SH21-044 - ELLENSBURG FAMILY MEDICINE PROOF OF INSURANCE

Home Browse Search

A� o® CERTIFICATE OF LIABILITY INSURANCE oAT11/101Dl21 11/1012021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: T CMBF Group CM&F Group Inc. AX ac° i o Ert: 1.800-221-4904 AIC No ADDRESS: info�cmfgroup.cem 110 West 40th Street 10th Floor, Suite 1000/1001 X NeWYOrk, NY 10018 INSURE S AFFORDINGCOVERAGE NAICN INSURERA: MEDICAL PROTECTIVE COMPANY- MPC 11/29/2022 INSURED INSURERS: INSURERC: Ellensburg Family Medicine 2156 PAYNE RD ELLENSBURG, WA98926-7898 INSURERD: INSURER E: INSURER F: DAMA ET RENT D cc PREMISES Ea ourrence COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTRnm TYPE OF INSURANCE ADDL SUER wyn POLJCYNUMBER MOMII,DDYEFF Map TY' LIMITS A X COMMERCIALGENERALLUIBIUW X U54661 11/29/2021 11/29/2022 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE I OCCUR DAMA ET RENT D cc PREMISES Ea ourrence $ 1,000,000 MED EXP (Any one person) $ PERSONAL S ADV INJURY $ 1,000,000 GENL AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 6,000,000 X PDODY PRO- LOC PRODUCTS-COMPIOPAGG$ 6,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per nodded) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ It WORKERS COMPENSATION ANDEMPLOYERS-LUUBLITY YIN PER OTH- STATUTE ER ANYPROPRIETORIPARTNERIEXECUTIVEE.L. EACH ACCIDENT $ MI OFFICEREMBERMI-JOEDP F-1 NIA E.L. DISEASE -EA EMPLOYEE $ (Mandatory In NH) if yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY UMIT $ A Professional Liability U54661 11129/2021 11/29/2022 Per Incident 1,000,000 Aggregate 6,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more apace is required) Occurrence Coverage General Liability Additional Insured: Killitas County Nurse Practitioner Group 230 Grant Rd Ste B27 Ellensburg, WA98926 Kittitas County 230 Grant Rd Ste B27 205 W 5th Ave Ellensburg,WA98926 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZEDREPRESENTATIVE (119AR-201R ACORD CORPORATION_ All riohte ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD