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02/11/2020 14:12 5096631152 PAGE 02/03 <br />CHUBS 4D <br />ACE American Insurance <br />Company <br />PRODUCER NUMBER 273865 <br />Psychologists' Professional Liability <br />Claims Made Insurance <br />Policy Declarations <br />DATE of LISUE I November 26, 2019 <br />PSYCHOLOGISTS' PROFESSIONAL LIABILITY <br />CLAIMS MADE INSURANCE POLICY <br />NOTICE: THIS IS A CLAIMS MADE POLICY, PLEASE READ THE POLICY CAREFULLY <br />THIS POLICY/CERTIFICATE IS ISSUED IN ASSOCIATION WITH THE PSYCHOLOGISTS PURCHASING <br />GROUP ASSOCIATION <br />Item <br />POLICY/CERTIFICATE NUMBER: 58622189142 <br />Famed Insured: <br />Thomas Rowe <br />1. <br />Address: <br />Po Box 1946 <br />City, State & Zip Code: <br />Wenatchee, WA 988071W <br />2. <br />Policy Period: From: 12/01/2019 To: 12/01/2020 <br />12:01 A.M. local time at the address shown in Itern 1. <br />3. <br />COVERAGE <br />LIMITS OF LIABILITY <br />PREMIUM <br />Professional Liability <br />$1,000,000 Each Incident <br />$3,000,000 Aggregate <br />Wrongful Employment <br />$5,000 Aggregate <br />�b14.00 <br />Practices <br />REIMBURSEMENTS <br />Licensing Board Defense <br />$45.00 <br />$50,000 per Proceeding <br />Other Governmental Regulatory <br />$10,000 per Proceeding <br />Body Defense <br />Deposition Expense <br />$5,000 per Insured <br />Premises Medical Payment <br />$2,500 per Person <br />$75,000 Aggregate <br />Assault and/or Battery <br />$1,000 Aggregate <br />Loss of Eami s <br />500 eor Day, per Insured <br />1 $15,000 AagnmWe Per Incident <br />Sumbarge(s) <br />i <br />Total Premlum <br />$559.00 <br />4, <br />Retroactive bate 12101/1991 <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, PF33746 , PF15217a (05107), CC-1K11i (02/18), PF15245a, PF15313b, PF17914 (02145), <br />B. <br />Notice of claim should be sent to: <br />All other correspondence should be sent to: <br />Trust Risk Management Smvices, Inc. <br />Trust Risk Management Services, Inc. <br />111 Rockville Pike Ste 700 <br />1791 Paysphere Oide <br />Rockville MD 20850 <br />Chicago, IL 60074 <br />7. <br />REPRESENTATIVE. Agent or broker: <br />Trust Risk Management Services, Inc, <br />Office address_ <br />1791 Paysphere Circle <br />City, State, Zip <br />Chicago, IL 60674 <br />Website- <br />www.tmtinsurence_com <br />Phone: <br />1.877,637.9700 <br />PF -15215a (04/07) 9 2007 The Trust <br />