105538 O4.pdf

STATE OF NEBRASKA SERVICE CONTRACT AWARD

PAGE ORDER DATE

1 of 2 08/15/23

BUSINESS UNIT BUYER

15000070 JULIE SCHILTZ (DCS) CONTRACT NUMBER

VENDOR NUMBER: 3422708 105538 O4

VENDOR ADDRESS:

CYNTHIA J CUSICK

DBA CUSICK PSYCHOTHERAPY INC

725 E 5TH ST

FREMONT NE 68025-5163

AN AWARD HAS BEEN MADE TO THE VENDOR/CONTRACTOR NAMED ABOVE FOR THE SERVICES AS LISTED BELOW FOR THE

PERIOD:

SEPTEMBER 15, 2023 THROUGH MARCH 15, 2026

THIS CONTRACT IS NOT AN EXCLUSIVE CONTRACT TO FURNISH THE SERVICES SHOWN BELOW, AND DOES NOT PRECLUDE

THE PURCHASE OF SIMILAR SERVICES FROM OTHER SOURCES.

THE STATE RESERVES THE RIGHT TO EXTEND THE PERIOD OF THIS CONTRACT BEYOND THE TERMINATION DATE WHEN

MUTUALLY AGREEABLE TO THE VENDOR/CONTRACTOR AND THE STATE OF NEBRASKA.

Original/Bid Document 115883 O3

AGENCY SIGNATURE

R43500|NISK0001|NISK0001 20210628

Contract to supply and deliver Behavioral Health Services for the contract period of September 15, 2023, through March 15, 2026. The contract may be renewed for two (2) additional two (2) year periods when mutually agreeable to the vendor and the State of Nebraska Board of Parole.

Vendor Contact: Cindy Cusick Phone: 402-917-2570 Email: cindy_cusick@msn.com

Email invoices: nbop.invoices@nebraska.gov Accounts Payable Contact (402) 479-5715

**This contract is based on estimated usage. There is no guarantee that any or all estimated quantities will be used.

The contractor should not make any budgeting assumptions based on the estimated value of this contract**

Line Description Estimated Quantity

Unit of Measure

Unit Price

Estimated Extended Price

1 900.0000 EA 130.0000 117,000.00

2 900.0000 EA 130.0000 117,000.00

3 360.0000 EA 300.0000 108,000.00

4 360.0000 EA 130.0000 46,800.00

COGNITIVE BEHAVIORAL THERAPY

ALL LOCATIONS AND TELEHEALTH

INITIAL TERM SEPT 15, 2023 - MARCH 15, 2026

EMDR

ALL LOCATIONS AND TELEHEALTH

INITIAL TERM SEPT 15, 2023 - MARCH 15, 2026

SUBSTANCE ABUSE/RELAPSE

GROUP

ALL LOCATIONS AND TELEHEALTH

INITIAL TERM SEPT 15, 2023 - MARCH 15, 2026

SUBSTANCE ABUSE/RELAPSE IND

ALL LOCATIONS AND TELEHEALTH

BOARD OF PAROLE

Buyer: Julie Schiltz Phone: 402-479-5718 Email: julie.schiltz@nebraska.gov

DocuSign Envelope ID: 9327AC19-0847-43BE-85DF-D36316F048CC

9/12/2023

9/13/2023

STATE OF NEBRASKA SERVICE CONTRACT AWARD

PAGE ORDER DATE

2 of 2 08/15/23

BUSINESS UNIT BUYER

15000070 JULIE SCHILTZ (DCS) CONTRACT NUMBER

VENDOR NUMBER: 3422708 105538 O4

INITIALS

R43500|NISK0001|NISK0001 20210628

Line Description Estimated Quantity

Unit of Measure

Unit Price

Estimated Extended Price

5 720.0000 EA 130.0000 93,600.00

6 720.0000 EA 130.0000 93,600.00

7 288.0000 EA 300.0000 86,400.00

8 288.0000 EA 130.0000 37,440.00

9 720.0000 EA 130.0000 93,600.00

INITIAL TERM SEPT 15, 2023 - MARCH 15, 2026

COGNITIVE BEHAVIORAL THERAPY

ALL LOCATIONS AND TELEHEALTH

RENEWAL 1 MARCH 16, 2026 - MARCH 15, 2028

EMDR

ALL LOCATIONS AND TELEHEALTH

RENEWAL 1 MARCH 16, 2026 - MARCH 15, 2028

SUBSTANCE ABUSE/RELAPSE

GROUP

ALL LOCATIONS AND TELEHEALTH

RENEWAL 1 MARCH 16, 2026 - MARCH 15, 2028

SUBSTANCE ABUSE/RELAPSE IND

ALL LOCATIONS AND TELEHEALTH

RENEWAL 1 MARCH 16, 2026 - MARCH 15, 2028

COGNITIVE BEHAVIORAL THERAPY

ALL LOCATIONS AND TELEHEALTH

RENEWAL 2 MARCH 16, 2028 - MARCH 15, 2030

10 EMDR 720.0000 EA 130.0000 93,600.00

ALL LOCATIONS AND TELEHEALTH

RENEWAL 2 MARCH 16, 2028 - MARCH 15, 2030

11 288.0000 EA 300.0000 86,400.00SUBSTANCE ABUSE/RELAPSE

GROUP

ALL LOCATIONS AND TELEHEALTH

RENEWAL 2 MARCH 16, 2028 - MARCH 15, 2030

12 288.0000 EA 130.0000 37,440.00SUBSTANCE ABUSE/RELAPSE IND

ALL LOCATIONS AND TELEHEALTH

RENEWAL 2 MARCH 16, 2028 - MARCH 15, 2030

Estimated Total Order 1,010,880.00

DocuSign Envelope ID: 9327AC19-0847-43BE-85DF-D36316F048CC

STATE OF NEBRASKA CONTRACT AMENDMENT FORM 08/25/2014

ADDENDUM ONE (1) to CONTRACT AWARD Terms and Conditions

CONTRACT NUMBER 105538 O4

Behavioral Health

Between The State of Nebraska and Cynthia J. Cusick, dba Cusick Psychotherapy

The following clauses, Addendum One of Contract 105538 O4 have been reviewed and agreed upon between Cynthia J. Cusick, dba Cusick Psychotherapy “Contractor” and the State of Nebraska “State”. This Addendum will become part of the contract for Behavioral Health. The clauses of this Addendum shall supersede, prevail, and govern in the case of any inconsistencies with the clause indicated in Section III of the Request for Proposal.

