PROOF OF INSURANCE (2017 - 2018) CLOSED CERTWICAT'I'AE OF U'ABILITY IN%S)URANCE
THIS CERTW!"ATE �S WUr-0 P%S A FA?A7,'ER Oiz INFOR&IATION ONLY AM) CCNI`-!iRS NO RiGHTS UPON THE CERTIFICATE HOLDER, THM 1�
CEMIFICATL ;r,-,s nc-r OR NEWOWELY AMEND, FIAIIEND OR At TER 1HE COVERAGE AFFORDED ny 'THr:: POLICIES
V �.*07 CONSIr fl UT
RFLOW, TWI�S CFROW'=711, OF INSURANCE 00i-�S � �E A CON'T,'�ACT BETWIFFN ISSUING INSURER(S�, AUTHOR:2i;
REPRC-SENIZAIWE OR PRODUCER,AND 71KE CERTIFICATE HOLDER.
WPORTANT: if th; ADI)MONAL ij4sUper),thLp pancy(ir,q) nwst have ADDIT1.014ALWSURM provisions or be cndurwld
I� SU5ROGA7iO4 IS INAWED, suhloct to the)tormu and,comfivans of di a pnticr, conoin may roquiroan('slaorsomanL A on
lhi4�;ArW10=1 doos ftOLCOMiCt dqht�,to mio holdrr in Neu ofoucH ondoruomL(1t_(S). _,,
.0 n-i�r,r n "L iAS
I�
' 1 �
54�-G!)79 310 5016-6821
iAM 1 So,E�,,x JA"('' NLCq�
WH,%- AN H f- CINS LV?r A;11W AP e'qnqW C t=r RAOV
,; ,Ger
14 3
A, M�AV.K, C
'IN 11,,., )(I,
.NCINO CA 91 43c
-ICATE NUMER: REVISION WUMBER�
CEI
Tlij, rx ICY fl,8(00
Lf THIS
IS To Cj�fj�jjjA�
T'
iNSLIRFU', NAWD MOVE FOP THL
VANY, MV OT,r�24 o0N11 AlMi R , PEC) TO
r',E�CIFICATT 40JNY BF',, ISSUED OR MAY PERTAIN, 1HE HEREM IS SUBJ%C7 lc�,VL THE Q.-..Rtn,
JNMS L45I,.N REDUCz"U'O'PAIICLAIMS,
19Pq s, vO_Cv UIPSIlVYfA u,y IX
'k
I COMMERCIAL—,,EWHRA1,,,JAnhLJTY � LAPf (,'�rCORR'N";L
M,R') wuvr,,anV L 5,000
N 92,92 2f,4,74-2 CAii�.V20 IF uv 16""Z018
r
N� N, &,. I ^i Wq rR'ic,n, II rrP'"Y 4 I'Y""A 'a✓s"vMr g. �
rxcr.31.,i'JAU
5,
I On
ar
AN'll CUIPLU"t 1,51JAWWrY
M, 07,10�K_1016 U'7 1� 20 1
W! W e
W),000
_-LVA
MWQ spme Is mquird)
_�E P'now Of.1xPr_.RA=N15 hdaMMI'd ftMA*6 s6hWdavo,mav be"0001tm
II
ZTjrCANC FLI-A['ION
IC WT H=)ER.
SAL,OVLU AN
,.Y OF'THZ AGOVI:QFSCRj8C0 FOUCIES BE CELLS gEFORE 1
EZpjfVjfIjN oATF- Tijr�PEOF. NOTIC-C VOLL BE DE-11VCRED IN
ACrORDANCE 1oVI'r-VrHE POLICY PROVISIONS.
jul,iiaij Pourv,oerjaykTnen',
548 MPM SIRF'T 6U 7 1�L,t�4 7 V 0 G LP R f,-V T
Sugondo. 90',Ir 4�
i(�tl1988-2015ACORDl',C,RPORATiON, All rights reserved.
