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rH[JHIHI" <br />AGE American lnsurance <br />Company <br />PRODUCER NUMBER 273865 <br />Psychologists' Professional Liability <br />Claims Made lnsurance <br />Policy Declarations <br />DATE OF ISSUE November 26,2019 <br />PSYCHOLOGISTS' PROFESSIONAL LIABILITY <br />CLAIMS MAPE INSURANCE POLICY <br />NOTICE: THIS I$ A CLAIMS MADE POLICY, PLEASE READ THE POLICY CAREFULLY <br />THIS POLICY/CERTIFICATE IS ISSUED IN ASSOCIATION WITH THE PSYCHOLOGISTS PURCHASINC <br />GROUP ASSOCIATION <br />Item POLICYICERTIFICATE NUMBER: 58G22169142 <br />1 <br />Named lnsured: <br />Address: <br />City, State & Zip Code: <br />Thomas Rowe <br />Po Box 1946 <br />Wenatchee, WA 98807 1946 <br />2 Policy Period; <br />12:01 A.M. local time at the addre$s $hown in ltem 1. <br />From: 12lUl2A19 To: 1210112020 <br />3 COVERAGE LIMITS OF LIABILIry PREMIUM <br />$514.00 <br />$4s.00 <br />Professional Liability <br />Wrongful Employment <br />Practices <br />Licensing Board Defense <br />Other Governmental Regulatory <br />Body Defense <br />Deposition Expense <br />Premises Medical Payment <br />Assault and/or Battery <br />Loss of Earnincs <br />$1,000,000 Each lncident $3,000,000 Aggregate <br />$5,000 Aggregate <br />REIMBURSEMENTS <br />$50,ooo <br />$10,000 <br />per Proceeding <br />per Proceeding <br />$5,ooo <br />$2,500 <br />per lnsured <br />per Person <br />$500 per Dav, per lnsured <br />$75,000 <br />$1,ooo <br />$15,000 <br />Aggregate <br />Aggregate <br />Aooreoate Per lncident <br />Surcharge(s) <br />Total Premium $55S.00 <br />4.Retroactive Date 1210111991 <br />5.This policy is made and accepted subject to the printed conditions in this policy logether with the provisions, stipulations and <br />agreements contained in the following form{s} or endorsement(s), <br />PF15215a, PF33748 ,PF15217a (05/07), CC-1K'l1i(02/1e), PF15245a, PFl5313b, PF17914 (02/05), <br />0,Notice of claim should be sent to: <br />Trust Risk Management Services, lnc, <br />111 Rockville Pike Ste 700 <br />Rockville MD 20850 <br />All other correspondence should be sent to: <br />Trust Risk Management Services, lnc. <br />1791 Paysphere Circle <br />Chicago, lL 60674 <br />7 REPRESENTATIVE:Agent or broker: <br />Office address: <br />City, State, Zip <br />Website: <br />Phone: <br />Trust Risk Management $ervices, lnc. <br />1791 Paysphere Circle <br />Chicago, lL 60674 <br />www.trustinsurance.com <br />1.877.637.9700 <br />PF-15215a (A4n7)O 20AT The Trust