By signing this Addendum, the Contractor guarantees compliance with the provisions stated herein.

Section III. Contractor Duties J. Insurance Requirements

The Contractor shall throughout the term of the contract maintain insurance as specified herein and provide the State a current Certificate of Insurance/Acord Form (COI) verifying the coverage. The Contractor shall not commence work on the contract until the insurance is in place. If Contractor subcontracts any portion of the Contract the Contractor must, throughout the term of the contract, either:

1. Provide equivalent insurance for each subcontractor and provide a COI verifying the coverage for the subcontractor;

2. Require each subcontractor to have equivalent insurance and provide written notice to the State that the Contractor has verified that each subcontractor has the required coverage; or,

3. Provide the State with copies of each subcontractor’s Certificate of Insurance evidencing the required coverage.

The Contractor shall not allow any Subcontractor to commence work until the Subcontractor has equivalent insurance. The failure of the State to require a COI, or the failure of the Contractor to provide a COI or require subcontractor insurance shall not limit, relieve, or decrease the liability of the Contractor hereunder.

In the event that any policy written on a claims-made basis terminates or is canceled during the term of the contract or within one (1) year of termination or expiration of the contract, the contractor shall obtain an extended discovery or reporting period, or a new insurance policy, providing coverage required by this contract for the term of the contract and one (1) year following termination or expiration of the contract.

If by the terms of any insurance a mandatory deductible is required, or if the Contractor elects to increase the mandatory deductible amount, the Contractor shall be responsible for payment of the amount of the deductible in the event of a paid claim.

Notwithstanding any other clause in this Contract, the State may recover up to the liability limits of the insurance policies required herein.

4. COMMERCIAL GENERAL LIABILITY INSURANCE AND COMMERCIAL

AUTOMOBILE LIABILITY INSURANCE

The Contractor shall take out and maintain during the life of this contract such Commercial General Liability Insurance and Commercial Automobile Liability Insurance as shall protect Contractor and any Subcontractor performing work covered by this contract from claims for damages for bodily injury, including death, as well as from claims for property damage, which may arise from operations under this contract, whether such operation be by the Contractor or by any Subcontractor or by anyone directly or indirectly employed by either of them, and the amounts of such insurance shall not be less than limits stated hereinafter.

The Commercial General Liability Insurance shall be written on an occurrence basis, and provide Premises/Operations, Products/Completed Operations, Independent Contractors, Personal Injury, and Contractual Liability coverage. The policy shall include the State, and others as required by the contract documents, as Additional Insured(s). This policy shall be primary, and any insurance or self-insurance carried by the State shall be considered secondary and non-contributory. The COI shall contain the mandatory COI liability waiver language found hereinafter. The Commercial Automobile Liability Insurance shall be written to cover all Owned, Non-owned, and Hired vehicles.

REQUIRED INSURANCE COVERAGE

COMMERCIAL GENERAL LIABILITY

General Aggregate $2,000,000 Personal/Advertising Injury $1,000,000 per occurrence Medical Payments $5,000 any one person

PROFESSIONAL LIABILITY

All Other Professional Liability (Errors & Omissions)

$1,000,000 Per Claim / Aggregate

5. EVIDENCE OF COVERAGE

The Contractor shall furnish the Contract Manager, with a certificate of insurance coverage complying with the above requirements prior to beginning work at:

Agency: Department of Correctional Services Attn: Assistant Materiel Administrator Email: DCS.Purchasing@nebraska.gov

These certificates or the cover sheet shall reference the RFQ number, and the certificates shall include the name of the company, policy numbers, effective dates, dates of expiration, and amounts and types of coverage afforded. If the State is damaged by the failure of the Contractor to maintain such insurance, then the Contractor shall be responsible for all reasonable costs properly attributable thereto.

Reasonable notice of cancellation of any required insurance policy must be submitted to the contract manager as listed above when issued and a new coverage binder shall be submitted immediately to ensure no break in coverage.

6. DEVIATIONS

The insurance requirements are subject to limited negotiation. Negotiation typically includes, but is not necessarily limited to, the correct type of coverage, necessity for Workers’ Compensation, and the type of automobile coverage carried by the Contractor.

mailto:DCS.Purchasing@nebraska.gov

This Addendum and any attachments hereto will become part of the Contract. Except as set forth in this Addendum, the Contract is unaffected and shall continue in full force and effect in accordance with its terms. If there is conflict between this Addendum and the Contract or any earlier addendum, the terms of this Addendum will prevail.

IN WITNESS WHEREOF, the parties have executed this Addendum as of the date of execution by both parties below.

State of Nebraska Contractor: Cynthia J. Cusick, dba Cusick

Psychotherapy

By: __________________________ By:__________________________ (Signature) (Signature)

Name: ________________________ Name:________________________

(Printed) (Printed)

Title: _________________________ Title:_________________________

Date:_________________________ Date:_________________________

9/12/2023

LIMHP, LICSW

Cindy CusickRosalyn Cotton

9/13/2023

Chairperson

Customer ID: 1HGLDPZZEC4 1/30/2023

Cynthia J Cusick

725 East 5th STreet

Fremont, NE 68025

Thank you for purchasing your Professional Liability policy with the NASW Risk Retention Group. Enclosed please find your policy documents (proof of coverage).

We thank you for having considered NASW for your Professional Liability needs ; if you have any questions regarding this matter, please contact us at 888.278.0038.

Dear Cynthia J Cusick, Sincerely, NASW RRG Plan Administrator

888.278.0038 customerservice@naswinsure.com

SOCIAL WORKERS PROFESSIONAL AND SUPPLEMENTAL LIABILITY

INSURANCE POLICY DECLARATIONS - CLAIMS MADE AND REPORTED

Policy Number: P-IND3YZ7SJ2RJK-05

Cynthia J CusickNamed Insured:

Efectve Date:

Expiraton Date:

03/23/2023

03/23/2024

NOTICE: A LOWER LIMIT OF LIABILITY APPLIES TO JUDGEMENTS OR SETTLEMENTS WHEN THERE ARE ALLEGATIONS OF SEXUAL MISCONDUCT. (SEE POLICY FOR

DETAILS) THE POLICY CONSISTS OF THE FOLLOWING COVERAGE PARTS FOR WHICH A PREMIUM IS INDICATED, THIS PREMIUM MAY BE SUBJECT TO ADJUSTMENT.

725 East 5th STreet

Fremont, NE 68025

1HGLDPZZEC4Customer ID:

Retroactve Date: 03/23/2018

Address:

LIMITS OF LIABILITY PREMIUMPROFESSIONAL LIABILITY COVERAGE A

Liability Per Claim Limit $1,000,000.00 $180.20

Liability Aggregate Limit $3,000,000.00

PREMIUMLIMITS OF LIABILITYSUPPLEMENTAL LIABILITY COVERAGE B

Liability Aggregate Limit $3,000,000.00

Liability Per Claim Limit $1,000,000.00

$5,000 per depositon/$35,000 per policy periodDepositon Expense

Subpoena Expense $400.00 per policy period

$45,000.00 per policy periodState License Board Investgaton Defense

$15,000.00 per policy periodEmergency First Aid

$25,000.00 per policy periodHealth Informaton - HIPAA

$15,000.00 per policy periodFirst Party Assault

$5,000 per incident/$50,000 per policy periodMedical Payments

$1,000 per day/$35,000 per policy periodWage Loss and Expense

LIMITS OF LIABILITYADDITIONAL COVERAGES C PREMIUM

TOTAL PREMIUM FOR THIS COVERAGE PART: $180.20

NOTICE: THIS POLICY IS ISSUED BY YOUR RISK RETENTION GROUP. YOUR RISK RETENTION GROUP MAY NOT BE SUBJECT TO ALL OF THE

INSURANCE LAWS AND REGULATIONS OF YOUR STATE. STATE INSURANCE INSOLVENCY GUARANTY FUNDS ARE NOT AVAILABLE FOR YOUR

RISK RETENTION GROUP.

ATTENTION: THE POLICY OF INSURANCE IDENTIFIED ABOVE HAS BEEN ISSUED TO THE NAMED INSURED FOR THE POLICY PERIOD INDICATED. ALL INSUREDS ARE

SUBJECT TO THE LIMITS OF LIABILITY THAT ARE APPLICABLE TO THE POLICY. THE LIMITS OF LIABILITY MAY NOT BE STACKED TO INCREASE THE AMOUNT WE

WILL PAY FOR ANY CLAIM. THE AGGREGATE LIMIT MAY HAVE BEEN REDUCED BY PAID CLAIMS. Regarding Cancellaton: Should the policy be cancelled before the expiraton date thereof, notce will be delivered in accordance with the policy provisions to the Named Insured.

Authorized Representatve:

Tony Benedeto License: CA# 0F76076, AR# 1322

Brokered and Administered by:

The NASW RRG Inc. supports this policy with its full faith, credit and assets.

This policy is reinsured by Swiss Re America.

Policy Form: RRG PLI-1131 (January 9, 2017);

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE

CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE

WILL BE DELIVERED ON ACCORDANCE WITH POLICY PROVISIONS.

THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT

AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT

CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.

CERTIFICATE OF LIABILITY INSURANCE

DATE (MM/DD/YYYY)

01/30/2023

IMPORTANT: If the certifcate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certifcate does not confer rights to the certifcate holder in lieu of such endorsements.

PRODUCER

NASW RRG Plan Administrator

1200 East Glen Avenue

Peoria Heights, IL 61616-5348

CONTACT

NAME:

PHONE

(A/C, No, Ext):

FAX

(A/C, No):

E-MAIL

ADDRESS:

INSURER(S) AFFORDING COVERAGE NAIC #

INSURED

Cynthia J Cusick

725 East 5th STreet

Fremont, NE 68025

INSURER A:

INSURER B:

INSURER C:

INSURER D:

INSURER E:

14366

INSURER F:

CERTIFICATE NUMBER: P-IND3YZ7SJ2RJK-05 REVISION NUMBER: 001

THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.

NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR

MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS

SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.

INSR

LTR

TYPE OF INSURANCE ADDL

INSR

SUBR

WVD

POLICY NUMBER POLICY EFF

(MM/DD/YYYY)

POLICY EXP

(MM/DD/YYYY)

LIMITS

COMMERCIAL GENERAL LIABILITY

COMMERCIAL GENERAL LIABILITY

GEN'L AGGREGATE LIMIT APPLIES PER:

CLAIMS-MADE OCCUR

POLICY PROJECT LOC

EPLI - CLAIMS MADE

EPLI - OCCUR

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES

AUTHORIZED

REPRESENTATIVE

N N

CUSTOMER ID: 1HGLDPZZEC4

EACH OCCURRENCE

DAMAGE TO RENTED

PREMISES (Ea Occurrence)

MED EXP (Any one person)

PERSONAL & ADV INJURY

GENERAL AGGREGATE

PRODUCTS - COMP/OP AGG

NASW Risk Retention Group

AUTOMOBILE LIABILITY

ANY AUTO

OWNED

AUTOS ONLY

HIRED AUTOS

ONLY

SCHEDULED

AUTOS

NON-OWNED

AUTOS ONLY

UMBRELLA

LIAB OCCUR

EXCESS LIAB CLAIMS-MADE

DED RETENTION

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY

ANY PROPRIETOR/ PARTNER/

EXECUTIVE OFFICER/ MEMBER

EXCLUDED?

