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PF-15224a (05/07)© 2007 The Trust Page 1 of 1 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />Named Insured <br />Katrina Kuzyszyn-Jones <br />Endorsement Number <br />Policy Symbol <br />CRL <br />Policy Number <br />78G27815467 <br />Policy Period <br />05/02/2023 to 05/02/2024 <br />Effective Date <br />05/02/2023 <br />Issued By (Name of Insurance Company) <br />ACE American Insurance Company <br />Additional Named Insured(s) <br />It is agreed that: <br />1. The Named Insured shown in Item 1 of the Declarations of this policy is amended to include the following entity(ies) <br />and if a Retroactive Date is listed opposite any entity(ies’) name, the Retroactive Date set forth in the Declarations is <br />deleted with respect to such entity(ies) and replaced with the Retroactive Date listed below: <br />Additional Named Insured(s):Retroactive Date <br />KKJ Forensic and Psychological Services, PLLC 03/23/2012 <br />The Purpose Center 05/02/2023 <br />2. The following is hereby added to the CONDITIONS section of the policy. <br />ď‚·Authorization: By acceptance of this policy the first Named Insured set forth in the Declarations, or in any <br />Named Insured Amended endorsement, agrees to act on behalf of all other Insureds, including any Insured <br />listed on this endorsement, with respect to the giving and receiving of all notices to the Company as may be <br />required by the terms of this policy, any right of cancellation and in the receiving of any return premiums that may <br />become due hereunder. <br />All Insureds agree that the first Named Insured listed in the Declarations or in any Named Insured Amended <br />endorsement, is hereby designated to so act on their behalf. <br />All other terms and conditions of this policy remain unchanged. <br />________________________ <br />Authorized Agent <br />DocuSign Envelope ID: ACEF8EF9-2EFA-4F7D-B215-CAC4F234E1F6