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I ••• • • <br />~-~ Physicians <br />Insurance <br />/. MUTUAL COM~~N'f <br />CONFIRMATION OF INSURANCE COVERAGE <br />PROFESSIONAL LIABILITY INSURANCE POLICY <br />CLAIMS-MADE <br />1301 Second Avenue , Suite 2700 <br />PO Bo, 91220 <br />s~attla, WA 98111 <br />1206) 343-7300 <br />IBOO) 962-1399 <br />F 1206) 343-7100 <br />Named Insured; <br />Paramedical Employee: <br />Elkhorn Valley Corp dba Family Health Care <br />of Ellensburo <br />Aaron David Long, ARNP <br />Policy Number: 002258000 <br />Reference Number: 376778 <br />Mailing Address: 107 E Mountain Vw Ave Ste 1 <br />Ellensburg, WA 98926 <br />POLICY PERIOD: January 1, 2018 to January 1, 2019 <br />at 12:01 a.m . local time at the address shown above <br />RETROACTIVE DATE : September 1, 2012 <br />This document will confirm that Physicians Insurance A Mutual Company (the <br />Company) provides professional liability insurance to Aaron David Long, ARNP, <br />subject to the Company's minimum liability limits of $1 ,000,000 each medical <br />incident and $5,000,000 aggregate. <br />The certificate of Insurance is issued as a matter of information only and confers <br />no rights upon the certificate holder. This confirmation does not amend, extend or <br />otherwise alter the terms, conditions or limits of the insurance afforded by the <br />policy. If the Policy, or coverage for any person, is canceled for any reason or if <br />the terms of the policy are changed, we will notify the Named Insured only. <br />This confirmation was issued on November 16, 2017. <br />To our Insureds: This confirmation of coverage is provided for your use for hospital privilege requirements, <br />HMOs, PPOs, etc. You are authorized to photocopy and distribute as needed without further permission <br />from or notification to the Company. <br />376778 <br />COI-Pl.080712 <br />72 376778 002258