1c EXECUTlVE FlISK INDEMNITY INC. _inlSllred by: AMERICAN PROFeSSIQNALAGENCY.INC. 95 8101dwlly. AmltyVill8, NowYor1< 1170' THIS IS A CLAlMSoMADE POLICY, PLEAS! !lEAD THE ENTIRE POLICY CAREfULLY. EllecutlvD Rllk Indemnity Inc. Administrative Offices: Simsbury, CT 06070 Offered through the Professional Counselors purchasing Group, Inc. NOTICE: A SMALLER UMIT OF covERAGE APPLIES TO JUDGMENTS OR SETTLEMENTS WHEN THSAE ARE ALLEGATIONS OF SEXUAL MISCONDUCT ISEE THE SPECIAL PROVISION 'SEXUAL MISCONDUCT" IN 'niE POUCY). TAI!ILE OF CONTENTS Page I. What This Policy Covers ..................... ...........................",......."........."................................ ,.......................................,.. , II. Additional t1entlfits ,...., ....................... ................., ...... .......... ...... .......,........... "............... ..... .................. ..... ....... ............... 2 III. When a Claim is Covered ",......"........,.....................,...................,..................,........"........"."...,,,................,..........,...... 2 IV, Exclvsior\s _ Claims Not Covered .................,......"...,...,................................................................,......,,,....,,..,......,.......,3 V. Limits of Coverage ,................,...........,.......................1........".'''..'............................. .........................................111........... 3 V I. Sexual Misconduct '00'" '0.......".........'. ......... n...... ...... ........ ...,. ..... ,.,.. ..I"" ,,,''' ,...."".,...... ..... ............ ...., .... ,... II II"'U ,......" ,. 4 VII. Other Provisions Affecting Coverage .,..,.."."........,......................"...................... ...",........"..,..".............,.."...............,.. 4 VIII. Definitions...,. ,.......................... .................. ............. ..""......" .............. ,................. ................,............""., ..",......."...,......5 Subject to the applicable limits and all of the terms, concllllons and ellcluslons of tl1la Policy, EllDolltlve Risk Indemnity Inc. agrees as followw; I. WHAT THIS POLlCV COVERS: A. ps~holoni5ts' ProfAssional LiAbilitY': W. will pay amounts You are legally required to pay to others as judgments or se\tl~eMS u thll result of eny Claim against YIIII for Your Wrongful Acts, or for the Wrongful Act& of othars for whom You Bre legally responsible. Howev",', th", Claim mu'llbe Ilrst made during the Policy Period. B. Premises Liabillt>L;, W. will pay amounts V",u are I&gally raquired to pay to others as judgments or sellleme"ts as tM resu" of any Claim against Yo... for E1cdlly InjUry or Property Damage caused by an Ol;currellce on the premises used principally in Vo..r practice as a psyChologist. However. the ClaIm must b& lil'$t made dunng the Policy Period. C. Co~t~ RAlated tn Ucen"ina Board Inv8sticFltions.: We will pay rllasonable coals You Incur for