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/ <br />Psychologists' Professional Liabil ity <br />Clalms Made Insurance <br />Policy Declarations <br />ACE American Insurance <br />Company <br />I PRODUCER NUMBER 1 273865 DATE OF ISSUE I November 26, 2018 <br />PSYCHOLOGISTS' PROFESSIONAL LIABILITY <br />CLAIMS MADE INSURANCE POL1CY <br />NOTICE: THIS IS A CLAIMS MADE POLICY, PLEASE READ THE POLICY CAREFULLY <br />THIS POLICY/CERTIFICATE rs ISSUED IN ASSOCIATION WJTI-1 THE PSYCHOLOGISTS PURCHASING <br />GROUP ASSOCIATION <br />Item POLICY/CERTIFICATE NUMBER: 58G 22169142 <br />Named Insured: Thomas Rowe <br />1. Address: Po Box 1946 <br />City , State & Zip Code: Wenatchee , WA 98807 1946 <br />2. Policy Period: From: 12/01/2018 To : 12/01/2019 <br />12 :0 1 A.M . local time at the address shown in Item 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 $51 4 .0 0 <br />Practices <br />REIMBURSEMENTS <br />Licens ing Board Defense $50 ,000 per Proceeding $45 .0 0 <br />Other Governmental Regulatory $10 ,000 per Proceeding <br />Body Defense <br />Deposition 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 per Dav, per Insured $15,000 Aaareqate Per Incident <br />Surcharge(s) <br />Total Premium $559.00 <br />4. Retroactive Date 12/0 1/1991 <br />5. This policy is made and accepted subject to the printed conditions in this policy together with the provisions, stipulations and <br />agreements conta ined in the following form(s) or endorsement(s). <br />PF15215a , PF33748 , PF15217a (05/07), CC-1 K11 i (02/18), PF15245a, PF15313b, PF17914 (02/05 ), <br />6. Notice of claim should be sent to: All other correspo ndence should be se nt to: <br />Trust Risk Management Services, Inc. Tru st Ri sk Management Services, Inc. <br />111 Rockville Pike Ste 700 1791 Paysphere Circle <br />Rockville MD 20850 Chicago, IL 60674 <br />7. REPRESENTATIVE : Agent or broker: Trust Risk Ma nagement Servi ces, Inc. <br />Office address: 1791 Paysphere Circle <br />City , State, Z ip Chicago, IL 60674 <br />Website : www.trustinsurance.com <br />Phone: 1.877.637.970 0 <br />PF-15215a (04/07) © 2007 The Trust