(Mandatory in NH)

Y/N

PROPERTY DAMAGE

(Per accident)

BODILY INJURY (Per accident)

BODILY INJURY (Per person)

COMBINED SINGLE LIMIT

(Ea accident)

AGGREGATE

EACH OCCURRENCE $

PER STATUTE OTHER

E.L. DISEASE - POLICY LIMIT

E.L. DISEASE - EACH EMPLOYEE

E.L. EACH ACCIDENT $

$If yes, describe under

Description of Operations below

A

Professional Liability Insurance

Retroactive Date: 03-23-2018

03/23/2023 03/23/2024P-IND3YZ7SJ2RJK-05

$1,000,000.00 Per Claim Limit

$3,000,000.00 Aggregate Limit

$45,000.00 State Licensing Board Limits

N/A

(ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

CERTIFICATE HOLDER CANCELLATION

OTHER

ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD

1988-2015 ACORD CORPORATION. All rights reserved.©

RRG PLI Claims Made Policy: “RRG PLI - 1131 (January 9, 2017)” Page 1 of 26

© 2017 NASW Risk Retention Group, Inc. All rights reserved.

NOTICE: This policy is issued by your risk retention group. Your risk retention group may not be subject to all of the insurance laws and regulations of your state. State insurance insolvency guaranty funds are not available for your risk retention group.

NASW Risk Retention Group, Inc. (the Company) District of Columbia

CLAIMS MADE AND REPORTED SOCIAL WORKERS PROFESSIONAL AND SUPPLEMENTAL

LIABILITY POLICY

NOTICE: THIS POLICY PROVIDES SOCIAL WORKERS PROFESSIONAL LIABILITY CLAIMS MADE

AND REPORTED COVERAGE. COVERAGE IS LIMITED GENERALLY TO LIABILITY FOR CLAIMS

ARISING FROM A PROFESSIONAL INCIDENT HAPPENING ON OR SUBSEQUENT TO THE

RETROACTIVE DATE STATED IN THE POLICY AND BEFORE THE END OF THE POLICY PERIOD

WHEN THE CLAIM IS FIRST MADE AGAINST YOU AND REPORTED TO US IN WRITING DURING

THE POLICY PERIOD OR ANY APPLICABLE EXTENDED REPORTING PERIOD. A LOWER LIMIT OF

LIABILITY APPLIES TO SOME OF THE COVERAGES IN THIS POLICY. THIS POLICY IS SUBJECT TO

ARBITRATION IN ACCORDANCE WITH THE PROVISIONS SET FORTH BELOW IN SECTION VII(K).

PLEASE REVIEW THIS POLICY CAREFULLY AND DISCUSS THIS COVERAGE WITH YOUR LEGAL OR

INSURANCE ADVISOR.

Throughout this Policy, the words You, Your, and Insured refer to each person or entity that is an Insured under this Policy. The words We, Us, and Our refer to the Company providing this insurance. Bolded words and phrases used in this Policy have special meaning as defined in this Policy, including in Section III, Definitions.

In consideration of the payment of premium, the undertaking of the Insured to pay any applicable Deductible to the degree one is stated in the Declarations, and in reliance on all of the statements made and information You furnished to Us, including all representations made in the Application, and subject to the Limits of Liability as set forth in the Declarations and described in Section IV of this Policy, and the terms, conditions and other provisions of this Policy, We and You agree as follows:

I. INSURING AGREEMENT

Coverage Part A: Professional Liability Coverage

We will pay on Your behalf those amounts that You become legally obligated to pay as Damages for a Claim alleging a Professional Incident in Your provision of Professional Services to others, provided:

A. The Professional Incident takes place on or after the Retroactive Date and before the end of the Policy Period, and

RRG PLI Claims Made Policy: “RRG PLI - 1131 (January 9, 2017)” Page 2 of 26

B. The Claim is first made against You and reported to Us in writing during the Policy Period or any applicable Extended Reporting Period pursuant to the reporting procedures set forth in Section VII.A.

Coverage Part B: Supplemental Liability for Business Invitees

The coverage under Coverage Part B does not apply to any Claim or Damages that is covered under Coverage Part A or Coverage Part C.

A. Bodily Injury and Property Damage Coverage for Business Invitees

We will pay on Your behalf those amounts that You become legally obligated to pay as Damages, for a Claim alleging Bodily Injury or Property Damage to a Business Invitee that takes place while You are providing Professional Services, provided:

1. The Professional Services take place on or after the Retroactive Date and before the end of the Policy Period,

2. The Bodily Injury or Property Damage takes place in the Workplace where Professional Services are being rendered to the Business Invitee or another person that the Business Invitee is accompanying,

3. The Bodily Injury or Property Damage occurs before the end of the Policy Period, and

4. The Claim is first made against You and reported to Us in writing during the Policy Period or any applicable Extended Reporting Period pursuant to the reporting procedures set forth in Section VII.A.

B. Personal Injury Coverage for Business Invitees

We will pay on Your behalf those amounts that You become legally obligated to pay as Damages for a Claim alleging Personal Injury to a Business Invitee that takes place while You are providing Professional Services, provided:

1. The Professional Services take place on or after the Retroactive Date and before the end of the Policy Period,

2. The Personal Injury takes place in the Workplace where Professional Services are being rendered to the Business Invitee or another person that the Business Invitee is accompanying,

3. The Personal Injury occurs before the end of the Policy Period, and

RRG PLI Claims Made Policy: “RRG PLI - 1131 (January 9, 2017)” Page 3 of 26

4. The Claim is first made against You and reported to Us in writing during the Policy Period or any applicable Extended Reporting Period pursuant to the procedures identified in Section VII.A.