fellS charged by a~ attomey rap resenting You in lhe investigetlon or defanse of any procaedi~g first brought during thl Policy Period before a elate licensing board or gover"mental regulatory body. The amount shown in Item 4(b) of me Declarations Is the most We will be 1I11ble to pay for each of Yo... ""der this Saction I.e. .1- form ca2'12t{7/1SMl , 1<1:12 FROM:ERIC W G"'Il)ERPH D '-" \J 7145444996 TO",4 647 6515 """ ,--J P.005'005 NDl)-j.3-2001 CALr~ORNIA STATE AMeNDATORY ENDORSEMENT This endorsemMI. which is effective C 12:01 a.m on ". fOfms part of policy No. >, issued 10 ". by>. ExtCtJrlVE nISi:: INDEMNITY IN~, In consideration of lhe premium charged. it is understood and agreed that: (1) We may non-renew this policy by mailinc Or delivering notice of non.renewal to You and to the agenlat the mailing address shown on the policy alleast Sixty (IlO), but not more than one hundred twenty (120), da)'!l before the Expil'$lion Oat. set forth in Item 2(b) of the Oeclal'llllons, (2) We may condition renewal of this policy upon a reduction in limits. eliminetion of covereges. Increase In deductlblllS or Increase by 25% or more of the I'lIle upon which the premium Is based, by mailing or dlllvering wrilten notice of such reneWllI etI,nge(s) to You and to Ihe agent et the mailing Idclress $IIOWn on the polley at hlasl slxty (80), but not more than one hundnld twenty (120), days beforelha I:xpiralion Date set forth In Item 2(b) of Ihe Declarations. (3) If. if! connection with any non-renlWBl or renewal conditioned upon renewal chenge(s) as described in paragraphs (1) and (2) above, We do not mall or cleliver notice to You i' least sixty (1lO) clays \lefor, th. Expiration Oatil set forth in 118m 2(b) of the Declarations, tile coverage afforded under thIs policy will continue in force wllh no change in its terms, condillon5 and limitations for sixty (liD) clays after We mall or deliver s\leh not/CliO You, (4) Nothing in thiS endOnlementls Intended, nor shall It be construed, to vary, alter' or-amend any of the terms, conditions or limitations of this policy except IS state4 above. --, All other terms, conditions lIntJlimltations of this policy shall r'Ilmain unGhangl!d. INTATIVE C22092 (7-95) Endorsemenl No. > ~ q&FORN CRISTINE LEE SHAW Deputy City Attorney Fonno used on: C22129 " NDV-15-21"11"11 1"18: 41"1 FROM: ERIC W CO';" IVERPH D .--.. 7145444996 "'". '-' 1 TO'714 647 6515 '-..I.' P.1"I1"12'1"I03 Under Clllif(lfnl' law, "Ileh driver and each owner of II motor vehicle must be able to establish financial r"sponslblllty at all times. One of the Evidence of Liability Insurance cards priMed below must be kept in each vehicle insured under your POliCY for BOdily Injury and Property Damage Liability. We strongly sugge.t that, in addition. each drivel carry Ii card. EaCh card lists all Insured vehicles, drivers, and vehicle Identification numbeu. Please Cl,Jt c,rds on dolled IiMS. Fold down lhe