ACO RD 26(2016103) The ACORD name and logo are registered mark5 of ACORD
G Policy No. 92 922579 2 HASSAN, EROL E CMP-1788.1
Pape 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 203
ENCINO CA 91436-9535
Name And Address Of Additional Insured Person Or Organization:
THE CITY OF EL SEQUNDO, ITS OFFICERS, OFFICIALS, EMPLOYEES AGENTS AND
VOLUNTEERS
398 MAIN ST
EL SEGUNDO CA 90295-3813
1, SECTION II -M-- WHO IS AN INSURED of b. If coverage provided to the additional in-
SECTION 11 -- LIABILITY is amended to in- sured Is rewired by a contract or agree»
clude, as an additional lnsured,anyr person or rnent, the Insurance provided to the
or anization shown in the chMedula, but only additional insured will not be broader than
wi respect to lI'atrility for bodily Injurryy , that which you are required by the contract
"property damage", or"personal and advert9s-, or agreement to provide for such addition-
Ing injury"caused, in whole or in part,by; al insured; and
a. Ongoing Operations
c. If the contract or agreement between you
(1) Your acts or omissions;or and the additional insured is governed by
(2) The acts or omissions of those acting California Civil Code Section 2782 or
on your behalf, 2782.17 a, the Insurance provided to the
in the performance of our on oln opera- additional insured is the lesser of that
p' g p which:
tions for that additional insured;or
b. Products–Completed Operations (1) fe allowed for the satisfaction of a all-
P P fence or indemnity obligation by Cali-
"Your work" performed for that additional fomia Civil Cade Section 2782 or
Insured ands Included in the "products- 2782..05 for your sole liability;or
completed'operations hazard". (2) You, are required by contract or
However,Paragraph 1.above is subject to the agreement to provide for such addl'-
following: tional insured,
a. The insurance afforded to the additional We have no duty to defend or indemnify the
insured only applies to the extent permit- additional insured under this endorsement un-
ted by law, til a claim or'soft"is tendered to us.
o.Cry l„Slate Form Mutual Autornobilo Insurance Company,2013
Includes 000ft ed matariat of lnauranoo Woes Ofte,Inc.,adth Its parmkealon.
C YPinN'U 0
CMP4786.1
Page 2cf2
2. Any Insurance provided to the additional In. (3) The nature and location of any injury
sured shall only apply with respect to a claim or damage arising out of the 'occur-
made or a "suit" brought for damages for rence"or offense;
which you are provided coverage, b. Tender the defense and indemnity of any
3. With respect to the insurance afforded, to the claim or "suit" to us and to all other insur-
additional insured, the followin: is added to ers who may have Insurance potentially
SECTION It---LIMITS OF INORANCE: available to the additional insured;and
If coverage provided to the additional Insured c. Agree to make available any other insur-
is required by contract or agreement, the most ante the additional Insured has for de-
we will pay on behalf of the additional insured fense or damages for which we would
will bete lesser of the amount of insurance: rovide coverage under SECTION It --
a.
a. Required by the contract or agreement;or EIABILITY.
b. Available under the ap8licable Limits Of 5. With respect to the Insurance afforded the ad-
Insurance shown in the eclarations, ditional insured, the following replaces SEC.
TION 11 —LIABILITY of ParagrVh 7, Other
This endorsement shall not Increase the ap. Insurance of SECTION I AND S ICTION 11—
9 licable Limits Of Insurance shown in the COMMON POLICY CONDITION&
eclarations, a. This insurance is primary to and will not
4. With respect to the insurance afforded to the seek contribution from any other insurance
additional insured, the following is added to available to the additional insured, provided
Paragraph 3. Duties In The Event Of Occur. that the additional insured is a named in-
ronce, Offense, Claim Or Suit of SECTION sured under such other insurance.
11—GENERAL CONDITIONS: b. Regardless of any agreement between
The additional insured must: you and the additional insured, this Insur-
ance is excess over any other insurance
a. See to it that we are notified as soon as whether primary, excess, contingent or on
practicable of an "occurrence" or an of- any other basis for which the additional in-
fense which ray result in a claim, To the sured has been added as an additional in-
extent possible, notice should Include: sured on other policies.
(1) How, when and where the "occur- There will be no refund of premium In the event
rence'or offense took place; this endorsement is cancelled.
(2) The names and addresses of any in-
jured persons and witnesses;and All other policy provisions apply.
CMP-4786.1 1007033 1480111 05-21-2014
V,copyri t,State Foam Mutual Aulornobft tnauranoe Company,2013
Includes copydlJ%1tad snalariat or insurance Services office,Inc.,vAltv Its permission.
