COI_58G28676876_Expires_2_17_26__1_.pdf

815Ren (2011)

February 04, 2025

Dr. Aleksandr Levitan 2198 E Camelback Rd Ste 210 Phoenix, AZ 85016 4746

RE: Your Trust Sponsored Professional Liability Insurance Policy # 58G28676876

Dear Dr. Aleksandr Levitan

Thank you for your continued participation in the Trust Sponsored Professional Liability Program.

Enclosed is your Trust Sponsored Professional Liability Insurance Renewal. In an effort to conserve resources and "go green" with your renewal, we have not included a copy of your insurance policy form as part of this renewal packet. The insurance policy form was provided to you previously, and the enclosed endorsements included in this renewal packet will reflect changes to your coverage, if any. If you would like a copy of the policy form, you are able to request it by accessing your account at the Online Service Center at www.trustinsurance.com or by contacting our Customer Service Center. We urge you to read this renewal packet and notify us if you believe any changes are necessary.

At the first notice of claim, lawsuit or incident, please contact our Customer Service Center immediately at

1.877.637.9700. We will assist you in providing the necessary information to get your claims process started. Our claims staff is dedicated to listening, understanding, and taking action to route your claim to the appropriate experts working on your behalf.

If you have not already done so, be sure to access your Online Service Center account at www.trustinsurance.com. Your account is available 24 hours a day, 7 days a week, with anytime access to your professional liability insurance form. You can request additional Memorandums of Insurance, view all of your account transactions, submit requests for changes, update your personal information and (if eligible) renew your policy. For your convenience we have provided your user name at the bottom of this letter. If you wish to change your customer information, simply log into the Online Service Center and click on Customer Service.

Should you have any questions regarding this correspondence, or for additional information regarding further membership benefits and other membership insurance options, please be sure to contact us at 1.877.637.9700. Our professional staff is available to assist you Monday-Friday 8:30am-6:00pm (est) or visit our website at www.trustinsurance.com. You may also email us your questions at info@trustrms.com.

Sincerely, John W. Davison, Ph.D., MBA, CEO Trust Risk Management Services, Inc.

Licensed Producer - Sheila LeBeau, CA #OF77147, FL #PO99941. Principal Place of Business - Maryland. Insurance provided by ACE American Insurance Company, Philadelphia, PA and its U.S.-based Chubb underwriting company affiliates. Program Administered by Trust Risk Management Services, Inc.

OSC User Name: alevitan

PF-15215a (04/07) © 2007 The Trust

Psychologists’ Professional Liability Claims Made Insurance

Policy Declarations

ACE American Insurance Company

PRODUCER NUMBER 273865 DATE OF ISSUE February 04, 2025

PSYCHOLOGISTS’ PROFESSIONAL LIABILITY

CLAIMS MADE INSURANCE POLICY

NOTICE: THIS IS A CLAIMS MADE POLICY, PLEASE READ THE POLICY CAREFULLY

THIS POLICY/CERTIFICATE IS ISSUED IN ASSOCIATION WITH THE PSYCHOLOGISTS PURCHASING

GROUP ASSOCIATION

Item POLICY/CERTIFICATE NUMBER: 58G28676876

1.

Named Insured: Dr. Aleksandr Levitan

Address: 2198 E Camelback Rd Ste 210

City, State & Zip Code: Phoenix, AZ 85016 4746

2. Policy Period:

12:01 A.M. local time at the address shown in Item 1.

From: 02/17/2025 To: 02/17/2026

3. COVERAGE LIMITS OF LIABILITY PREMIUM

Professional Liability Wrongful Employment Practices

$2,000,000 Each Incident $4,000,000 $5,000

Aggregate Aggregate $1,584.00

REIMBURSEMENTS

Licensing Board Defense Other Governmental Regulatory

Body Defense Deposition Expense Premises Medical Payment Assault and/or Battery Loss of Earnings

$100,000 $15,000

$5,000 $2,500

$500 per Proceeding per Proceeding per Insured per Person per Day, per Insured

$75,000 $1,000

$15,000

Aggregate Aggregate Aggregate Per Incident

$75.00

Surcharge(s)

Total Premium $1,659.00

4. Retroactive Date 02/17/2019

5. This policy is made and accepted subject to the printed conditions in this policy together with the provisions, stipulations and agreements contained in the following form(s) or endorsement(s).

