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01/19/2018 15:49 5095631152 PAGE 04 /0 4 <br />I <br />mACE Amoriean Insurance Company <br />Psychologists' Professional Liability <br />Claims Made Insurance <br />Policy Declarations <br />F'~OPUCE~ NUMSER I 273865 DATE OF ISS ~~ <br />PSYCHOLOGISTS' PROFESSIONAL LIABILITY <br />CLAIMS MADE INSURANCE POLICY <br />I December 04. 2017 <br />THIS POLICY/CERTIFICATE IS ISSUED IN ASSOCIATION \VITH THE PSYCHOLOGISTS PURCHA SING <br />GROuP ASSOCIA TION <br />Item POLICY/CERTIFICATE NUMBER: 58G22169142 <br />Named Insured: Thomas Rowe <br />- <br />1-Address : Po Box 1946 <br />City, State & Zip Code: Wenatchee, WA 988011946 <br />2. Policy Period : ~rom : 12/01/2017 To: 12 /01 /2018 <br />12:01 A.M. local time at the address shown in Ilem 1 . <br />3 . COVERAGE LIMITS OF LIABILITY PREMIUM <br />Professional Liability $1.000.000 Each Incident $3,000.000 Aggregate <br />Wrongful Employment $5,000 Aggregate $514 .00 <br />Practices <br />REIMBURSEMENTS <br />Licensing Board Defense $50,000 per Proceading $45 .00 <br />Other Governmental Regulatory $10,000 per Proceeding <br />Body Dafense <br />Depogiti ~m Expense $5,000 per Insured <br />Premises Medical Payment $2,500 per Person $75,000 Aggregate <br />Assault and/or Battery $1,000 Aggregate <br />Loss of Earnings $500 Qer Day. per Insure d $15.000 AQ£lregate Par Jncident <br />Surcharge(s) <br />Total Premium $559.00 <br />4. Retroactive Date 12/01/1991 <br />5 . This policy is made and accepted SUbject to the printed condltlon$ in this policy together wfth the provisions, stipulations and <br />agreements contained in the following form es) or endorsernent(s). <br />PF '15215a, PF33748 , PF15217a (OS/07). CC-'IKI1h (03/14), PF '15245a, PF15313b, PF17914 (02 /05). <br />6. Notice of claim should be sent to: All other correspondence should be sent to: <br />Trust Risk Management Services, Inc. Trust Risk Management Services, Inc. <br />111 Rockville Pike Ste 700 1791 Paysphare Circle <br />Rockville MD 20850 Chicago, IL 60674 <br />1. REPRESENTATIVE: Agent or broker: Trust Ri5k Management ServiCEI$, Inc. <br />Office address: 1791 Paysphere Circle <br />City, State, Zip Chicago,ll60674 <br />WebSite : www.trustinsuranca.com <br />Phone: 1.877.637.9700 <br />PF-152 15a (04/07) © 2007 The Trust