Account Number- CA SUSA 16501CATE Date: 2/16/17 Initials; LPD
CERTIllur"14%rJ'*AF INSURANCE
ALLIED WORLD INSURANCE COMPANY
CIO: American Professional Agency, Inc.
95 Broadway, Amityville, NY 11701
800-421-6694
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 Named Insured; Additional Named Insureds:
SUSAN SAXE-CLIFFORD, PH.D. SUSAN SAXE-CLIFFORD, PHD
A PROFESSIONAL CORP. CATHY GOODMAN, PHD
16530 VENTURA BLVD WILLIAM SMITH, PSY.D.
STE 603
ENCINO CA 91436
Type of Work Covered: PROFESSIONAL PSYCHOLOGIST
Location of Operations :
(If different than address listed above)
Claim History:
Retroactive date is 03 01/2004
Policy Effective Expiration Limits of
Coverages Number Date Date Liability
NAL/ 2, 000, 000
. PROFS
SSIO
, LIABILITY 5011-0137 3/01/17 3/01/18 4, 000, 000
NOTICE OF CANCELLATION WILL ONLY BE GIVEN TO THE FIRST NAMED INSURED, WHO SHALL
ACT ON BEHALF OF ALL INSUREDS WITH RESPECT TO GIVING OR RECEIVING NOTICE OF
CANCELLATION.
Comments: Defense Reimbursement Proceedings Limit is $75, 000 . 3/11 ADDL.INS .BELOW:
This Certificate Issued to:
Name: SUSAN SAXE-CLIFFORD, PH.D.
A PROFESSIONAL CORP.
Address: 16530 VENTURA BLVD
STE 603 Aut orized Representative
APA 00138ENCIII060RO14436
° AC+OURA HILBSOCA.,... �"�IV1EF��CU'RYl ..,, _„, ,..,,..,. _.,..,. ....
V PRODUCER
5008
ROAD STE 200 B&B PREMIER INS 043988 06 !
91301 (I N S U R A N C E COMPANY Ad DT41I1IM1a8ILlw POLICY DECLARATIONS
R QI94 t' h8lJI1JMBER �, 'Is1Y RIO '' h�id3 tbNtiw&UgEt�fis1Ct IMP�I��l�PM10v@OE G XC1�JSI,{��I i
rTaom04E02p20017E_ _ S,IN ANN CSU 9�OT U
..
. , I._...-, ,_�, .w.r... A1TP1,10.Al1LLli 1"a RLI.t�a1s'IEIIAUI: fi�INfr fJLJ1'Nal'Llt�d'1TdEl Ta,LtAl1ILlT1”
..y. 6 140095. �PE115DNS INSURED
—_POL . PERIOD."'' 1 . Dram nor pr o' rI ttw.rle 4I uaDDwwc4, e.tl 6V tlt n r E6
01itA1
FRANCIS Ifii d Barry CIAirliant WIien ar Vto tITIOlor VffIJdwClcp t5V1>eij6 tiro J tart/
,,_.. woa4�02�2a,�.
"behefil
it
w6d Or
�"NgtV6'Et�tld5llrMED +a, r t c
0 ,.. z otomy a ar l
i
ORD { 0 by.a porton 01tod below 109arrJlrrm'a art 4^vl vna tlw
q emott milder art whe..ther the rarruwl s;y,.Edt�wmird to i"Ve
r"CfFlNVErtS CLIFFORD
l
jFRANCIS CLIFFORD
SUSAN SAXE-CLIFFORD
0 F
°
MAi4&Nt+ 4906 OAK LANE DR _ I
,
S ADDRESS ENCINO, CA 31;.915-4001
1 2013 CVIERCEI E,E 950ea+utLE ads - �
I9PTtpN R 1rUDDH'H6 JB _ _ ,.. _-ST DR VAutAVlED Pucdt D ,x „ Ls w_ n
iCaI YEAR �, a+f WAGON AVs D WAG 4D. �. . d NU Vlfs tb t w,.,
t 6DA 58036 N 0612013
2 2015 FORD EX EXPLORER ` ., A6P 3 N 1112014
13 FORDaEX�' An��ecerr�teNG GT �Nitresto�a �c� rxratxarauAsecu'rYt ',gas tAa.t.�r„w�aaN Aotaa�a�aratiaaaazatrreua�rt�Trrtwztrnwtttawrueuaaaanr�rwtwaN7aaascusrEoaeovE. � h
t"a4"aD6aa21 N 04/2016
GIwR ., cwa:tNTet@p, ct ..