PF15215a, PF33748 , PF15217a (05/07), CC-1K11k (04/22), PF15245a, PF15224a, PF15235a, PF22543, ALL5X45, PF17914

(02/05), PF41673 (05/14), PF51569, PF51697,

6. Notice of claim should be sent to:

Trust Risk Management Services, Inc.

111 Rockville Pike Ste 700 Rockville MD 20850

All other correspondence should be sent to:

Trust Risk Management Services, Inc.

1791 Paysphere Circle Chicago, IL 60674

PF-15215a (04/07) © 2007 The Trust

7. REPRESENTATIVE: Agent or broker: Trust Risk Management Services, Inc.

Office address: 1791 Paysphere Circle City, State, Zip Chicago, IL 60674

Website: www.trustinsurance.com Phone: 1.877.637.9700

PF-33748 (04/11)

Renewal Notice

IMPORTANT INFORMATION TO ALL POLICYHOLDERS

AS PART OF OUR EFFORT TO REDUCE OUR USE OF PRINTED PAPER, PLEASE BE ADVISED THAT THE ENCLOSED POLICY DOES NOT INCLUDE A COPY OF THE FOLLOWING FORM: PF15217a Psychologist CM Policy (05/07) WE HAVE NOT INCLUDED THIS FORM BECAUSE SUCH FORM WAS PREVIOUSLY

PROVIDED TO YOU AND SINCE THAT TIME, THERE HAVE BEEN NO MATERIAL CHANGES TO THE

FORM.

IF YOU WOULD LIKE TO OBTAIN COPIES OF THE FORM(S) PLEASE CONTACT US AT:

TRUST RISK MANAGEMENT SERVICES, INC.

1791 Paysphere Circle

Chicago, IL 60674

OR

Phone: 1.877.637.9700 Fax: 1.877.251.5111 info@trustrms.com www.trustinsurance.com

CC-1K11k (04/22)

SIGNATURES

Named Insured Dr. Aleksandr Levitan

Endorsement Number

Policy Symbol

CRL

Policy Number 58G28676876

Policy Period 02/17/2025 to 02/17/2026

Effective Date 02/17/2025

Issued By (Name of Insurance Company) ACE American Insurance Company

THE ONLY COMPANY APPLICABLE TO THIS POLICY IS THE COMPANY NAMED ON THE FIRST

PAGE OF THE DECLARATIONS.

By signing and delivering the policy to you, we state that it is a valid contract.

INDEMNITY INSURANCE COMPANY OF NORTH AMERICA(A stock company) BANKERS STANDARD INSURANCE COMPANY(A stock company)

ACE AMERICAN INSURANCE COMPANY(A stock company) ACE PROPERTY AND CASUALTY INSURANCE COMPANY(A stock company)

INSURANCE COMPANY OF NORTH AMERICA(A stock company) PACIFIC EMPLOYERS INSURANCE COMPANY(A stock company)

ACE FIRE UNDERWRITERS INSURANCE COMPANY(A stock company) WESTCHESTER FIRE INSURANCE COMPANY(A stock company)

436 Walnut Street, P.O. Box 1000, Philadelphia, Pennsylvania 19106-3703

BRANDON PEENE, Secretary JOHN J. LUPICA,President

Authorized Representative

CC-1K11k (04/22)

PF-15245a (05/07) © 2007 The Trust Page 1 of 1

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

Named Insured Dr. Aleksandr Levitan

Endorsement Number

Policy Symbol

CRL

Policy Number 58G28676876

Policy Period 02/17/2025 to 02/17/2026

Effective Date 02/17/2025

Issued By (Name of Insurance Company) ACE American Insurance Company

Retroactive Date(s) Designated Individual(s) or Entity(ies)

It is agreed that, in consideration of the premium charged, and solely with respect to the following designated individual(s) or entity(ies), Item 4. of the Declarations, Retroactive Date, is deleted with respect to such designated individual(s) or entity(ies) and replaced with the Retroactive Date for such designated individual(s) or entity(ies) listed in below.

