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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