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<br />12105/02 rRll 17: 13 HX 7147310367 <br /> <br />!IELH N SeRif ARTZ , M.D. <br /> <br />rlJ002 <br /> <br />/. <br /> <br />. <br /> <br />LEXINGTON I;\lSURANCE COMPANY <br />'~LM[NGTON,DELAWARE <br />ADMINISTRATIVE OFFICES: 200 STATE STREET, BOSTON, MA 02]09 <br />(A Capital Stock Insurance Company) <br /> <br />PSYCHlATRISTS PROFESSIONAL LIABILITY INSURANCE POLICY <br />CLAIMS MADE DECLARATIONS <br /> <br />~ mY 1115 <br />['l /' VJV <br /> <br />Policy Number: <br /> <br />PSCOO - 046661 J <br /> <br />Producer: William F, Galtney. on oet~ of the <br />P~ychjatrl$ta' Purcha$ing Grou,:), he. <br />clo Profess.iol13l Risk Management Serv'c9s Ifle. <br />Renewal of: Address: 151~ Wilson ell/d., Sllo. 800 <br />Member Number: 13191 Ai:!"GlO", VA 22.09 <br /> <br />Item I. First Named Insured aJ1d Mllilillg Address: Item 2. Policy Period: <br />Melvin Schwartz, MD From 12:01 a.m. !>..gust!, 2002 <br />17862 East 17th Street To 12:01 1lJ71, A 'su'tl, 2003 <br />East Building, Suite 112 Lo",1 tin..! the oddre: ,"'own in l'<m 1. <br /> <br />Tustin, CA 92780 <br /> <br />ltern 3, <br /> <br />Named Insureds: <br /> <br />S.ctlon n A. <br /> <br />Mervin Schwartz, M.D. <br /> <br />Section n B, <br /> <br />Item 4. <br /> <br />Limits of Liabilit)' <br /> <br />( i ) Section n A, <br /> <br />Eaeh Medical Incident <br />$1,OOO,COO <br /> <br />Each Policy P'~ <br />$3,000,000 <br /> <br />Section n B. <br /> <br />subject to; <br /> <br />(li) Sexual Misconduct Sublimit ofS $25,000 <br /> <br />Each Medioal I ocident <br /> <br />(iii) Professional Office Premis~s $ RefeTio endorsement#79517 Per A :cident <br />$ ~efer to endorsement #79517 Each "o!icy Period <br /> <br />Item 5. <br /> <br />Retroactive'Dale: <br /> <br />May l, 1996 <br /> <br />Item 6. <br /> <br />Endorsements a~ched at issuance: 52133 (Ed. 3/1994); 79389 (Ed. 6/2002); 79390 (Ed. <br />4/2002); 79507 (Ed. 412002); 795]0 (Ed. 4/2002); 79511 (Ed. 412002); 795]7 (l'd. 6/2002); <br />80263 (Ed. 6/2002); 80343 (Ed. 612002) <br /> <br />Item 7. <br /> <br />Annual Premium <br />Surplus line Ta:\: <br />Stamping Fee <br /> <br />$5,876 <br />$176..3 ' <br />$14,69 <br /> <br />Item 8. <br /> <br />Extended Reporting Period Premium Option <br /> <br />SInclu( :d <br /> <br />~ <br /> <br />79389(6/02) <br /> <br /> <br />Ed-D) <br />BEN AMIN KAYFMAN <br />hlet A liltanl City AtlllffllJY <br /> <br />,4~- <br />Pri d: 7132/0; <br />