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2020/03/01 Susan Saxe-Clifford Liability Insurance Certificate23 ' ALLIED ALLIED WORLD INSURANCE COMPANY i W O R L O A stock insurance company, incorporated under the laws of New Hampshire 1690 New Britain A.enn S .* e, ur a 101, Farraington, CT 06032 (1-800-421-6694) CLAIMS -MADE PSYCHOLOGISTS' PROFESSIONAL AND BUSINESS LIABILITY POLICY 1 / 2 5 / 2 0 — A THIS IS A CLAIMS MADE POLICY -PLEASE READ CAREFULLY A NOTICE: A LOWER LIMIT OF LIABILITY APPLIES TO JUDGEMENTS OR SETTLEMENTS WHEN THERE ARE ALLEGATRIQNS OF SEXUAL MISCONDUCT (SEE THE SPECIAL PROVISION "SEXUAL MISCONDUCT" IN THE POLICY). POLICY NO: 5 011— 013 7 ITEM I. (a) NAME AND ADDRESS OF INSURED: SUSAN SAXE—CLIFFORD, PI-I.D. A PROFESSIONAL CORP. 16530 VENTURA BLVD STE 603 ENCINO, CA 91436 ITEM 3. POLICY PERIOD: ITEM 4. LIMITS OF LIABILITY: (a)$ 2, 000, 000 ITEM 5 TEM 6. TEM 7, ACCOUNT NO: CA—SUSA165-0 0427263C ITEM 1. (b) ADDITIONAL NAMED INSUREDS: SUSAN SAXE—CLIFFORD, PHD CATHY GOODMAN, PHD WILLIAM SMITH, PSY.D. MEREDITH RIMMER, PH.D. TYPE OF ORG: PROFESSIONAL CORPORATION FROM: 03/01/20 TO: 03/01/21 12:01A.M. STANDARD TIME AT THE ADDRESS OF THE INSURED AS STATED HEREIN: PER -CLAIM -INSURING AGREEMENT A. (c) $ 4, 000,000 AGGREGATE (b) $ 2 0 0 0 0 0 0 PER -CLAIM -INSURING AGREEMENT B.(1) and B.(2) (d) $ 15 0 0 0 0 PER PROCEEDING PREMIUM 'PION PSYCHOLOGIST INDEPENDENT CONTRACTOR DEFENSE LIMI CHARGE FOR CORPORATIO ADDITIONAL .INSURED RETROACTIVE DATE: 0 3 / 01 / 0 4 EXTENDED REPORTING PERIOD ADDITIONAL PREMIUM (if exercised):$ CHEDULED TEM 8. POLICY FORMS AND ENDORSEMENTS ATTACHED TO THIS POLICY �PA`PSY 00002 00 (06/14) APA 00127 04 (06/14) NUMBER S T N S RATE ANNUAL PREMIUM S 4 1121.00 4,260.00 1 26.00 26.00 290.00 1 1494.00 1,494.00 13 350.00 TOTAL PREMIUM: 5, 8 4 2. 0 0 RATING CREDIT INCLUDED APA-PSY 00001 00 (06/14) THIS IS NOT A BILL. PREMIUM HAS BEEN PAID, AUT RIZED COMPANY REPRESENTATIVE America rofessional Agency* 95 Broadway, Amityville, NY 1170I CRED Policy No. h ' 9225 i 9 2 CMP-4786.1 Page 1 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CMP-4786.1 ADDITIONAL INSURED — OWNERS, LESSEES, OR CONTRACTORS (Scheduled) This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 92 922579 2 Named Insured: CLIFFORD, SUSAN SAXE DR A PROFESSIONAL CORPORATION 16530 VENTURA BLVD STE 603 ENCINO CA 91436-5017 Name And Address Of Additional Insured Person Or Organization: CITY OF MENIF'EE 29844 HAUN RD MENIFEE CA 92586 6539 SECTION II — WHO IS AN INSURED of SECTION If — LIABILITY is amended to in- clude, as an additional insured, any person or organization shown in the Schedule, but only with respect to liability for "bodily injury", "property damage", or "personal and advertis- ing injury" caused, in whole or in part, by: a. Ongoing Operations (1) Your acts or omissions; or (2) The acts or omissions of those acting on your behalf; in the performance of your ongoing opera- tions for that additional insured; or b. Products — Completed Operations "Your work" performed for that additional insured and included in the "products - completed operations hazard". However, Paragraph 1. above is subject to the following: a. The insurance afforded to the additional insured only applies to the extent permit- ted by law; b. If coverage provided to the additional in- sured is required by a contract or agree- ment, the insurance provided to the additional insured will not be broader than that which you are required by the contract or agreement to provide for such addition- al insured; and