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812 Rate Summary Page | 1 <br />June 12, 2023 Rate Summary <br />Named insured Katrina Kuzyszyn-Jones Switch Over Credit No <br />Application ID/ <br />Policy <br />78G27815467 BOP Credit No <br />Effective Date 05/02/2023 CE Discount No <br />Retroactive Date 05/02/2007 Group PCF No <br />Prescription Privileges No <br /># of Employees for EPLI No <br />Limits of Liability <br />Professional Liability $1,000,000 Each Incident $3,000,000 Aggregate <br />Wrongful Employment Practices $5,000 Aggregate <br />Reimbursements <br />Licensing Board Defense $100,000 per Proceeding <br />Other Governmental Regulatory Body Defense $15,000 per Proceeding <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 day, per Insured $15,000 Aggregate per Incident <br />Owners <br />Name Field of Practice Degree Retroactive Date Hours Worked CE Credit PCF Rate <br />Katrina Kuzyszyn-Jones Psychologist PsyD 05/02/2007 20 0%No $ 493 <br />Employees <br />Name Field of Practice Degree Retroactive Date Hours Worked CE Credit PCF Rate <br />Mackenzie Howard Counselor MA 07/01/2021 30 0%No $ 372 <br />Julianne Ludlam Psychologist PhD 06/01/2022 20 0%No $ 242 <br />Kaytie Mero Counselor MA 06/01/2022 20 0%No $ 159 <br />Lisa Foss Counselor MA 06/01/2022 20 0%No $ 159 <br />Independent Contractors <br />Name Field of Practice Retroactive Date Rate <br />Michelle Chase Counselor 05/02/2023 $ 8 <br />Whitney Wall Psychologist 05/02/2017 $ 37 <br />Vicarious Parties <br />Name Type Degree Rate Date Rate <br />Stephanie Skibba Employee PsyD 09/19/2022 $ 39 <br />Additional Insureds <br />Name Type Rate Date Rate <br />Orange County Government Organization 07/19/2021 $ 72 <br />Additional Insured - Landlords <br />Name Address City State Zip <br />DocuSign Envelope ID: ACEF8EF9-2EFA-4F7D-B215-CAC4F234E1F6