middle and carry in your wallet. The cards become invalid on the policy e~pira!lon or termination date. They may nol be used as proof of insurance for a driver or vehicle nOl covered under your policy. Interinlurange Exchange of the AutomobilG Club EVIDENCE OF LIABILITY INSURANCE , I NAMEO lNSU~tD : GRUVER, ERIC W AND LINDA 5 . , ~O"CY NwnA G 9818~~o : EmCTIVE om O~/ 13/0 I EXPIRATION OATE 04/13/02 I Th~' POliCY OfOVIDOS iU lout LntI minimum Imounllii Qf liability : insuranCe t8Qllitect by ,1'1. C'- VEH CQr,E $Ee'l'ION I $Q:i~ fQf" ,1'1, I s.oecllied vehicles ~O Aimed Im~u'MS al'\d l'IUIY ~ttlvida eovlr.o. for I otrllr genom; Ind Qrhlr ...eni~I.. (15 llrOYlae~ gV ttlo IMut(lI"lCI17l0IlCy. If you nave IIn 8CC"ident: GOlltIG names ana acJC1rossas of; . fill ptrSQnO in th, Qth,r ...."hi.:;I,('); _ III pilson, orlMrwi.. irwotved in rhe .ceid,nt. 'or l1i,m!:lIO " p.aeatrianl; - III witi'll'"', O(Jl thD ol'iv8('& Iic(!nao numbtlr 01 me per&OntliJ wM drovt tnG ,oll'ltf v6l\itlll(.s), and !l\~ Vllil'liCI6(1) lit....u pl6h~, i/'leludil'lO U'1I1 stale 0/ registrahon. 00 no, admit reitloniibility for or diiCUSS me c;i~um5tlanOQ' of the ,t;;c;:kltnr wilh anygne other Il1ln the wli..., gr In ,UU'IQriUICI A.uto Club oI:1.ims represeotative. Da I'IOll1it.Clost! yOUI pOlity limllllo lfIy61'l1l. """..~lllOly .tlH'" Iny olllm.. .1.,l-U00-672-dZd u-eOO-"ClAIM). 2:.& houtt. day. ., daYI .. w..k. For poll'y c"'al1iO" ClaI11-Boo-sa.-6U1, - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - I.UAvl".url:ftt:.. t:.llt"ha~Q1' 6' the Aut....bll. Club EVIOENCE OF LIABILITY INSURANce I N-.MEO INsu~EO : GRUVER. ERIC W AND LINDA S , 'OetCY NUMO.R G 981 B~~o : EFFEC",VE ~.rE O~/13/0 1 EXPIRATION DATE 0~/13/02 : n.il policy tlrolllde! lliI lea.sl tM minimuM M\Our'ltlii 6f liability , in!urlnr;e required by lilt CA VE."l CODE SECTION 16086 for the specified vohlclo$ Gnd n&m8d insured, and may PI'9Vlt;t, c;qv,r'lIil.1Qr , olhQr porion, aM othRr vel1icles '$ provijjed toy tile insurance PGliCY. If yau hiVe In .ccl~ln'~ Cet !Ile namei and IClorel!U!S or~ - 1111 per,gR6 in ttMI other vehitle(::.); - .11 p,rag... "Ihcrwin involved in rhe 8Gcident. lor o".mglo III t1ft1,&tri,r\,: ~ all wilnosses. Gellhe driver's lic.an'liI number or the person($) whO drove rP'lo other 'l'ohicIO(S), and the vlnlCls(s) lIeanso pia,.. InCludinO thO &\11' or t.gi,tration. Cto not Idmlt rHponllibilily tor or discu&& tho cllcLlmltln-:ol 01 the Iccidlnt .....ith I"yone Olnr.r tl'la,.. thO ptlliC6 or 11'1 ruJtl\o/iucl Auto Club (laiml5 regre~entative. 00 not diSCIOSO ~our f)Olicy limitllO iDnyonl. I",mldl.cely ,eport any clalJll to UI 8.t 1.IOD.S72-S24' (1"'OU~.7(:LA!"", 24 hOW". Clay, 1 Cla)'. a wOGk. for pDtiC)' ehllna.l. call 1-800-g2...Gt 4'. ----------------------------.---------.