c. If the contract or agreement between you and the additional insured is governed by California Civil Code Section 2782 or 2782.05, the insurance provided to the additional insured is the lesser of that which: (1) Is allowed for the satisfaction of a de- fense or indemnity obligation by Cali- fornia Civil Code Section 2782 or 2782.05 for your sole liability; or (2) You are required by contract or agreement to provide for such addi- tional insured. We have no duty to defend or indemnify the additional insured under this endorsement un- til a claim or "suit' is tendered to us. ©, Copyright, State Farm Mutual Automobile Insurance Company, 2013 Includes copyrighted material of Insurance Services Office, Inc., with its permission. CONTINUED 2. Any insurance provided to the additional in- sured shall only apply with respect to a claim made or a "suit" brought for damages for which you are provided coverage. 3. With respect to the insurance afforded to the additional insured, the following is added to SECTION II — LIMITS OF INSURANCE: If coverage provided to the additional insured is required by contract or agreement, the most we will pay on behalf of the additional insured will be the lesser of the amount of insurance: a. Required by the contract or agreement; or b. Available under the applicable Limits Of Insurance shown in the Declarations. This endorsement shall not increase the ap- plicable Limits Of Insurance shown in the Declarations. 4. With respect to the insurance afforded to the additional insured, the following is added to Paragraph 3. Duties In The Event Of Occur- rence, Offense, Claim Or Suit of SECTION 11— GENERAL CONDITIONS: The additional insured must: a. See to it that we are notified as soon as practicable of an "occurrence" or an of- fense which may result in a claim. To the extent possible, notice should include: (1) How, when and where the "occur- rence" or offense took place; (2) The names and addresses of any in- jured persons and witnesses; and C M P-4786.1 CMP-4786.1 Page 2 of 2 (3) The nature and location of any injury or damage arising out of the "occur- rence" or offense; b. Tender the defense and indemnity of any claim or "suit" to us and to all other insur- ers who may have insurance potentially available to the additional insured; and c. Agree to make available any other insur- ance the additional insured has for de- fense or damages for which we would provide coverage under SECTION 11 — LIABILITY. 5. With respect to the insurance afforded the ad- ditional insured, the following replaces SEC- TION 11 --LIABILITY of Paragraph 7. Other Insurance of SECTION I AND SECTION II — COMMON POLICY CONDITIONS: a. This insurance is primary to and will not seek contribution from any other insurance available to the additional insured, provided that the additional insured is a named in- sured under such other insurance. b. Regardless of any agreement between you and the additional insured, this insur- ance is excess over any other insurance whether primary, excess, contingent or on any other basis for which the additional in- sured has been added as an additional in- sured on other policies, There will be no refund of premium in the event this endorsement is cancelled. All other policy provisions apply. 10, Copyright, State Farm Mutual Automobile Insurance Company, 2013 1007033 148011 08-21-2014 Includes copyrighted material of Insurance Services office, Inc., with its permission. -A►CQ1�2'�� �,..,.