Designated Individual(s) or Entity(ies) Retroactive Date(s) Aleksandr Levitan 02/17/2019

The premium for this endorsement is included in the premium shown on the Declarations unless a specific amount is shown here:

Additional Premium:

Return Premium:

All other terms and conditions of this policy remain unchanged.

Authorized Agent

PF-15224a (05/07) © 2007 The Trust Page 1 of 1

Named Insured Dr. Aleksandr Levitan

Endorsement Number

Policy Symbol

CRL

Policy Number 58G28676876

Policy Period 02/17/2025 to 02/17/2026

Effective Date 02/17/2025

Issued By (Name of Insurance Company) ACE American Insurance Company

Additional Named Insured(s)

It is agreed that:

1. The Named Insured shown in Item 1 of the Declarations of this policy is amended to include the following entity(ies) and if a Retroactive Date is listed opposite any entity(ies’) name, the Retroactive Date set forth in the Declarations is deleted with respect to such entity(ies) and replaced with the Retroactive Date listed below:

Additional Named Insured(s): Retroactive Date Levitan & Associates Psychological Services 02/17/2019

2. The following is hereby added to the CONDITIONS section of the policy.

Authorization: By acceptance of this policy the first Named Insured set forth in the Declarations, or in any Named Insured Amended endorsement, agrees to act on behalf of all other Insureds, including any Insured listed on this endorsement, with respect to the giving and receiving of all notices to the Company as may be required by the terms of this policy, any right of cancellation and in the receiving of any return premiums that may become due hereunder.

All Insureds agree that the first Named Insured listed in the Declarations or in any Named Insured Amended endorsement, is hereby designated to so act on their behalf.

All other terms and conditions of this policy remain unchanged.

PF-15235a (05/07) © 2007 The Trust Page 1 of 1

Named Insured Dr. Aleksandr Levitan

Endorsement Number

Policy Symbol

CRL

Policy Number 58G28676876

Policy Period 02/17/2025 to 02/17/2026

Effective Date 02/17/2025

Issued By (Name of Insurance Company) ACE American Insurance Company

Additional Insured

It is agreed that in consideration of the premium charged, the individual(s) or entity(ies) designated below shall be an Insured, under Section III. PERSONS INSURED, but only with respect to such individual’s or entity’s liability arising solely out of an Incident caused by the sole negligence of another Insured:

Additional Insured Address

Maricopa County O/C of Risk Management 301 W Jefferson St. Suite 910 Phoenix AZ 85003

Arizona Supreme Court Administrative Office of the Courts 1501 West Washington, Suite 337Phoenix AZ 85007

The premium for this endorsement is included in the premium shown on the Declarations unless a specific amount is shown here:

Additional Premium:

Return Premium:

All other terms and conditions of this policy remain unchanged.

PF-22543 (05/07) © 2007 The Trust Page 1 of 1

Named Insured Dr. Aleksandr Levitan

Endorsement Number

Policy Symbol

CRL

Policy Number 58G28676876

Policy Period 02/17/2025 to 02/17/2026

Effective Date 02/17/2025

Issued By (Name of Insurance Company) ACE American Insurance Company

Landlord Additional Insured

It is agreed that the designated individual(s) or entity(ies) shown below shall be included as (an) Insured(s) solely to the extent provided under Section III. PERSONS INSURED.

Landlord Additional Insured Address

Camelback Building, LLC 2198 East Camelback Road, Suite 201 Phoenix AZ 85016

The premium for this endorsement is included in the premium shown on the Declarations unless a specific amount is shown here:

Additional Premium:

Return Premium:

All other terms and conditions of this policy remain unchanged.