------------------------- II you hovI an Z1cclt1Gnl: a.l th. n.mull.nl:llllJdrn.... Df: . all ~&Qn, in tn. Olhl!H'" v,hi'9le(,); . .11 person. othel'wi..e involved in the 8ccident, for 9xarnplQ as p.d_ttriana: - ell wim.,1508S. Oct the dri\lcrs license numbOf ot rn. p<<:lonW who erov. 1M 1 other vchiclo(s), and the ",ohleto(s) IIconsG pftn., in..I~(iinSllh~ : I lutlll or r.oi IlratiOr\. I I POLICY NUMBER G 9B 18440 00 not admit tlil,pon~ibililY for or discuss Thi cl,eumDlllneoJl 01 I : EFFECTIVe OAT! 04/' 3/01 EXPiRATION DATE 04/13/02 ihu~:C~:~~;~~ :::r~:'~:::6~han the police or an euThotitod : I Thi$1tOlicy PfQvtQicl.I IU.l1ho mi1'llmum o.moullliS 01 liability DO 1161 dilel6~e 'lOut ~6liey ti""ilt 16 "I'l'yonll. I I inlufb.it~6 (OOui~o~ &y th. CA VEH CODE. S!CTtON 16Cl51 for I.... ImrDltt;llaClllly report any Q."lm 1:'1..... '" 1-1QO.G'1a...u...G : : IpOCllied vsnlcle' and namld inlureds ,nlj may pro\lIC1' coverage for Ct-aOD-&7CLAIM). 24 haur'l D. dA~. 7 day, a. weelie. I , Q1h.... ~er$l;In" ~n~ ol"or ve"'Il;;lol iU pfovidt<l (..y It!. lnil.lrl/'1a JIOII~y. rtClr POl 1",/ Ghlngll, ~.111-800.1J14-81 'I, 1 ,_____________________________._______________________-----------1 I ~o..., II you 1l8ve In aggilittnt: I f~' Interinsur8nCID Exchangl Of the Q,t thl n,ml'" .nG' p"rfll30lli 0'; I ~:s9IJ Auiomoblle Club . ..II persons in the olh.er veni.ele(s)i : ~"'I"\~ EVIDENCE OF I.IAUll.lYy INSURANCii . all perSOfl8 olherwlse [nvolVeo if' ,,,e oeclamn. fOl' Ixamtlll al pede5trio.n~: . tltl w1rn'$'.'. Gotl ItJe arr..en lictl1lC numtlo( or tho j:lllrjOI)(.&)~-tlp r otller vehiele(s), a ,," ~r:n.,.)" I $late of regi,mUion. " 00 not I!dmi[ respon5iDlliry f or d' eire c.. of theaccldlll'ltwitharl Or\ 9Ii~or. r.''-1' .' Al,ltoClubclaims presef'lt_I!'.' I','::: '3HAW 00 nOl di&CIO.&8 yout POliCY' lfR.d-n~m'_~' Il"tt:ornev IMmediately reltcut .ny M:Yul.t '-800-612-12.6 U-llOD-67CLAIM). Z" hOUlS. day, 7 dlya. w.,k. For polh:y change., caU1_IOO_92..eU1. lnt...lnJurance lixchange of Ihe Automobile Club EVIDENCE OF L1"61L1TY INSURANCE s ; NAME.D INSURED ,GRUVER, ERIC W AND LINDA 5 , : po"cy NUMa~R G 9818440 I EFFECTIVE O,\TE O~/ 13/0 1 EX~lftATION OATI 04/13/02 I , 'rl,il WlitOy ~u'c;wid.5 It lellllt the rTlImmum amounts 0' liability I insuranoe rElQuir8d Dy the CA veHCOOI SICTION 18056 to, 1M , $J;Jecified v~h~le, CEnci named in,urecJs .en'lO may proviae co~srAgo ror I othilll' per&en& find other v.t1iilf-l", 11.5 provided by th., insurance pOlic)I. , ITS~ ~loli1 ----~----------------------------------------------------------- 7145444996 ~- . NOV-15-2001 08:40 FROM:ERIC W ~~I~ERPH 0 '- / TC"714 647 6515 "'" P.00Y003 1--------------------------------------------------------------- Yto.r ~ake VEHICL.1iS OESCAIBED ON POLICY: Vehitl~ Idenlificalion HO.(VIN) 1995 1994 1998 BENZ OL~S PORS W~BEA32EXSC24778~ lG3WH15MBRD'53542 WPOCA2~81wu622610 ORIVEAS NAhilO ON 'OLleV, LaCI Name First GRUVER, ERI C Ii GRUVER. LINDA S 1_________________________________________---------------------- VB""eLBS DESCRISro ON OOLICV: DRIVERS NA".o ON PO.ICY, y.., Make V,hicl6 Id61UlrleaUol\ No.