� CERTIFI ATE @I` I IAB !CITY IhISUI4i�ICE DATE (MI E CERTIFICATE €S ISSUED A5 A MATTER OF IWFO1iMgT10ti DNLY AND CONFERS f4[} RIGHTS UPON THE CERTIFICATE HOLDER- TH S FICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AII�tlEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES E TAT GEOR PRODOF #NStiRA110E ROES IyOT COI+ISTTTUTE A COFtTFtAt:T B>rTWEfN THE5SUING #HSiJRER�S}, AUTHORI2EIDESE�fTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER INIpORTAMT; if the corliflcate holder is an AD# -INSURED, th® policy{les} must have A#)€]!T€DN141 €NSIIRED if SUBROGATION #S WAIVED, subject tD the terms and eonditil of the Po#Icy, cvrta#n poilcles Ina rn airs an endo►seision A this cealif#caty doss not confer rights td tits to endorsed. PRODUCER L erttl kale hnldrr Irf !#flu at such endorseme s . staternertt on R'*teFail"7i7 ERGL HASSAN NTA EROL HASSAIv Wawa=: 44 3540 HIGHLAND AVE 310 545 fi579 K 3ti? 545 �821 MANHATTAN BEACH, CA 90266 �i0i71tE�$: - rkSURF - - ---w- �!!�c covErlacE _ salt r r+suRen 11i iLNRER A ; State Farm Cxeoe�ral Insurance Corrgxarfy 25151 CLIFFORD. 5USAN SAXE DR A PROFEMONAL rrsalgl�z e : ,Slate Farm Flre arts# Cast ally Cpmperty 2`�143 CORPORATION ON ER 16530 VENTURA RLVC) STE 603 1NstJf{ER o: OVERAGES CERTIFICATE NUMBER: INSLq:BiF; — — _, .-- - THIS IS TI3 CERTIFY THAT THE POLICIES OF INSURANGFw LISTED KLOW HAVE BEEN I.S5111=0 Tp THE INSURED V►,tAMEp A NUMBER: VE PUM THE POLICY PERIOD INDICATED. NOTVMTHSTANLNWG ANY REQUIREMENT TERM OR CCSNDrnON OF ANY CONTRtACT OR OTHER [DOCIJAtF:,IaT WITH RESPECT TO WHICH I'll EXCLUCERTIFICATEIONS ND O ITIONS bF1 UC PIDUCI PERTAIN, THE 1rJSURANCE AFFORDED BY THE pODCIES DESCRIBE HEREIN I& SUBJECT TO ALL. THE trl3ll� FJCCLUSiprISANp C4NpiT10M3 OF SLhGH POLICIES. LIMFPS uHUV1M MAY HAVE SEEN REDUCED BY PAID CLAMAS. TDDLSU®R - - -------- YPE of BtSURAIJ ...--- - CE - F iCi NUMBER COIrAe�.l't'CEAL SiI?NI?RAL. LiA81iaTy -... (:LhiM -MhpE f occu t ' �� EACCi1 OCCURWil 1 g PRCh/ISF a 5 sDt�,allir A NC]#d C?VIlI iEEi H#i2ED AU_TC3 -- Y! 42-82-2579 2tP - U4l1$lz¢2Q _ trreri arc per�rn}72.000,0— GEWL AGGREGATE LIMIT APPLIES P'Eit a Q4118d2021 PLR50NAL & ADVY JRYPOLICY D. LI}, i3�rrEHALRGCRL tTfiOTI PRf3Pi • cf!►P7 ,q AUTOMOBILE UAi lYs .., ANY AUTO rCQ Nw r s OVIi m SCHEDULED %JLJt if _ AUTOHIIIIES SWILY R4JURY (Par nelson) AUTQ5 UttLY NO a"Im AUTOS ONLY k3Cd13ILY INJURY (P 8ccicYenCl � �� I TY [a 3r�ri0 , f UMBRELLA UA® OCCUR i _.... ZXCESS UAB t$ W1iS MAOF' IhCxf OCCURRII i DIED RFTFNTI i � A CWMV.ATE S VLORKERS COMpENSAT ION -. AND EMPII LIIkSILITY S .ANYPROPpiETOR,PARTW-R&KC-ri171VF YIN xcw[>ED7 FYI k lA f� S2-C7-E13Ct8-5 PC E r' R - fmandL:RlM n Noz � {M:ndah�►y Ip RNj 1r es desct171a vnd�r � 07101/2019 L1 E,gCry �� 0710112020 f 1 M00.000 E# #lA5FA3E -ER EAii'LOYC _! 1,000,000�FS7i'L:fdRT10MS0efGry _ EL. LNSFASF -PpLrcy LwFT 3 1.000.000 DE*SCRIPT'K?M OF OPERA7mS 0 LOC.AT*NS I VEHHII 1ACORD ti1►r, A it lr.f Rorft k. SchMduit. Diu he 4 P5YCt7L.00y1CALSERVICES Y LL.cfl.drmo,� NIC Of Til All DESCRIBED CITYTt E%PFEtlL710N IDATE THEREOF, NOTICE POLICIES WILBL CBE CELLEO DELIVI REQpM EMP O €dl S 2984 ITS N RD RS, Af,E NT> 8, ACCOf2DAlWCE WITH THE POLICY PRCMStOH�. EIvIPI.0YEE5 2984�4 HAUN RD MENIFFE, CA 9258r3 7AMaRePjSjATWI i ACORD 25 (201f f03) 1"8-2015 ACORD CORPORATION- All rights rmerved. The ACORD name and logo are ►esg#ster'ed marks of ACORD 1001406 1328.q.12 O3.14s�2Q1G PRODUCER B&B PREIVI ER INS M E R C U RY 5008 CHEHESEBRO ROAD STE 200 044006 06 AGOURA SILLS, CA 91301 AIM INSURANCE COMPANY AUTOMOBILE POLICY DECLARATIONS TELEPHONE;{$181 223 8383 IMPORTANT COVERAGE EXCLUSION POLICY IV UMER B_ POLICY PERIOD I APPLICABLE TO ALL COVERAGES; INCLUDING 136T NOT LIMITED TO. LIAEILITY __. 