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PSA Amendment Family Healthcare (2)
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11. November
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2018-11-20 10:00 AM - Commissioners' Agenda
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PSA Amendment Family Healthcare (2)
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Last modified
11/26/2018 3:59:18 PM
Creation date
11/26/2018 3:58:30 PM
Metadata
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Template:
Meeting
Date
11/20/2018
Meeting title
Commissioners' Agenda
Location
Commissioners' Auditorium
Address
205 West 5th Room 109 - Ellensburg
Meeting type
Regular
Meeting document type
Fully Executed Version
Supplemental fields
Alpha Order
e
Item
Request to Approve an Amendment to the Professional Services Agreement between Kittitas County and Family Healthcare of Ellensburg for 11/1/18-12/31/18
Order
5
Placement
Consent Agenda
Row ID
49352
Type
Contract
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Physicians <br />Insurance <br />1301 Saeond Avenue, Suite 2700 <br />PO 80•91220 <br />Seattle. WA. 98111 <br />(206) 343-7300 <br />1800) 962-1399 <br />F (206) 343-7100 <br />A. MUTUAL. CC>Mfl-"NY <br />Named Insured: <br />CONFIRMATION OF INSURANCE COVERAGE <br />PROFESSIONAL LIABILITY INSURANCE POLICY <br />CLAIMS-MADE <br />Elkhorn Valley Corp dba Family Health Care <br />of Ellensburi:i <br />Policy Number: 002258000 <br />Paramedical Employee: Ryan Beachy, PA-C Reference Number: 240453 <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: February 4, 2009 <br />This document will confirm that Physicians Insurance A Mutual Company (the <br />Company) provides professional liability insurance to Ryan Beachy, PA-C, <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 />240453 <br />COI-Pl.080712 <br />73 240453 002258
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