(VLN) l..8.9l Name Fint 1995 BENZ WDBEA32EXSC247782 GRUVER, ERIC W 1~~4 OLDS lG3WH15MBRD353542 GRUVER, LINDA S 1- 199B PORS ~POCA2~81WU&22&10 . I----------------------------------~-~--------_.---------------- Year VEHICLES DESCRIB'O ON POLICY: 1995 1994 1998 Milke BENZ OLDS PORS Vehiclo tdentifiCllItiQn NQ_(VIN) WDBEA32EXSC247782 lG3WH15~8RD353542 WPOCA2981WU622610 DAIVERS N...ED ON POLlCV; LHtNlI.'"tFil'lt GRUVER. ERIC W GRUVER. LINDA S I l____________________~_______________~___________r-------------- YsAt t.lake vEHICLES DESeAIBED ON POLICY: 1995 1994 199B BENZ OlOS PORS Vatliele Identification No.{VIN) WDBEA32EXSC2477B2 lG3WH15~8RD353542 WPOCA2981Wu622610 D~IV!AS NAMED ON ~O.ICV, LaSI Naml Firli' GRUVER. ERI C W GRUVER, LINDA S l________~-------------------------~---------------------------- IT"ilO5fiD ",,,\n.. MAY-03-2001 14:08 FROM:ERIC W GRUVERPH 0 7145444996 TD:714 245 8094 P.003/003 -- ""'" DfCLARA TlONS SPECIAL SENTINEl PACKAGE SUPER BTRUCK IHSURAHCE E~"?Gi' I!J FARMERSIIfSURAHCE EXCHANGE 0 FIRE IHSURANCE EXCHANGE MEMBERS 01 FARMERS INSURANCE GROUP OF COMPANIES ~ HOME OFFICE: 4680 WILSHIRE BlVO. LOS ANGelES. CALIFORNIA 90010 ~ 1. Named tnslll'efl ~iting AddIoSs . ERIC GRUVER 97-15-P26 01S0~-~0-07 Agent Policy Number Type 01 o Parlnersl1ie.. 0 Corp. 8usiness PSYCHOLOGY OFFICE o JoInt Venlure U OIganlzation (Other than Parlnetship or joInt Venlu"'l 2. Policy Period rrom 081'25/00 \notllrior to time applied lor) to 081'25/01 2:0\ a.m. Standalll Time. II this policy replocos other coyorageo lhat end at noon $landalll time on the same day this policy beeins. this polley will not ta~e effect until tile other COverage ends. Thl. polley wlIleeoUnue lor IU"...ln policy perlodl .. 101lowI: II we elecllo contillUllthts Insurance. we will "new this polley if you pay the required renewal premium for each successlve policy period subject \0 out premiums. rules and forms then In effect 3. Insured tocation same as mail/ng addl8SS unless oUlerwis. slated: 17772 SEVUlTEtHTH STREET SUITE 106 TUSTIN CA 92780 : 17772 SEVENTEENTH STREtT . SUITE 106 TUSTIN Plllmalic Acc't No. Prod. Count CA 92780 TIle Ilimed Insured is an Individual unless OthC1Wise slated: 4. Mortgage Hofdcts Loan # Loan # 5. Premium $ 500.00 0 -x- W MoI1Qage Holder Pays 6. Policy Fonns and EndOlSCmtl.1s aUached al inception: 25-2611. 25-2880 E6036-ED1 E~168-ED1 E400q-en1 Eq216-ED1 E3026-ED1 7. We omvlde insurance onIv lor those COVetaaes indicated bv a _cmc Ilm~ or bv an -rif COVERAGES 25-2191 S90Q3-ED1 EQ103-ED2 SECTION 1 A.8uildlllll Il-Businoss Personal Property tMfTS OF INSURANCE 22,000 DfOUCTIBlE 2&0 .pplles U'Ut=. os'*' ~on """ea1ecl..Qy anCil lJS100OsSOO Us NONE Property and less 0' Incom. C.Loss allncome (Not ex 12 consecutive months! OPTIONAL COVERAGES Swimming PooIlF.nces and Walkways Building Glass(B1an~e\) OUtdoor Sign Coveraae Valuable Papers (In addition to S 1 000 included.) OCTUAllOSS SUSTAlN[O SECTION II ~ o