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L <br />F^J1 Phy;l5,inns Insurance <br />PO Box 84453 <br />Seattle, WA 98124-5753 <br />(206) 343-7300 <br />(800) 962-1399 <br />www.phyins.com <br />CONFIRMATION OF INSURANCE COVERAGE <br />PROFESSIONAL LIABILITY INSURANCE POLICY <br />CLAIMS.MADE <br />Named lnsured: <br />Mailing Address: <br />Byron L Haney, MD <br />107 E Mountain View Ave Ste 1 <br />Ellensburg, WA 98926 <br />Policy Number: 178152000 <br />POLICY PERIOD: January 1,2020 to January 1,2021 <br />al 12:01 a.m. local time at the address shown above <br />RETROACTIVE DATE: September 3, 1990 <br />This document will confirm that Physicians lnsurance A Mutual Company (the <br />Company) provides professional liability insurance to Byron L Haney, MD, subject <br />to the Company's minimum liability limits of $1,000,000 each medical incident and <br />$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 />othenvise alter the terms, conditions or limits of the insurance afforded by the <br />policy. lf the Policy, or coverage for any person, is canceled for any reason or if the <br />terms of the policy are changed, we will notify the Named lnsured only. <br />This confirmation was issued on April 13,2020 <br />To our lnsureds: 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 />cor-Pr.080712 <br />21 178152