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<br />N-2002-105 <br /> <br />r <br /> <br />-. <br /> <br />LEGION INSURANCE COMPANY <br />ONE LOGAN SQUARE, SUITE 1400 <br />P!llLADELPlliA, PA 19103 <br /> <br />PROFESSIONAL LIABILITY INSURANCE POLICY <br /> <br />A CLAIMS MADE POLICY <br /> <br />Policy Number : PL5 _ 258027 Producer: Professional Risk Management Services, Inc <br />Renewal of: PL4 _ 258027 Address: (in California, d/b/a Cal-psych Insurance Agency, Inc.) <br />Member Number: 13191 1515 Wilson Boulevard, Suite 800 Arlington, Virginla 22209 <br /> <br />Item 1. First Named Insured and Mailing Address: Item 2. Policy Period: <br />Melvin Schwartz, MD From 12,0 I a.m. August I, 200 I <br />.14'"5 La>l 17tl, Shc(t, EJ<iit! Ii To 12,01 a.m. August \,2002 <br />-21T Local time at the address shown m item 1 <br /> <br />8al,ta ,'\na, CA.92791 new a Mv (55 : <br />11'3'u>:2- c 1(~ s+ tPIIZ-.. <br /> <br />\\.lS11f\, Co. ctd.IW <br /> <br />Item 3. <br /> <br />Named Insureds: <br /> <br />Section II A. <br /> <br />Melvin Schwartz, M,D. <br /> <br />Section II B, <br /> <br />Item 4. <br /> <br />Limits of Liability <br /> <br />( i ) <br /> <br />Each Medical Incident <br />Section II A. $1,000,000 <br /> <br />Each Policy Period <br />$3,000,000 <br /> <br />Section II B. <br /> <br />subject to: <br /> <br />( ii ) Sexual Misconduct Sublimit of $25,000 <br /> <br />Item 5. <br /> <br />Retroactive Date: <br /> <br />May 1, 1996 <br /> <br />Item 6. <br /> <br />Endorsements attached at issuance: 410082 (Ed, 2/2001); 450021 (Ed. 212001); 461326 <br />CM (Ed. 4/1997); 461396 (Ed. 7/1998); 461397 (Ed, 7/1997); 462913 (Ed. 2/2001); 462917 <br />(Ed. 212001); 462920 (Ed. 2/2001); 470023 (Ed, 2/2001) <br /> <br />Item 7. <br /> <br />Annual Premium <br /> <br />$4521 <br /> <br />Item 8. <br /> <br />Extended Reporting Period Premium Option <br /> <br />$Included <br /> <br />APPROVED AS TO FORM <br />/' <br /> <br />410082 2101 <br /> <br /> <br />Printed: 07/1 0/200 1 <br />