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PF-15215a (04/07)© 2007 The Trust <br />Psychologists’ Professional Liability <br />Claims Made Insurance <br />Policy Declarations <br />ACE American Insurance <br />Company <br />PRODUCER NUMBER 273865 DATE OF ISSUE June 12, 2023 <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 POLICY/CERTIFICATE NUMBER: 78G27815467 <br />1. <br />Named Insured:Katrina Kuzyszyn-Jones <br />Address:5317 Highgate Dr Ste 213 <br />City, State & Zip Code:Durham, NC 27713 6622 <br />2.Policy Period: <br />12:01 A.M. local time at the address shown in Item 1. <br />From:05/02/2023 To:05/02/2024 <br />3.COVERAGE LIMITS OF LIABILITY PREMIUM <br />Professional Liability <br />Wrongful Employment <br />Practices <br />$1,000,000 Each Incident $3,000,000 <br />$5,000 <br />Aggregate <br />Aggregate $1,581.00 <br />REIMBURSEMENTS <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 Earnings <br />$100,000 <br />$15,000 <br />$5,000 <br />$2,500 <br />$500 <br />per Proceeding <br />per Proceeding <br />per Insured <br />per Person <br />per Day, per Insured <br />$75,000 <br />$1,000 <br />$15,000 <br />Aggregate <br />Aggregate <br />Aggregate Per Incident <br />$75.00 <br />Surcharge(s) <br />Total Premium $1,656.00 <br />4.Retroactive Date 05/02/2007 <br />5.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, PF33748 , PF15217a (05/07), CC-1K11k (04/22), PF15245a, PF15234a, PF15224a, PF15235a, PF22543, PF15282b, <br />PF17914 (02/05), <br />6.Notice of claim should be sent to: <br />Trust Risk Management Services, Inc. <br />111 Rockville Pike Ste 700 <br />Rockville MD 20850 <br />All other correspondence should be sent to: <br />Trust Risk Management Services, Inc. <br />1791 Paysphere Circle <br />Chicago, IL 60674 <br />DocuSign Envelope ID: ACEF8EF9-2EFA-4F7D-B215-CAC4F234E1F6