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Physicians <br />Insurance <br />A MUTUAl COMPANY <br />PHYSICIAN & SURGEON PROFESSIONAL LIABILITY POLICY <br />DECLARATIONS PAGE <br />Policy Number: 241181000 <br />Named Insured/Ma ili ng Addre s s <br />John R Walters, MD <br />Family Health Care of Ellensburg <br />107 E Mountain View Ave Ste 1 <br />Ellensburg, WA 98926 <br />POLICY PERIOD: January 1,2018 to January 1,2019 at 12:01 a.m. Pacific Standard TIme <br />The limit of the Company's liability shall be as stated subject to all provisions of the policy. <br />COVERAGES <br />A. Medical Professional Liability <br />B. Reserved <br />C. Reserved <br />D. Disciplinary Proceeding Defense <br />Reimbursement <br />LIMITS OF <br />LIABILITY <br />$1,000,000 Each Medical Incident <br />$5,000,000 Aggregate <br />Retroactive Date : September 1, 2007 <br />LIMITS OF <br />INSURANCE <br />$50,000 Per Investigation <br />$50,000 Aggregate <br />1301 Second Avenue. Suit~ 2700 <br />PO Box 91220 <br />Seattle. WA 98111 <br />(206) 343-7300 <br />(800) 962-1399 <br />F (206)343-7100 <br />PREMIUM <br />$10,373 <br />Included <br />2018 Total Premium $10,373 <br />This policy is issued for the period stated above and may be renewed at the option of the Company . The terms and <br />conditions of the policy shall remain unchanged for succeeding policy years unless endorsed by the Company or a new <br />policy is issued at the time of renewal. <br />To the extent permitted by law and subject to the approval of the Washington State Insurance Commissioner. the Company <br />has a right to increase Its surplus by issuing a capital call on its members. <br />DEC-PISTD.010110 11/16/17 Rate Code : WA Class: 12 241181