Coverage Part C: Additional Coverages

The additional coverages set forth in Coverage Part C are each subject to a separate Limit of Liability set forth in the Declarations for that Coverage Part C Subpart. Each such separate Limit of Liability for an additional coverage set forth in Coverage Part C is in addition to, and does not reduce, the Limits of Liability applicable to Coverage Parts A and B. If there is no Limit of Liability set forth in the Declarations for an additional coverage under Coverage Part C, then there is no coverage under this Policy for that additional coverage. The coverage under Coverage Part C does not apply to any Claim or Damages that is covered under Coverage Part A or Coverage Part B.

A. Emergency First Aid

We will pay for those expenses that You have voluntarily incurred for first aid rendered as a result of Bodily Injury to a Business Invitee in the Workplace used principally in the Named Insured’s practice as a social worker, provided:

1. The incident that causes the Bodily Injury takes place on or after the Retroactive Date and before the end of the Policy Period;

2. The first aid was provided within a 48-hour period from the time the Bodily Injury first happened;

3. Documentation of the expenses is timely provided to Us; and

4. The incident was timely reported to Us in writing during the Policy Period or any applicable Extended Reporting Period pursuant to the procedures identified in Section VII.A.

B. Health Information- HIPAA

1. We will pay for reasonable attorney’s fees, costs, expenses or fees that You incur in responding to a Claim first made by a regulator against You for any Privacy Wrongful Act, provided:

(a) the Privacy Wrongful Act arises solely out of Your performance of Professional Services;

(b) the Privacy Wrongful Act took place on or after the Retroactive Date and before the end of the Policy Period; and

RRG PLI Claims Made Policy: “RRG PLI - 1131 (January 9, 2017)” Page 4 of 26

(c) the Claim for a Privacy Wrongful Act was first made against You and reported to Us in writing during the Policy Period or any applicable Extended Reporting Period pursuant to the procedures identified in Section VII.A.

2. We will pay those reasonable amounts that You incur in notifying Your clients of a Privacy Wrongful Act as mandated by any U.S. federal or state privacy protection statutes or regulations, provided:

(a) The Privacy Wrongful Act arises solely out of Your performance of Professional Services;

(b) the Privacy Wrongful Act took place on or after the Retroactive Date and before the end of the Policy Period; and

(c) The Privacy Wrongful Act was reported to Us in writing during the Policy Period or any applicable Extended Reporting Period pursuant to the procedures identified in Section VII.A.

Coverage under this Coverage Part C, Subpart B.2 applies regardless of whether or not a Claim for a Privacy Wrongful Act is made against You.

We will not, however, pay for any penalties, fines or other fees assessed against You by any regulatory or other authority arising from, caused by, or related to a Privacy Wrongful Act.

C. State Licensing Board Investigation Defense

Subject to our right to select counsel, We will pay Your Claim Expenses to respond to an investigation or proceeding by a state licensing board, or other regulatory body that licenses or regulates Your work as a social worker, concerning Your provision of Professional Services, provided:

1. The Professional Services take place on or after the Retroactive Date and before the end of the Policy Period, and

2. Notice of the investigation or proceeding is first received by You and reported to Us in writing during the Policy Period or any Applicable Extended Reporting Period, pursuant to the reporting procedures set forth in Section VII.A.

We will not, however, pay for any penalties, fines or other fees assessed against You by any licensing board or regulatory body. Under no circumstances does this coverage extend to any criminal proceeding or Medicaid or Medicare investigation.

D. First Party Assault

RRG PLI Claims Made Policy: “RRG PLI - 1131 (January 9, 2017)” Page 5 of 26

We will pay for any:

1. Medical expenses incurred as a result of Bodily Injury to You; and

2. The repair or replacement of damaged or stolen personal property owned by You;

as a result of an Assault by, or at the direction of, a person other than You, that occurs during the Policy Period, and which happens at Your Workplace or elsewhere while You are conducting Professional Services, provided that the Assault was reported to Us in writing during the Policy Period or any applicable Extended Reporting Period pursuant to the procedures set forth in Section

VII.A.

This coverage does not apply to Bodily Injury or to damage or theft of personal property arising from any type of transportation used by You to go to or from Your Workplace, or to damage, theft of any business or personal property owned, leased or rented by any other person or entity while in Your possession.

E. Medical Payments

We will pay for any amounts that You are legally obligated to pay as medical payments arising from Bodily Injury suffered by a Business Invitee, where such Bodily Injury occurred in Your provision of Professional Services to others in Your Workplace, provided that:

1. The incident that causes the Bodily Injury takes place on or after the Retroactive Date and before the end of the Policy Period;

2. Documentation of the medical payments is timely provided to Us; and

3. The incident was timely reported to Us in writing during the Policy Period or any applicable Extended Reporting Period pursuant to the procedures identified in Section VII.A.

F. Wage Loss and Expense

We will pay for Your lost wages per day, plus reasonable costs and expenses, caused by Your attendance at Our request at any trial(s), hearing(s), mediation(s), or arbitration proceeding(s) involving any Claim against You for Damages covered under this Policy, regardless of the number of Insureds, mediations, trials, hearing or arbitration proceedings, provided that documentation of these expenses is timely provided to Us.