ALL-5X45 (11-96) Ptd, in U.S.A Page 1 of 1

QUESTIONS ABOUT YOUR INSURANCE?

Answers to questions about your insurance, coverage information, or assistance in resolving complaints can be obtained by calling Chubb, Customer Support Service Department, at 1-800-352-4462.

U.S. Treasury Department’s Office Of Foreign Assets Control ("OFAC")

Advisory Notice to Policyholders

This Policyholder Notice shall not be construed as part of your policy and no coverage is provided by this Policyholder Notice nor can it be construed to replace any provisions of your policy. You should read your policy and review your Declarations page for complete information on the coverages you are provided.

This Notice provides information concerning possible impact on your insurance coverage due to directives issued by OFAC. Please read this Notice carefully.

The Office of Foreign Assets Control (OFAC) administers and enforces sanctions policy, based on Presidential declarations of "national emergency". OFAC has identified and listed numerous:

Foreign agents;

Front organizations;

Terrorists;

Terrorist organizations; and Narcotics traffickers;

as "Specially Designated Nationals and Blocked Persons". This list can be located on the United States Treasury's web site – http//www.treas.gov/ofac.

In accordance with OFAC regulations, if it is determined that you or any other insured, or any person or entity claiming the benefits of this insurance has violated U.S. sanctions law or is a Specially Designated National and Blocked Person, as identified by OFAC, this insurance will be considered a blocked or frozen contract and all provisions of this insurance are immediately subject to OFAC. When an insurance policy is considered to be such a blocked or frozen contract, no payments nor premium refunds may be made without authorization from OFAC. Other limitations on the premiums and payments also apply.

PF-17914 (2/05) Reprinted, in part, with permission of Page 1 of 1 ISO Properties, Inc.

PF-41673 (05/14) Page 1 of 1

Named Insured Dr. Aleksandr Levitan

Endorsement Number

Policy Symbol

CRL

Policy Number 58G28676876

Policy Period 02/17/2025 to 02/17/2026

Effective Date 02/17/2025

Issued By (Name of Insurance Company) ACE American Insurance Company

Licensing Board Defense Reimbursement - Arizona

It is agreed that the Psychologist’s Professional Liability Policy (Claims Made) or the Research or Academic Psychologist’s Professional Liability Policy (Claims Made), whichever is applicable, is amended at Section V, Supplementary Payments, by deleting in its entirety subsection B1, Licensing Board Defense Reimbursement and replacing it with the following:

1. Licensing Board Defense Reimbursement:

up to the Licensing Board Defense Reimbursement Limit set forth in the Declarations per Insured for attorney fees, expenses or fees incurred by the Insured for: (a) the investigation or defense of a proceeding before a licensing board that regulates the practice of psychology or other associated professional services; and/or (b) any proceeding before a state court to determine whether there is a substantial basis to refer a complaint alleged against an Insured to a licensing board as provided in A.R.S. §32-2081(B).

The notice of investigation or proceeding must be:

a. received by the Insured during the Policy Period and reported to the Company or its authorized agent during the Policy Period or within sixty (60) days thereafter or

b. received by the Insured and reported to the Company or its authorized agent during any Extended

Reporting Period of this policy for occurrences that were alleged to have occurred on or after the Retroactive Date and prior to the end of the Policy Period. Such notices must be reported to the Company or its authorized agent within ninety (90) days of receipt.

All investigations or proceedings arising out of the same or related investigation or proceeding by any licensing board which will also include any proceeding before a state court described in the first paragraph above in subsection (b) shall be considered as having been first made at the time the notice of investigation or proceeding is first received by the Insured and the amount so payable shall not exceed the per proceeding Licensing Board Defense Reimbursement Limit set forth in the Declarations. There is no coverage provided for a licensing board’s investigatory fees or costs. Fees or expenses incurred as a result of medical or psychological treatment rendered to the Insured are not covered.