EaJthquak. Oamag. ll-8uslness Liability. InclUding Producls and Completed IMllS \If LlA8ILrlI Operations. (Annual aggregate applies lor all ~nces Annual AGan:catel durina the '0Il.l S 1 000 000 Hire Legal Liability 575.000 Included unless olIIer option Indicated by an I!I 05100,0000 $150.000 each OCCUllence 'Subiecl \0 \he annual aoareaoal. sh f.Medic31 payme~ls to ~ (Subjeclto the annual aggregate shown for Cover.me D.l EPlACEMENT COST $ :a _uealJCo UllI, 'ppllo1 lInJaa orner E S opUoft I",,~ <_. $ LIability and Modicars lor Cov. OJ 5.000 each person o Prnress~labl!1ty ls,", attached .ndom:m.nll 1iI1'VCOV~ SECTION III AGreement '.Emalovee DishollCSlY _AIl""""'nt If.8road Form Mone. and Sccurilles~nSlde Aarccmenllll.8road Form Monev and SecurllieSoOulSlde Clime Aurccmelll tV-Med.cal Pa rnents Agre~ IteIlIions . ......." ... ...TION.... \~ t~ 1 \ Counl~ned \ 1L......u ~ iChaol Yigliotta Deputy City I~, t1nrnev limIt of liability Annual Aggregate) ....-.. ( J . V 5 000 1 000 1 000 500 each person 2 500 DEDUCTIBLE NONE 1250 $250 NONE NONE --- Representative MRY-03-2001 14:08 FROM:ERIC W GRUVERPH D 7145444996 TO:714 245 8094 I 1/12/ 0 1 . A PSYCHOL~~E~U~i6~E~~i~N~~D~~~iiI~~""LI ~y' " 'rHi'fi's"A tUIMS MADt POLICY. Pl.EASE READ CAREFUl.l. Y -. ***; RENEWAL.'*,'".. \OnCl A LOWER LIMIT OF LIABILITY'IIP'PLIES TO JUDGEMENTS OR SETTLEMENTS WHEN THERE ARE AlLEG,\TIONS OF SE,\l.\I. .\IISCONDUCT (SEE THE SPECIAL PROVISION 'SEXUAL MISCONDUCT" IN THE POLICY). , DECLARATIONS POLICY NQ 008-1751708 ACCOUNT NO: CA-CRUEIH-O 00062689 trI"ll I \>1 NAME AND ADDRESS OF INSURED: ITEM I. (b) ADDITIONAl. NAMED INSUREDS' P.OO2'003 ~... ., ....... ~., ERIC WAYNE GRUVER. PH.D. 17772 17TH ST. SUITE 106 TUSTIN, CA 92780 " TYPE OF ORO: INDIVIDUAL ITEM 2 ADDITIONAL INS E CITY OF ANAHEIM ANAHE! M . CA CITY OF SANTA ANA ORANGE CO. SHERIPPS DEPT POLICE & PERSONNEL DEPT.550 NORTH FLOWER 24 CIVIC CENTER PLAZA SANTA ANA. CA 92702 SANTA ANA, CA ~2702 FROM: . 03/01/01 TO: 03/01/02 12;llIA.M. STANDARD TIME ATTHEADDRESS OFTHE INSUREOAS STATED HEREI:>:. !TE.ll J {'OLleY PERIOD: ITE.\14 LIMITS Of LIABILITY: (I) S EACH WRONGFUL ACT OR SERIES OF CONTINUOUS, REPEATED 2,000.000 OR INTERRELATED WRONGFUL ACTS OR OCCURRE"ICE 50.000 DEFENSE REIMIlURSEMENT (bl S (<l S 4. 000. 000 AOOl\EGATE ~s PREMIUM SCHEDULE A 1\ A I MBER RA E ANN AL PART TIME PSYCHO~GISTS DEFENSE LIMIT ADDITIONAL INSOREDS 1 3 ... ... RETROACTIVE DAn 03/01/92 EXTENDED REPORTINO PERIOD ADDITIONAL PREMIUM (if..miscd):$ I'r(\1 S POLICY FORMS AND ENDORSEMENTS ATTACHED TO THIS POLICY C22129 (7/95 ED.