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01 ," 1,1," 2 013 15: 49 5 09 6 G _33 1152 <br />ACE American Insurance Company <br />I PRODUCIER INUMBER 1273865 -1 <br />FAC31E C14 04 <br />Psychologists' Professional Liability <br />Claims Made Insurance <br />Policy Declarations <br />F—GATE OF ISSUE 0ecamber 04, 2017 <br />PSYCH(aLOGISTS' PROFESSIONAL LIABtLl7Y <br />CLAIMS MADE INSURANCE POLICY <br />THIS POLICY,."CERTIFICATE IS ISSUED IN ASSOCIATION WITH THE PSYCHOLOGISTS PLrRCHASING <br />GROUP ASSOCIATION <br />ltp,m <br />POLIO'/CERTIFICATE NUMBER-, 58G22169142 <br />Named Insured: <br />Thomas Rowe <br />Address, <br />Po'Box 1946 <br />City, State & Zip Code--,- <br />Wenatchee, WA 98807 -1946 <br />2. <br />Policy Period, rrrom: 12/01/2017 To: 12/01/2018 <br />12:01 A.M. local time at the address shown in Item 1. <br />COVERAGE <br />LIMITS OF LIABILITY <br />PREMIUM <br />Professional Liability <br />$1,000.000 Each Incident <br />$3.,000,000 AggrGgatG <br />Wrongful Employment <br />$5,000 Aggregate <br />$514.00 <br />PmCtices <br />REIMBURSEMENTS <br />Licensing Board Defense <br />$45,00 <br />$50,000 -per Proceeding <br />Other Govemmental Regiiiatory <br />$10,000 per Proceeding <br />eddy Dofansa <br />Deposition Expense <br />$5,000 per Insured <br />Premises Medical Payment <br />$2,500 per Person <br />$757000 Aggregate <br />Assault and/or Battery <br />$j11000 Aggregate <br />Loss of Earnings <br />$500 per Day, per Insured <br />1 $15,000 AgZeate Per Incident <br />.2 <br />Surcharge(s) <br />Total Premium <br />$;5) 59.00 <br />4% <br />Retroactive Date 11241111991 <br />.5. <br />This policy is made and accepted subject to the printed conditions in this policy together with tho provisions, stipulations and <br />agreements contained in the following form(s) or endorsement(s), <br />PF -152-15a? PF33748, P17152 -17a (05/07), CC-IKI-Ilh (03/14), PF15245a, PF15,313b, PF17914 (02/05). <br />Notice of claim should be sent tow. <br />Trust Risk Management Ser -vices, Inc. <br />All other correspondanco should be sent to: <br />Trust Rlsk Management Services, Inc. <br />111 Rockville Pike Ste 700 <br />1791 Paysphore Cirplp, <br />Rockville MD 20850 <br />Chicago., IL 60674 <br />7. <br />REPRESENTATIVE: Agent or broker; <br />Trust Disk Management Services, Inc. <br />Office address: <br />1791 Paysphere Orde <br />City, State., Zip <br />Chicago., IL 60674 <br />Website: <br />www.trustinsuranco.com <br />Phone.- 1 <br />1.377, 637.9700 <br />PF -15215a (04./07) �D 2007 The Trust <br />