Laserfiche WebLink
The Medical Protective Company° <br />A STOCK INSURANCE COMPANY <br />5814 Reed Road, Fort Wayne, Indiana 46835 <br />Strength. Defense. Solutions. Since 1899. <br />MULTI -SPECIAL TY HEALTHCARE PROFESSIONAL <br />MASTER POLICY <br />SCHEDULE OFINSUREDS ENDORSEMENT <br />Item I (a) of the CERTIFICATE is as follows: <br />ITEM 1(a) NAMED INSURED <br />PROFESSIONAL SERVICES <br />PREMIUM <br />SPECIALTY <br />AFFILIATED ITEM 1(a) NAMED <br />SURCHARGE <br />TYPE <br />MODIFIED <br />PREMIUM <br />RETROACTIVE <br />I) Individual <br />COVERAGE <br />SURCHARGE <br />DATE* <br />E) Entity <br />ENDORSEMENT <br />TAXES <br />CLASS <br />(If Applicable) <br />S) Student <br />NUMBER <br />(If Applicable) <br />Ellensburg Family Medicine <br />Each employee, shareholder, partner, volunteers or <br />independent contractor Healthcare Professional of <br />Ellensburg Family Medicine but only while providing <br />professional services on behalf or under the direction or <br />control of Ellensburg Family Medicine excluding any <br />physician, podiatrist, chiropractor, optometrist, nurse <br />midwife, certified registered nurse anesthetist or dentist <br />unless designated as an Insured under your Certfcate <br />or by endorsement listed on your certificate. <br />Item I (b) of the <br />is as follows: <br />E Not Applicable Included <br />Not Applicable Included <br />Kittitas County All 1(a) Named Insureds Listed Above Included <br />Kittitas County All 1(a) Named Insureds Listed Above Included <br />All other terms and conditions of the Policy remain unchanged. <br />18505 08/13 <br />PREMIUM <br />AFFILIATED ITEM 1(a) NAMED <br />SURCHARGE <br />ITEM 1(b) ADDITIONAL INSURED <br />INSURED <br />TAXES <br />(If Applicable) <br />Kittitas County All 1(a) Named Insureds Listed Above Included <br />Kittitas County All 1(a) Named Insureds Listed Above Included <br />All other terms and conditions of the Policy remain unchanged. <br />18505 08/13 <br />