RRG PLI Claims Made Policy: “RRG PLI - 1131 (January 9, 2017)” Page 6 of 26

G. Deposition Expense

We will pay for Your reasonable legal expenses incurred by You for Your subpoenaed and legally required appearance at a deposition to provide testimony involving Your provision of Professional Services during the Policy Period, provided that:

1. A Claim has not been asserted against You;

2. The treatment about which You will testify could, in Our judgment, reasonably lead to a Claim being asserted against You which would otherwise be covered under this Policy; and

3. The deposition expense coverage is subject to Our right to select counsel.

H. Subpoena Expense Reimbursement

We will reimburse You for reasonable legal expenses incurred and paid by You for legal assistance in complying with any subpoena, including but not limited to You providing medical record information, and for any other subpoena request, provided that:

1. You receive the subpoena during the Policy Period and report Your receipt of the subpoena and intent to seek reimbursement to Us in writing during the Policy Period pursuant to the reporting procedures set forth in Section VII.A;

2. You provide satisfactory documentation of the legal fees incurred in responding to the subpoena and Your payment of same, along with a valid, executed W9; and

3. The total reimbursement for all subpoena expenses under this Policy shall not exceed $400.00, regardless of the amount expended by You or the number of subpoenas received during the Policy Period.

DEFENSE, CLAIM EXPENSES, SETTLEMENT

A. The following applies only to Coverage Parts A and B:

We will have the right and duty to defend You, including the right to select counsel, against any Claim brought against You to which this Policy applies regardless of whether the Claim is groundless, false or fraudulent. We will have no duty to defend You against any Claim for which there is no coverage under this Policy. We have the right to conduct any investigation or negotiation and, with the written consent of the first Named Insured, which consent will not be unreasonably withheld, make any settlement of a Claim. If We recommend a settlement to You that is acceptable to the claimant and You refuse to consent to the settlement and elect to contest the Claim or continue any legal proceedings in connection with such Claim then, subject to the Limits of Liability section of this Policy, Our Limit of Liability for that Claim will not exceed the amount for which that Claim could have been settled, plus the Claim Expenses incurred by Us to defend that Claim.

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B. We will have the right, but not the duty, at Our sole discretion to investigate any Damages, Claim or Potential Claim.

C. We will have the right, but not the duty, to appeal any judgment or award against You.

D. You may not incur any Claim Expenses, admit liability, make any payment, or settle any Claim without Our prior written consent, which will not be unreasonably withheld. We will not be liable for any expense, settlement, assumed obligation or admission to which We did not consent.

E. Subject to the applicable Limit of Liability, We will pay all Claim Expenses that We incur in the investigation and defense of any Claim under Coverage Parts A or B or that We incur under Coverage Part C. Claim Expenses are within the Limit of Liability.

F. You agree to cooperate with Us in defending, investigating and settling any Claim and agree, as a condition of coverage under this Policy, to submit to Us upon request any information and documentation that We may require in the investigation and defense of any Claim.

G. If We exercise Our right to appeal, We will pay the premiums for any appeal bonds for the covered part of the judgment, but We have no obligation to apply for, furnish or have any court approve of such bonds or provide any collateral for such bonds.

H. Our duty to defend You ends upon exhaustion of the applicable Limit of Liability in the payment of Damages and Claim Expenses, which can include tendering the Limit of Liability into court.

II. POLICY TERRITORY

This Policy applies to Professional Incidents, Bodily Injury, Property Damage, Privacy Wrongful Acts, Personal Injury, or Assaults that take place anywhere in the world, but only if the Claim is made and the Suit is brought or the licensing board or regulatory investigation or proceeding is conducted in the United States of America, its territories or possessions, or Puerto Rico.

III. DEFINITIONS

A. Assault means any willful attempt or threat to inflict Bodily Injury upon the person of another, when coupled with an apparent present ability to do so, and any intentional display of force that would give the victim reason to fear or expect immediate bodily harm.

B. Bodily Injury means physical injury, sickness, disease, mental illness or emotional distress sustained by any person, including death resulting therefrom.

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C. Business Invitee means any natural person to whom You are rendering Professional Services, or who is accompanying a natural person to whom You are rendering Professional Services, solely in their capacity as one who is invited by the Insured to enter into and remain in the Workplace for a purpose directly connected with the rendering of Professional Services. A Business Invitee will not include any person who enters the Workplace without an Insured’s knowledge or permission, or any person who is an Insured.

D. Claim(s) means

1. a written demand for money or services, naming You and alleging Damages caused by a Professional Incident, but solely as respects Coverage Part A;

2. a written demand for money or services naming You and alleging Damages for Bodily Injury or Property Damage to a Business Invitee, but solely as respects Coverage Part B; or

3. a regulatory proceeding or formal investigation concerning a Privacy Wrongful Act arising solely out of Your performance of Professional Services, but solely as respects Coverage Part C., Subpart B.1.

4. an administrative proceeding or formal investigation concerning Your provision of Professional Services commenced by a regulator, but solely as respects Coverage Part C, Subpart C.

A Claim will be considered first made when notice of such Claim is first received by any Insured, if it is reported to the Company in writing in accordance with the terms and conditions of this Policy.

All Claims arising out of the same Professional Incident will be considered as having been made at the time the first report of such a Claim, whenever made.

Claim also means a Potential Claim involving a Professional Incident, which You report to Us as soon as practicable during the Policy Period. The report of such a Potential Claim must include:

1. The date, time and place of the Potential Claim and the identity of any Insured involved;

2. A description of the Professional Services that You performed;

3. The type of Claim You anticipate; and

4. The name and address of the injured party and any witnesses.

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If You submit written notice to Us containing the information listed in 1-4 above, then any Claim that may subsequently be made against You arising out of the same Professional Incident will be deemed, for the purposes of insurance under the Policy, to have been made during the Policy Period in effect at the time such written notice was submitted to Us.

E. Claim Expense(s) means the reasonable and necessary fees charged by an attorney(s) or independent adjustor(s) designated by Us and all other fees, costs, expenses resulting from the investigation, adjustment, defense and appeal of a Claim, including costs taxed against an Insured and all interest on the entire amount of any judgment rendered against an Insured, if incurred by Us, or by You with Our prior written consent. The reasonableness of the fees paid to counsel will be determined by the rates We actually pay to attorneys retained by Us in the jurisdiction where the Suit, administrative proceeding or investigation is pending for similar Claims.

