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••• ,. .. Physicians <br />Insurance <br />A 1.AUTUAl COMP.,),NV <br />CONFIRMATION OF INSURANCE COVERAGE <br />PROFESSIONAL LIABILITY INSURANCE POLICY <br />CLAIMS-MADE <br />1301 Second Avenue, Suite 2700 <br />PO Box 91220 <br />Seattle, WA 98111 <br />(206) 343-7300 <br />(BOO) 962-1399 <br />F (206) 343-7100 <br />Named Insured: Elkhorn Valley Corp dba Family Health Care <br />of Ellensburq <br />Policy Number: 002258000 <br />376778 Paramedical Employee: <br />Mailing Address: <br />Aaron David Long, ARNP <br />107 E Mountain Vw Ave Ste 1 <br />Ellensburg, WA 98926 <br />POLICY PERIOD: January 1, 2019 to January 1, 2020 <br />ID Number: <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 <br />confers no rights upon the certificate holder. This confirmation does not amend, <br />extend or otherwise alter the terms, conditions or limits of the insurance <br />afforded by the policy. If the Policy, or coverage for any person, is canceled for <br />any reason or if the terms of the policy are changed, we will notify the Named <br />Insured only. <br />This confirmation was issued on January 1, 2019 . <br />To our Insureds: This confirmation of coverage is provided for your use for hospital privilege requirements, HMOs, <br />PPOs, etc. You are authorized to photocopy and distribute as needed without further permission from or <br />notification to the Company. <br />72 376778 <br />DOC UI