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NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA. <br />2704 Commerce Drive, Suite B., Harrisburg, PA 17110 <br /> ADMINISTRATIVE OFFICES: 70 Pine Street, New York, NY 10270 <br /> (A Capital Stock Insurance Company) <br /> <br />PSYCHIATRISTS PROFESSIONAL LIABILITY INSURANCE POLICY <br /> CLAIMS MADE DECLARATIONS <br /> <br />Policy Number: <br />Renewal of.' <br />Member Number: <br />Item 1. First Named Insured and Mailing Address: <br /> Melvin Schwartz, MD <br /> 17862 East 17th Street <br /> East Building, Suite 112 <br /> Tustin, CA 92780 <br /> <br />PSC01 - 0466611 Producer: Professional P~sk Management Services. Inc. <br /> Address: (In California, d/b/a Professional Risk Management Insurance Agency) <br />t 3191 1515 Wilson Blvd., Suite 800 Arlington, Virginia 22209-2402 <br /> <br /> Item 2. Policy Period: <br /> From 12:01 a.m. August I, 2003 <br /> To 12:01 a.m. August l, 2004 <br /> Local time at the address shown in item 1. <br /> <br />Item 3. <br /> <br />Named Insureds: <br />Section II A. <br /> <br />Melvin Schwartz, M.D. <br /> <br />Section H B. <br /> <br />Item 4. <br /> <br />Item 5. <br /> <br />Item 6. <br /> <br />Limits of Liability <br /> <br /> Each Medical Incident <br />Section II A. $1,000,000 <br /> <br />Each Policy Period <br />$3,000,000 <br /> <br />Section liB. <br /> <br />subject to: <br /> <br />ii ) Sexual Misconduct Sublimit of $25,000 Each Medical Incident <br />iii) Professional Office Premises Refer to endorsement #79517 Per Accident <br /> Refer to endorsement #79517 Each Policy Period <br /> <br />Retroactive Date: May 1, 1996 <br /> <br />Endorsements attached at issuance: 79493 (Ed. 6/2002); 79495 (Ed. 4/2002); 79507 (Ed. <br />4/2002); 79510 (Ed. 4/2002); 79511 (Ed. 4/2002); 79517 (Ed. 6/2002); 80263 (Ed. 6/2002); <br />80343 (Ed. 6/2002) <br /> <br />Item 7. Annual Premium $4,207 <br /> CIGA $83.92 <br /> <br />Item 8. <br /> <br />79493(6/02) <br /> <br />Extended Reporting Period Premium Option <br /> 1~}103 ()J~ SV C[?JAO~lddV <br /> <br /> $Induded <br /> <br />AUTHOR/ZED REPRESENT~flVE <br /> Printed: 7/1/03 <br /> <br /> <br />