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= <br /> DocuSign Envelope ID: o240er38-3r84-4*4e'e0e8-C4r5eAC37487 <br /> C ^S1 ^02/22/ 16°MAC5825182'00^511354745 ^ O/B ° ORIG IMAGE COPY <br /> 0410440 GREAT AMERICAN E&S INS CO <br /> Administrative Offices CG 87 13 (Ed. 06/14) <br /> �o/��xo�mm <br /> `�"^E����MEx�C'�� oo"/�m/ox �5oo2 <br /> INSURANCE GROUP mommoowvh Policy No. MAC 502-51 -82 - 00 <br /> PROFESSIONAL LIABILITY COVERAGE PART <br /> DECLARATIONS PAGE <br /> This is a Claims-Made Policy. Please Read the Entire Policy Carefully. <br /> NAMED INSURED: KAH CARE, LLC POLICY PERIOD: <br /> 02/ 16/ 16 to O2/ 1G/ 17 <br /> LIMITS OF INSURANCE: <br /> Aggregate Limit $ 3, 0 0 0 , 0 0 0 Each Act, Error, or Omission $ 1 , 0 0 0 , 0 0 0 <br /> RETROACTIVE DATE <br /> This insurance does not apply to any act, error, or omission which occurs before the Retroactive Date, if' any, <br /> shown here: 02/ 16 / 1 4 (enter date or "none" if does not apply) <br /> DESCRIPTION OF BUSINESS: <br /> Form of Business ( ) Individual ( ) Joint Venture ( ) Partnership <br /> ( X ) Organization (Other Than Partnership or Joint Venture) <br /> TOTAL ADVANCE PREMIUM $ 1 , 58 3 . <br /> Premium shown is payable: $ |NCL at inception; <br /> FORMS AND ENDORSEMENTS Applicable to this Coverage Part and made part of this Policy at time of issue are <br /> listed on the attached Forms and Endorsements Schedule CG 88 01 (11/85). <br />