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C1-1UBB' <br />AC American lnsui artca <br />Company <br />F� DUC-� �JU1�tBc� i 273305 <br />Psychclog i;ts4 Prollessional Liability <br />Claims Mamma lnsura^ce <br />Poli y Declarations <br />j'0 18 <br />I CA •� uf-- it SJ{.JE � ia�o �i'? icor ?J <br />, '2 <br />PSYCHOLOGISTS' PROFESSIONAL LIABILITY <br />CLAIMS NIA ' INSURANCE POLICY <br />NO <br />TICE: T l A CLAIMS MADE POLICY, PLEASE READ THE POLICY CAR�r"-LILLY <br />THIS POLICY/CERTL9CATE IS ISSUED �T ASSSIOCIATIONIT WITH THE PSYCHOLOGISTS PURCHASENG <br />GROb? ASSOCIATION <br />1 141.em <br />_F <br />FOLICW11ERTIrIt.tA'E itlLliV E'R. 58G22 i 9142 <br />t <br />1 <br />Named Insured: Thomas Rowe <br />1. <br />Addrsss: Po Box 1946 <br />Cite, State & Zip Code: Wenatchee., SVA 96807 1946 <br />2. <br />Policy Pefiod: From: 12.101,'2018 To: 12101/2019 <br />2:� .,bl. !CC3! gime at t�=e address shownin !tem 1. <br />3. <br />CCVHRAGEE LIMITS S OF LIABILITY PR2"MIUM <br />f <br />Professioral Liability $1,OCC, 000 Each Incident $3,000,000 Aggregate <br />Wrongful. EjrnPloymant $5,000 Aggregate $-14.00 <br />Pr3ctices <br />- f <br />Licensing Board Defense $50,000 per Procee ting $45.00 <br />Cther Governmental Regulatcry $10,000 per Proceeding <br />Eddy Defense <br />Deposition ExperSe $5,000 per lnsurad <br />Premises /Medical Payment $2,500 per Person $75,OCC Aggregat.e <br />Assault and/or Battery $ ;,000 Aggregate <br />Loss of Earnings 1$500 cer Day, cer insured 1 $15,000 Aggregate Per Incident <br />Surcharge(s) <br />Total Premium � $ :59.00 <br />4. <br />Retroactive date 121011/1991 <br />5. <br />This policy is made and accepted subject to the printed conditions in this policy together with the provisions, stipulations and <br />agreements contained in the following form(s) or endorsement(s). <br />PF15215a, PF33748 , PF15217a (05107), CC -1 K11 i (02/18), PF15245a, PF15313b, PF17914 (02/05), <br />o. <br />notice of clay should be sent to: <br />All other correspondence should be sent to: <br />Trust Risk Management Services, Inc. <br />Trust Risk Management Services, Inc. <br />111 Rockville Pike Ste 700 <br />1791 Paysphere Circle <br />Rockville IMD 29850 <br />Chicago, IL 60674 <br />7. <br />R E P R E SE IN TA T 1 V E., Agent or broker-: <br />Trust Risk Management Services, Inc. <br />Office address: <br />1791 Paysphere Circle <br />i <br />Citty, State, Zip <br />Chicago, IL 60674 <br />Website: <br />w".trustinsurance.com <br />Phone: <br />1.877.537.9700 <br />P=-131/ 3a (1.41;;7) O 2007 The Trust <br />