All other terms and conditions remain unchanged.

Authorized Representative

WAIVER OF SUBROGATION (ARIZONA)

Named Insured Dr. Aleksandr Levitan

Endorsement Number

Policy Symbol

CRL

Policy Number 58G28676876

Policy Period 02/17/2025 to 02/17/2026

Effective Date of Endorsement 02/17/2025

Issued By (Name of Insurance Company) ACE American Insurance Company

Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy.

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

This endorsement modifies insurance provided under the following:

PSYCHOLOGISTS’ PROFESSIONAL LIABILITY POLICY (CLAIMS MADE)

PSYCHOLOGISTS’ PROFESSIONAL LIABILITY POLICY (OCCURRENCE)

It is understood and agreed that the Subrogation condition under section VIII. CONDITIONS is deleted and replaced by the following:

Subrogation: In the event of any payment by the Company under this policy, the Company shall be subrogated to all the Insured’s rights of recovery against any person, organization, or entity. The Insured shall execute and deliver instruments and papers and do whatever else is necessary to secure such rights.

The Insured shall do nothing to prejudice the position of the Company or its potential or actual rights of recovery after any Incident or Claim.

However, solely with respect to the entity(ies) shown in the Schedule below, the Insured and the Company hereby waive their rights of recovery. This waiver shall apply only with respect to Damages for an Incident arising out of work performed by an Insured on behalf of the Named Insured pursuant to a written agreement existing between the Insured and the entity(ies) shown in the Schedule below provided such agreement was executed and in effect prior to the time of the Incident and requires this waiver of subrogation. This waiver shall not be construed to be a waiver with respect to other operations of such entities in which you have no written or contractual interest.

Schedule

Arizona Supreme Court Administrative Office of the Courts 1501 West Washington, Suite 337Phoenix AZ 85007

All other terms and conditions of this Policy remain unchanged.

Authorized Representative

PF-51569 (01/19)

(272071) Page 1 of 1

ADDITIONAL INSURED(S) – PRIMARY AND NON-CONTRIBUTORY (ARIZONA)

Named Insured Dr. Aleksandr Levitan

Endorsement Number

Policy Symbol

CRL

Policy Number 58G28676876

Policy Period 02/17/2025 to 02/17/2026

Effective Date of Endorsement 02/17/2025

Effective Time of Endorsement, 12:01 local time at address shown in Item 1 of the Declarations.

Issued By (Name of Insurance Company) ACE American Insurance Company

Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy.

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

This endorsement modifies insurance provided under the following:

PSYCHOLOGISTS’ PROFESSIONAL LIABILITY POLICY (CLAIMS MADE)

It is agreed the policy is amended at Section VIII. CONDITIONS, Condition G. Other Insurance by adding the following:

With respect to the additional insured(s) shown in the Schedule below, this insurance is primary and will not seek contribution from any other insurance available to such additional insured, provided that:

The additional insured is a Named Insured under such other insurance; and

You have agreed in a written contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured.

SCHEDULE

Additional Insured(s):

Arizona Supreme Court

Administrative Office of the Courts 1501 West Washington, Suite 337Phoenix AZ 85007

All other terms and conditions of this policy remain unchanged.

Authorized Representative

PF-51697 (04/19) Page 1 of 1 (277755.1)

CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)

02/04/2025

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.

IMPORTANT: If the certificate 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 certificate does not confer rights to the certificate holder in lieu of such endorsement(s).

PRODUCER

Trust Risk Management Services, Inc.