LfT..W.,FORD,MOTOR CREDIT PO BOX 105704,,,
ATLANTA GA 30348 i
Coverage applies only if premium charge is listed below, Coverage/Limits are subject to all policy terms.
I LIMITS OF'LIABILITY PREMJ MS NON•FACTICIR.,,.. _.,...._,,.,_.... � _...
__.�..... Ci1�'i7S11;�+SEEi .. Y Id0llUllEfr1T ;
..,, 356 —... _. _._
BODILY LIABILITY
7Y EEACH ACH ACCIDENT 500,000 EACH ACCIDENT ARt$2 304 WCA 156 3 ITEMS INSURED AND AMOUNTS OF
-CYNIC'YitAEI:B gW1'Yf`k ASttl"1"a ....�.,.,., I$250�aaa',,. .._._,.�._,..�.,...,.w,..�.,,,,,.,,,, ._.,,,.,.,,,.—„ _. —.,...._..._3.... CA 294 ,....... 280.TRRFIN I INSURANCE FOR EACH ITEM ARE STATED
4250,000
PROPERTY DAMAGE HEREIN ITEMS INSURED ARE SUBJECT To
gR)Lw 11g49UNINSURED M L9A8HJTY „ $250 000 EACH PERSON $500,STS ._. DEDUCTIBLE.
ROD( RY . .,.... .__,.._,.�.___._,.._._...._._,_,. ...... .,.. 104 62 ..
PROPE'WtTY DAM flEtLIARtd,,J,T"M _._......,....,�.,...._, i.._ —... ......_ aorta 7.Cta5 ezSrJ?w o . . UrArw
$ MAXIMUM
m,.,, ._... T..� ,.°
COLLISION OVWCTIRLE WAIVER . .......1.,_. ,.._........4 �.....,..,.._,..' .!,..._....._....
4
MEDICAL 2
LEASEILOANIGAP COVERAGE CAR000
34 34 2CAR2 Y CAR 30 "- ---_
REPAIR OR
CAR CAR CAR 3
COMPREHENSIVESTCORAGE-EMEN7 FITDCTYRtE'CAR7...$500 CAR2 $500 Y CAR3$500 ..(..,w_._.,„ 6a..,�,.�._.. s8„ ,.
2 376 CA FRAUD
ASSESMpt{TS
p dDEDUCTHIU CARI $500 CAR2 $500 CAR3$500 892 79 „�..
itOADSONNCE ASSISTANCE i ..
EE
PER_. R .. 75 4 4 4 CIGA FEE F
RENTALICAREENEFIT tl$100 PER DAYCAR3030 DAYSAR2 $75 CAR3$ i 102 102102 INTERVENOR FEE O.0' �]
Y � 8
Efw1OOAS
ERnF5'gTTA, PRE tAq
17
. _CHEO TO THE POLICY MiunnS PER �.t 1104
0 0612016 U-236 W.._. 1972
POLICY FEE,
TOTAL PREMIUM 4,81 7.36
IMPORTANT INFORMATION
EFFECTIVE 04/02/2017
The enclosed Auto Insurance Renewal Jill and the U251 IMPORTANT NOTICE are part of this policy, These
�specify the amount of your premium, your payment options, any applicable fees, and the due date.
Your automobile insurance expires and coverage ceases at 12.,01AM on 04,/02/2017, Coverage under
(this policy will become effective provided you pay the premium and any applicable fees as indicated
Pon the Auto Insurance Renewal Bill, If you have any questions, please contact your agent or broker at
the phone number provided above..
_ .,.,,. _................._ ........... ._.,.__.,,......... _....,.... .._............ ..
Q MAILED TO:
E{u FRANCIS CLIFFORD
ENCI OAK LANE DR M.>rLIN NVW
49CIN0, CA 91316-4001 �. 6 140095420
LI ',�' NUMBER; 03/02/2017
A.,,..__.._...�. ..03/0 /
INSURED COPY