Claim Expense(s) does not include:

1. expenses of or relating to the institution or prosecution of a counterclaim or cross-claim by an Insured, including a counterclaim or cross-claim in a Suit that is covered by the Policy, unless the Company has provided prior written consent to the institution and prosecution of such counterclaim or cross-claim;

or

2. salary charges or expenses of Your regular employees or officials.

F. Damages means monetary compensatory judgments, awards, or settlements.

Damages does not include:

1. Costs of complying with requests, demands or orders for injunctive relief;

2. Fines and penalties, including but not limited to contractual, regulatory and statutory civil or criminal fines, penalties and sanctions;

3. Exemplary, multiple or statutory damages;

4. Punitive damages;

5. Restitution, return or forgiveness of fees, expenses or costs paid to or charged by an Insured; disgorgement or loss of profits by an Insured; or other costs of doing business;

6. Consequential damages; or

7. Matters or Damages deemed uninsurable under the law pursuant to which this Policy is construed.

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If a Suit, however, is brought against the Insured to which this insurance applies seeking both compensatory and punitive or exemplary damages, then We will afford a defense to such action, subject to all other terms and conditions of the Policy, without any liability for payment of such punitive or exemplary damages.

G. Insured, You and Your mean:

1. The Named Insured;

2. An employee of the Named Insured while acting in the scope of its employment by the Named Insured, but solely for its conduct in providing Professional Services on behalf of the Named Insured;

3. An officer or director of the Named Insured but solely for its conduct in providing Professional Services on behalf of the Named Insured.

In order to qualify as an Insured under this Policy, an individual must either:

1. hold an MSW, DSW, MA or MS degree in the field of social work from an accredited educational institution, and have earned the degree more than two

(2) years before the inception date of the Policy;

2. In the case of a social worker with less than two (2) years of social work services experience, an individual who graduated from college within the two (2) years prior to the inception date of the Policy and does not yet have its license to practice independently;

3. Hold a BSW, BA or BS degree in social work if the individual is providing social work services within the scope allowed by state regulatory boards; or

4. Be a social worker or psychologist who also holds a masters degree or doctorate degree in social work or psychology.

H. Limit of Liability means the amounts set forth in the Declarations of this Policy for the applicable Coverage Part and Subpart, and as described in Section V, Limits of Liability.

I. Named Insured means any organization or individual indicated in the Declarations.”

J. Personal Injury means injury, other than Bodily Injury, arising out of one or more of the following offenses:

1. False arrest, detention or imprisonment;

2. Malicious prosecution;

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3. The wrongful eviction from, wrongful entry into, or invasion of the right of private occupancy of a room, dwelling, or premises that a person occupies committed by or on behalf of its owner, landlord or lessor;

4. Oral or written publication of material that slanders or libels a person or organization or disparages a person’s or organization’s goods, products or services; or

5. Oral or written publication of material that violates a person’s right of privacy.

K. Policy means this insurance contract issued by Us to the Named Insured¸ including the Declarations page(s) and all endorsements to it.

L. Policy Period means the period from the inception date of this Policy set forth in the Declarations to the expiration date of this Policy as set forth in the Declarations or the cancellation or termination date, whichever occurs first.

M. Pollutants means any solid, liquid, gaseous, biological, radiological or thermal irritant or contaminant, including smoke, vapor, soot, fumes, acids, mold, silica, spores, asbestos, dust, fibers, fungi, alkalis, chemicals, nuclear materials and waste, including but not limited to medical waste and materials to be recycled, reconditions or reclaimed.

N. Potential Claim means a Professional Incident that has not yet resulted in a Claim but that an Insured has reason to believe may give rise to a Claim covered by this Policy, or that an Insured should reasonably foresee might be the basis of a Claim covered by this Policy.

O. Privacy Wrongful Act means an act, error or omission by the Insured that results in a breach or violation of the Health Insurance Portability and Accountability Act of 1996 or any regulation promulgated thereunder (collectively, “HIPAA”) in connection with the collection, use or security of “protected health information” of patients or clients, as that term is defined in HIPAA. Such information must be under the Insured’s care, custody or control and must be related to rendering of Professional Services to the patients or clients whose personally identifiable information and/or personal health insurance is at issue.

All such acts, errors or omissions, as referenced in this definition, that are actually or allegedly caused, committed or attempted by or claimed against one or more Insureds arising out of the same or relating to the same or series of related facts, circumstances, situations, transactions or events will be deemed to be the same Privacy Wrongful Act.

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P. Professional Incident means any act, error or omission in the providing of, or the failure to provide, Professional Services by You. This includes Your responsibility for anyone acting under Your direction and control. All Related Professional Incidents arising out of the provision of Professional Services to any one person will be considered one Professional Incident, irrespective of the number of Claims made or the number of Claimants or number of Insureds. The Limit of Liability for all Claims alleging Related Professional Incidents will be the Each Claim Limit as set forth in the Declarations, regardless of the number of Claims, claimants, Suits, Insureds, or Coverage Parts involved.

Q. Professional Services means solely those social work services rendered to others by a social worker who qualifies as an Insured under this Policy.

R. Property Damage means

1. physical injury to or destruction of tangible property including the loss of use thereof of property that is physically injured. All such loss of use will be deemed to occur at the time of the physical injury that caused it; and

2. loss of use of tangible property that is not physically injured. All such loss of use will be deemed to occur at the time of the incident that caused it.

For the purposes of this insurance, electronic data is not tangible property.

S. Related Professional Incidents means any actual or alleged separate, continuous, repeated or series of Professional Incidents directly arising out of or related to the same or similar service, transaction, event, representation, statement, practice, advice, decision or circumstance, or to a series of services, transactions, events, representations, statements, practices, advice, decisions or circumstances concerning the same patient or client. The determination of whether or not a Professional Incident constitutes a Related Professional Incident will not be affected by the identity or number of claimants, the identity or number of Insureds involved, or the existence of a separate duty or professional relationship.