1791 Paysphere Circle Chicago, IL 60674

CONTACT

NAME: Trust Risk Management Services, Inc

PHONE

(A/C, No, Ext): 877.637.9700

FAX

(A/C, No): 877.251.5111

EMAIL

ADDRESS: info@trustrms.com

INSURER(S) AFFORDING COVERAGE NAIC #

INSURER A: ACE American Insurance Company 22667

INSURED

Aleksandr Levitan 2198 E Camelback Rd Ste 210 Phoenix, AZ 85016 4746

INSURER B:

INSURER C:

INSURER D:

INSURER E:

INSURER F:

COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:

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 EACH OCCURRENCE $

CLAIMS MADE OCCUR

DAMAGE TO RENTED

PREMISES (Ea occurrence)

___________________________________ MED EXP (Any one person)

___________________________________ PERSONAL & ADV INJURY

GEN’L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $

POLICY

PRO-

JECT LOC PRODUCTS–COMP/OP AGG

OTHER:

AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT

(Ea accident)

ANY AUTO BODILY INJURY (Per Person) $

ALL OWNED

AUTOS

SCHEDULED

AUTOS BODILY INJURY (Per accident)

HIRED AUTOS

NON-OWNED

AUTOS

PROPERTY DAMAGE

(Per accident)

UMBRELLA LIAB OCCUR EACH OCCURRENCE $

EXCESS LIAB CLAIMS-MADE AGGREGATE $

DED RETENTION $

WORKERS COMPENSATION

AND EMPLOYERS LIABILITY

ANY PROPRIETOR/PARTNER/EXECUTIVE

OFFICER/MEMBER EXCLUDED?

(Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below

Y / N N / A

PER

STATUTE

OTH-

ER

E.L.EACH ACCIDENT $

E.L. DISEASE-EA EMPLOYEE $

E.L. DISEASE - POLICY LIMIT

A Psychologist's Professional Liability Retroactive Date: 02/17/2019

58G28676876 02/17/2025 02/17/2026 Each Incident Annual Aggregate

$2,000,000 $4,000,000

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required):

CERTIFICATE HOLDER CANCELLATION

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED

BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE

DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.

AUTHORIZED REPRESENTATIVE

ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORD

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.

IMPORTANT: If the certificate 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 certificate does not confer rights to the certificate holder in lieu of such endorsement(s).

PRODUCER

Trust Risk Management Services, Inc.

1791 Paysphere Circle Chicago, IL 60674

CONTACT

NAME: Trust Risk Management Services, Inc

PHONE

(A/C, No, Ext): 877.637.9700

FAX

(A/C, No): 877.251.5111

EMAIL

ADDRESS: info@trustrms.com

INSURER(S) AFFORDING COVERAGE NAIC #

INSURER A: ACE American Insurance Company 22667

INSURED

Aleksandr Levitan 2198 E Camelback Rd Ste 210 Phoenix, AZ 85016 4746

INSURER B:

INSURER C:

INSURER D:

INSURER E:

INSURER F:

COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:

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 EACH OCCURRENCE $

CLAIMS MADE OCCUR

DAMAGE TO RENTED

PREMISES (Ea occurrence)

___________________________________ MED EXP (Any one person)

___________________________________ PERSONAL & ADV INJURY

GEN’L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $

POLICY

PRO-

JECT LOC PRODUCTS–COMP/OP AGG

OTHER:

AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT

(Ea accident)

ANY AUTO BODILY INJURY (Per Person) $

ALL OWNED

AUTOS

SCHEDULED

AUTOS BODILY INJURY (Per accident)

HIRED AUTOS

NON-OWNED

AUTOS

PROPERTY DAMAGE

(Per accident)

UMBRELLA LIAB OCCUR EACH OCCURRENCE $

EXCESS LIAB CLAIMS-MADE AGGREGATE $

DED RETENTION $

WORKERS COMPENSATION

AND EMPLOYERS LIABILITY

ANY PROPRIETOR/PARTNER/EXECUTIVE

OFFICER/MEMBER EXCLUDED?

(Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below

Y / N N / A

PER

STATUTE

OTH-

ER

E.L.EACH ACCIDENT $

E.L. DISEASE-EA EMPLOYEE $

E.L. DISEASE - POLICY LIMIT

A Psychologist's Professional Liability Retroactive Date: 02/17/2019

Y 58G28676876 02/17/2025 02/17/2026 Each Incident Annual Aggregate

$2,000,000 $4,000,000

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required):

CERTIFICATE HOLDER CANCELLATION

Additional Insured - Landlord Camelback Building, LLC 2198 East Camelback Road, Suite 201 Phoenix, AZ, 85016

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED

BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE

DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.