0401 06 140095420 F1aom04/02/202012:01AM T004/0212021 tz BtAMI ONINSUR£0TOAISTS, PROVIDE PERSONS INSURED It Is ao ed that UNINSURED ftl1iosurarice afforded by this polwy OR LAT ER - NAMED INSURED - -- - - - - - - ;:; shall not apply nor accrLie_to The benefit of any insured or any FRANCIS CLIFFORD IIvrC party clainlaot when any motor vehicle is being use.(I.ur operated by a person lister] DRIVERS L?elow regardless of where the FRANCIS CLIFFORD Person.resides. or whether the ia6mn is licensed to drive. ' - SUSAN SAXE-CLIFFORD MAILING 4908 OAK LANE DR ADDRESS ENCINO, CA 91316-4001 CAH: YEAR ... - .... VEHICLE DESCRIPTION 1 2015 SERIAL NUMBER COST:DRVALUE. .iNEWlUSEDIFORD MUSTANG GT CPE 1 FA6PPU8CF4F5322694 RCH.: DATE . � H.P.;Cto 2 2016 FORD EXPLORER PLATINU UTL 4DR 1 FM5K8HT3GGB80021 N 1 1 /2014 3 2020:TESLA MODEL 3 SED 4DR 5YJ3E1EBXLF668490 N 04/2016 kP kf-iA' .CAR - LOSS PA YEES ILPI, AMAITIONgL.INTFREbTS IAII- LOSS PAYEES AND ADDITIONAL INT.FRLSTS. IuV. GARAG.fftG AUDRESSE I.GAj.AND REGISTERED OWNERS (101 OTHER THAN' HOSE LSOT D/ABOVEO .._ LGA7RQ�- _ - 1 LP FORD MOTOR CREDIT 3 LA TESLA PO BOX 105704 ATLANTA Pb BOX 4387 GA 30348PORTLAND OR 97208 i I Coverage applies only if premium charge is listed below C oilItAGES l FPVAITS QF LIit1B1LiTY BODILY INJURY LIABILITY 1$250,000 EACHPERSON $ 500,000 EACH ACCIDENT PROPERTY DAMAGE LIABILITY $250,000 EACH ACCIDENT UNINSURED MOTORISTS BODILY INJURY LIABILITY 9250,000 EACH PERSON $ 500,000 EACHACCIDENT UNINSURED MOTORISTS $T PROPERTY _DAMAGE LIABILITY_ MAXIMUM COLLISION DEDUCTIBLE WAIVER - "- --- -- - -- MEDICAL EXPENSE $5,000. - _.._ - --- - - -- -- LEAS EILOAN GAP COVERAGE CAR 1^-Y CAR - CAR I REPAIR OR REPLACEMENT CAR CAR - -- - -- -- — _ -- COST COVERAGE CAR COMPREHENSIVE DEDUCTIBLE CAR I $500 CAA2 $500 CAR3$500 COLLISION _ _ DEov_CTIBLE CART $ 500 CAR2 $500_ CARS $ 500 ROADS IWINGSISTANCE EACH ~CAR2 - (FOR TOWING SERVICES) C CAR1 $75 OCCURRENCE $75 CAR3 $75 RENTAL CAR BENEFIT $ 1 00 PER DAY 30 DAYS RSEMENTS ATTACHED: TO TNE:POLICY U-1 O 12/2018 —� - Coverage/Limits are subject to all policy terms. PFIEIU11lIIVIS NON -FACTORY. EQl1IPMENT CART I CARP CARS -- - - { ITEMS INSURED AND AMOUNTS OF 420 260 _ 402 INSURANCE FOR EACH ITEM ARE STATED 372 312 490 HEREIN, ITEMS INSURED ARE SUBJECT TO 21 2 140 278 THE DEDUCTIBLE. — - —6 — B B �.30 18 28 � -- 28 54 44 _60 ' 786 380 + 1346 _—_8 - — _ 8 8 148 148 _ 148 F'REMIUM5.PERCAR- 2070 1326 2750 IMPORTANT INFORMATION *For Non -Towing Services, Limit of Liability is $75 per Occurrence Towing and Non -Towing services per policy period. LARJr'`.. ITEh1SINBURED.. - ; LIfv1lT i - CALIFORNIA ASSESMENTS - CA FRAUD FEE 5.28 CIGA FEE INTERVENOR FEE TOTAL PREMIUM 6,151.28 Maximum 5 Occurrences in total for EFFECTIVE 04/02/2020 lThis amended policy declarations page replaces all declarations with the same or prior effective date, This renewal declarations page reflects change(s) in the policy which you have requested. The enclosed Auto Insurance Bill is part of this policy. It specifies the amount of your premium, your payment options, any applicable fees, and the due date. If you have any questions, please contact your agent or broker at the phone number provided above. Thank you for placing your business with Mercury Insurance Company, MAILED TO: FRANCIS CLIFFORD l 4908 OAK LANE DR ENCINO, CA 91316-4001 U-f 7B 07/2019 INSURED COPY RiL[CY:NUIVIBEFi 0401 06 140095420 — — — MAILI1 O'DATIE*s; 04/03/2020