T. Retroactive date means the date specified in the Declarations.

U. Sexual Misconduct means

1. any type of physical touching or caressing, or attempt thereof, or suggestion thereof, which could be considered sexual or erotic in nature, including consensual sexual activity or sexual activity in contravention of a professional code of ethics or conduct; or

2. any act of sexual assault, harassment or molestation.

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V. Suit means a civil proceeding seeking monetary damages, and includes an arbitration, mediation, or any other alternative dispute resolution procedure seeking such damages to which You submit with Our consent. Suit does not include an administrative hearing.

W. Workplace means the office where You provide Your Professional Services.

IV. LIMITS OF LIABILITY

A. Coverage Part A - Professional Liability Coverage Limits of Liability

Each Claim Limit

The Limit of Liability stated in the Declarations as the Each Claim Liability Limit for Coverage A is the most We will pay under Coverage Part A for all Damages and Claim Expenses arising out of, or in connection with, the same Professional Incident or Related Professional Incidents, regardless of the number of Claims, claimants, Suits, or Insureds involved.

B. Coverage Part B – Supplemental Liability for Business Invitees Limits of Liability

Each Claim Limit

The Limit of Liability stated in the Declarations as the Each Claim Liability Limit for Coverage B is the most We will pay under Coverage Part B for all Damages and Claim Expenses arising out of, or in connection with, the same incident or any related incidents, regardless of the number of Claims, claimants, Suits or Insureds involved, or Business Invitees that incur Bodily Injury, Property Damage or Personal Injury.

C. Coverage Part C - Additional Coverages Limits of Liability

The Limit of Liability stated in the Declarations for each Subpart of Coverage Part C is the most that We will pay under that Subpart, regardless of the number of Professional Incidents, Insureds, claimants, Business Invitees, Claims, incidents, Privacy Wrongful Acts, licensing investigations, proceedings, or Assaults.

If the Declarations identifies a “per incident” limit for a Subpart of Coverage Part C, that is the most that We will pay for any one incident or related incidents for which there is coverage under that Subpart of Coverage Part C of this Policy.

If the Declarations identifies a “per day” limit for a Subpart of Coverage Part C, that is the most that We will pay for any one day of expenses for which there is coverage under this Policy.

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If the Declarations identifies a “per policy period” limit for a Subpart of Coverage Part C, that is the most that We will pay for all Insureds for any number of matters during each Policy Period for that particular Subpart.

D. Aggregate Limit of Liability

The Limit of Liability stated in the Declarations as the Aggregate Limit is the most We will pay for all Damages and Claim Expenses under Coverage Parts A and B, regardless of the number of Claims, Professional Incidents, Insureds, Suits, claimants, incidents or Business Invitees that incur Bodily Injury, Property Damage or Personal Injury.

E. Sexual Misconduct Aggregate Limit

The most We will pay under this Policy for all Damages for Claims involving Sexual Misconduct is $25,000, as set forth in Section VI.J, regardless of the number of Claims, Professional Incidents, Insureds, Suits, claimants, or incidents.

Any Claim Expenses paid for a Claim involving Sexual Misconduct are in addition to this $25,000 aggregate limit for Damages for Claims involving Sexual Misconduct.

This $25,000 aggregate limit for Damages for a Claim involving Sexual Misconduct afforded by the Policy shall be part of, and not in addition to, the Limit of Liability shown in the Declarations as the Aggregate Limit.

We shall not be obligated to pay any Claim Expenses or any other amounts and will no longer have any duty to defend any Insured for any Claim involving Sexual Misconduct after this $25,000 aggregate limit has been exhausted by payment or tender of Damages included within this aggregate limit for a Claim involving Sexual Misconduct.

F. All Claims arising from Related Professional Incidents will be treated as one Claim.

Such Professional Incidents will be considered to have taken place when the earliest such Professional Incident commences. The applicable Limit of Liability will be the one from the Policy Period during which the first Claim was first made.

G. If any combination of Coverage Parts A, B and C, as shown in the Declarations applies to the same Claim or matter, Our liability is limited as follows:

1. In no event will the limits of liability of Coverage Parts A, B and C be added together, combined or stacked to determine the applicable Limit of Liability.

2. The total limits of liability under Coverage Parts A, B and C will not exceed the highest applicable limit of Coverage Part A, B or C, and

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3. We, in Our sole discretion, will determine which Coverage Part and Subpart applies.

V. COVERAGE EXTENSIONS

A. Estates and Legal Representatives

This Policy will afford coverage for a Claim to which this Policy applies if made against Your estate, heirs or legal representatives if You are deceased, or against Your legal representatives if You are incompetent or bankrupt, to the extent that in the absence of such death, incompetence, or bankruptcy, such Claim would have been covered by this Policy.

B. Spousal and Domestic Partner Liability

VI. EXCLUSIONS

We will not be liable to make any payment in connection with any matter, Claim or Damages based upon, arising out of or related to any actual or alleged:

A. Criminal, malicious, fraudulent, knowingly wrongful, or dishonest act(s) or omission(s), or willful violation(s) of any statute or regulation committed by You or with the knowledge, consent or approval of You. However, this exclusion will not apply unless there is a judgment, final ruling or admission adverse to You in any judicial, administrative or alternative dispute resolution proceeding establishing that such acts or omissions were malicious, fraudulent, knowingly wrongful or dishonest, or willful, or that You approved, consented to or had knowledge of such conduct. We will not be required to appeal any such adjudication, judgment or ruling. The conduct or knowledge of one Insured will not be imputed to another Insured.

B. Criminal proceedings, regardless of the allegations made against You;

C. Unjust enrichment, or obtaining any profit,…