AUTHORIZED REPRESENTATIVE

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.

IMPORTANT: If the certificate 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 certificate does not confer rights to the certificate holder in lieu of such endorsement(s).

PRODUCER

Trust Risk Management Services, Inc.

1791 Paysphere Circle Chicago, IL 60674

CONTACT

NAME: Trust Risk Management Services, Inc

PHONE

(A/C, No, Ext): 877.637.9700

FAX

(A/C, No): 877.251.5111

EMAIL

ADDRESS: info@trustrms.com

INSURER(S) AFFORDING COVERAGE NAIC #

INSURER A: ACE American Insurance Company 22667

INSURED

Aleksandr Levitan 2198 E Camelback Rd Ste 210 Phoenix, AZ 85016 4746

INSURER B:

INSURER C:

INSURER D:

INSURER E:

INSURER F:

COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:

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 EACH OCCURRENCE $

CLAIMS MADE OCCUR

DAMAGE TO RENTED

PREMISES (Ea occurrence)

___________________________________ MED EXP (Any one person)

___________________________________ PERSONAL & ADV INJURY

GEN’L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $

POLICY

PRO-

JECT LOC PRODUCTS–COMP/OP AGG

OTHER:

AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT

(Ea accident)

ANY AUTO BODILY INJURY (Per Person) $

ALL OWNED

AUTOS

SCHEDULED

AUTOS BODILY INJURY (Per accident)

HIRED AUTOS

NON-OWNED

AUTOS

PROPERTY DAMAGE

(Per accident)

UMBRELLA LIAB OCCUR EACH OCCURRENCE $

EXCESS LIAB CLAIMS-MADE AGGREGATE $

DED RETENTION $

WORKERS COMPENSATION

AND EMPLOYERS LIABILITY

ANY PROPRIETOR/PARTNER/EXECUTIVE

OFFICER/MEMBER EXCLUDED?

(Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below

Y / N N / A

PER

STATUTE

OTH-

ER

E.L.EACH ACCIDENT $

E.L. DISEASE-EA EMPLOYEE $

E.L. DISEASE - POLICY LIMIT

A Psychologist's Professional Liability Retroactive Date: 02/17/2019

Y 58G28676876 02/17/2025 02/17/2026 Each Incident Annual Aggregate

$2,000,000 $4,000,000

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required):

CERTIFICATE HOLDER CANCELLATION

Additional Insured Maricopa County O/C of Risk Management 301 W Jefferson St. Suite 910 Phoenix, AZ, 85003

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED

BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE

DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.

AUTHORIZED REPRESENTATIVE

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.

IMPORTANT: If the certificate 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 certificate does not confer rights to the certificate holder in lieu of such endorsement(s).

PRODUCER

Trust Risk Management Services, Inc.

1791 Paysphere Circle Chicago, IL 60674

CONTACT

NAME: Trust Risk Management Services, Inc

PHONE

(A/C, No, Ext): 877.637.9700

FAX

(A/C, No): 877.251.5111

EMAIL

ADDRESS: info@trustrms.com

INSURER(S) AFFORDING COVERAGE NAIC #

INSURER A: ACE American Insurance Company 22667

INSURED

Aleksandr Levitan 2198 E Camelback Rd Ste 210 Phoenix, AZ 85016 4746

INSURER B:

INSURER C:

INSURER D:

INSURER E:

INSURER F:

COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:

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 EACH OCCURRENCE $

CLAIMS MADE OCCUR

DAMAGE TO RENTED

PREMISES (Ea occurrence)

___________________________________ MED EXP (Any one person)

___________________________________ PERSONAL & ADV INJURY

GEN’L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $

POLICY

PRO-

JECT LOC PRODUCTS–COMP/OP AGG

OTHER:

AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT

(Ea accident)

ANY AUTO BODILY INJURY (Per Person) $

ALL OWNED

AUTOS

SCHEDULED

AUTOS BODILY INJURY (Per accident)

HIRED AUTOS

NON-OWNED

AUTOS

PROPERTY DAMAGE

(Per accident)

UMBRELLA LIAB OCCUR EACH OCCURRENCE $

EXCESS LIAB CLAIMS-MADE AGGREGATE $

DED RETENTION $

WORKERS COMPENSATION

AND EMPLOYERS LIABILITY

ANY PROPRIETOR/PARTNER/EXECUTIVE

OFFICER/MEMBER EXCLUDED?

(Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below

Y / N N / A

PER

STATUTE

OTH-

ER

E.L.EACH ACCIDENT $

E.L. DISEASE-EA EMPLOYEE $

E.L. DISEASE - POLICY LIMIT

A Psychologist's Professional Liability Retroactive Date: 02/17/2019

Y 58G28676876 02/17/2025 02/17/2026 Each Incident Annual Aggregate

$2,000,000 $4,000,000

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required):

CERTIFICATE HOLDER CANCELLATION

Additional Insured Arizona Supreme Court Administrative Office of the Courts 1501 West Washington, Suite 337 Phoenix, AZ, 85007

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED

BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE

DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.

AUTHORIZED REPRESENTATIVE

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.

IMPORTANT: If the certificate 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 certificate does not confer rights to the certificate holder in lieu of such endorsement(s).

PRODUCER

Trust Risk Management Services, Inc.

1791 Paysphere Circle Chicago, IL 60674

CONTACT

NAME: Trust Risk Management Services, Inc

PHONE

(A/C, No, Ext): 877.637.9700

FAX

(A/C, No): 877.251.5111

EMAIL

ADDRESS: info@trustrms.com

INSURER(S) AFFORDING COVERAGE NAIC #

INSURER A: ACE American Insurance Company 22667

INSURED

Aleksandr Levitan 2198 E Camelback Rd Ste 210 Phoenix, AZ 85016 4746

INSURER B:

INSURER C:

INSURER D:

INSURER E:

INSURER F:

COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:

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 EACH OCCURRENCE $

CLAIMS MADE OCCUR

DAMAGE TO RENTED

PREMISES (Ea occurrence)

___________________________________ MED EXP (Any one person)

___________________________________ PERSONAL & ADV INJURY

GEN’L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $

POLICY

PRO-

JECT LOC PRODUCTS–COMP/OP AGG

OTHER:

AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT

(Ea accident)

ANY AUTO BODILY INJURY (Per Person) $

ALL OWNED

AUTOS

SCHEDULED

AUTOS BODILY INJURY (Per accident)

HIRED AUTOS

NON-OWNED

AUTOS

PROPERTY DAMAGE

(Per accident)

UMBRELLA LIAB OCCUR EACH OCCURRENCE $

EXCESS LIAB CLAIMS-MADE AGGREGATE $

DED RETENTION $

WORKERS COMPENSATION

AND EMPLOYERS LIABILITY

ANY PROPRIETOR/PARTNER/EXECUTIVE

OFFICER/MEMBER EXCLUDED?

(Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below

Y / N N / A

PER

STATUTE

OTH-

ER

E.L.EACH ACCIDENT $

E.L. DISEASE-EA EMPLOYEE $

E.L. DISEASE - POLICY LIMIT

A Psychologist's Professional Liability Retroactive Date: 02/17/2019

58G28676876 02/17/2025 02/17/2026 Each Incident Annual Aggregate

$2,000,000 $4,000,000

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required):

CERTIFICATE HOLDER CANCELLATION

The Department of Child Safety 3003 N. Central Avenue, 20th Floor Phoenix, AZ, 85012

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED

BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE

DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.

AUTHORIZED REPRESENTATIVE