} C221HRRI~E ~ lC.)i(JYj fTE\1 (, IH~17 TOTAL PREMIUM, M chac] Vigliotta THIS IS 1<0'( A BILL PREMIUM HAS1qEE/'/,e.vD., '", "-_0" 1\I'f\~~{Itlf\J~1 Au-r RIZED COMPANY REPRE ENT...TI\'E Anc,ir:" pror~njglUlJ ^,~J(1. ~s Ilm;tdw;.l)'. ^n11Ir'III.:. " \\",,1 , EXECUTIVE RISK INDEMNIT' :{NC. ...... THIS IS A ClAIMS MADE POLICY. PLEASE REl.",JAREFULLY 1/13/99 _ A PSYCHOLOGISTS PROFESSIONAL LIABILITY POLICY . ... RENEWAL ... NOTICE: A LOWER LIMIT OF LIABILITY APPLIES TO JUDGMENTS OR SETTLEMENTS WHEN THERE ARE ALLEGATIONS OF SEXUAL MISCONDUCT (SEE THE SPECIAL PROVISION "SEXUAL MISCONDUCT" IN THE POLICY). DECLARATIONS ACCOUNT NO: CA-GRtJE 144-0 00062866 ITEM 1. (b) ADDITIONAL NAMED INSUREDS: POLICY NO: 601-0011376 ITEM 1. (a) NAME AND ADDRESS OF INSURED: ERIC WAYNE GRUVER.PH.O. 17772 17TH sr. SUITE 106 TUSTIN. CA 92680 TYPE OF ORG: INDIVIDUAL ITEM 2. ADDITIONAL INSUREDS: CITY OF ANAHE H! ITEM 3. ITEM 4. ANAHEIM. CA CITY OF SANTA ANA ORANGE CO. SHERIFFS OEPT POLICE & PERSONNEL DEPT.550 NORTH FLOWER 24 CIVIC CENTER PLAZA SANTA ANA. CA 92702 SANTA ANA. CA 92702 POLICY PERIOD: FROM: 03/01/99 TO: 03/01/00 12:01 A.M. STANDARD TIME AT THE ADDRESS OF THE INSURED AS STATED HEREIN: LIMITS OF LIABILITY: 2.000.000 EACH WRONGFUL ACT OR SERIES OF CONTINUOUS, REPEATE OR INTERRELATED WRONGFUL ACTS OR OCCURRENCE (a) $ (b) $ 50.000 DEFENSE REIMBURSEMENT (e) $ 4.000.000 AGGREGATE ITEM 5. CLASSIFICATION NUMBER RATE ANNUAL PREMIUM PART TIME PSYCHOLOGISTS 1 858.00 858.00 DEFENSE LIMIT 95.00 ADO IT IONAL I NSUREOS 3 100.00 RETROACTIVE DATE: 03/01/92 TOTAL PREMIUM: 1.053.00 PREMIUM SCHEDULE: ITEM 6. ITEM 7. EXTENDED REPORTING PERIOD ADDITIONAL PREMIUM (If exercised): $ 1.643.00 ITEM B. POLICY FORMS AND ENDORSEMENTS lLTTAr.:~~n TO THI~ POIIr.V. ~ /y/J r~./J~/J . 7145444996 ERIC GRUVER PH.D. 212 P02 OCT 14 '97 11:26 ~ EXe:CUf lYE RISlCtHoefCNITY INt:. ':"..., 18 A CLAIMS MAIlE POLlCY .Pl.SlII! ll!AD CAIr"" - :r "05/97 - A PS~OLOGISTS PAOFESSIOHAL LIAe~;Y POLICY . ... RENeWAL ... NOTICE: A LOWER LIMIT OF UABlLlTY APPLIES TO JUDGMENTS OR SETTLEMENTS WHEN THERE ARE ALLEGATIONS OF SEXUAL MISCONDUCT (SEE THE SPECIAL PROVISION "SEXUAL MISCONDUCT" IN THE POLICY), DECLARATIONS ACCOUNTNO:CA-GRUEI4.-0 0006288 ITEM I, (bl ADDITIONAL NAMl"D INSUREDS: 'OUCYNO: 801-0011378 'EM " (a~ NAME AND ADDRESS OF INSURED: ERIC WAYNE GRUVER. PH.D. 17772 17TH ST. SUITe 106 TUSTIN. CA 92680 TYPE OF ORO: INDIVIDUAL 'EM 2. ADDITIONAL INSUREDS: CITY OF ANAliE HI ANAHEIM. CA CITY OF SANTA ANA ORANGE co. SHERIFFS OEPT POLice ~ PERSONNEL DEPT.550 NORTH FLoweR 24 CIVIC CENTER PLAZA SANTA ANA. CA 92702 SANtA ANA. CA 92702 'EMS- POUCY PEFlIOD: FROM: 03'01/97 TO: 03/01'98 12:01 A.M. STANDARD TIME AT THE ADDRESS OF THE INSURED AS STATED HEREIN: EM 4. LIMITS OF LIABILITY: 2.000.000 EACH WRONGFUL ACT OR SERIES OF CONTINUOUS, REPEATED OR INTERRELATED WRONGFUL ACTS OR OCCURRENCE (a) $ (b) $ 50.000 DEFENSE REIMBURSEMENT (e) $ ..000.000 AGGREGATE EM 6. PREMIUM SCHEDULE: FICATI N 1ST PSYCHOL.OG1S DEFENSE l. 1111 n ADDITIONAL INSURED RATE 3t7.00 ANNUAL PREMI t.18S.00 95.00 100.00 CE CRi 3 RETROACTIVE DATE: 03'01/92 ~Jr~~~~~~:~~~tr::~c\'sed~ $ 2.. t5. 00 'EM 8. POUCY FORMS AND ENDORSEMENTS ATTACHED TO THIS POLICY: 129 (7/95 EO.>> C22128 C22092 EM 6, EM 7. TOTAL PREMIUM: 1.380.00 ~ ~~ ~ A~PANYREPR TATl\Ili "HIS IS NOT A BILL. PREMIUM HAS BEEN PAID.