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A� O® CERTIFICATE OF LIABILITY INSURANCE <br />DAT11110/2021 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />CONTACT <br />NAME: CM&F Group <br />CM&F Group Inc. <br />p"° Ne EH: 1-800-221-0904 � No: <br />E-MAIL <br />ss: info�cmfgroup.com <br />110 West 40th Street <br />10th Floor, Suite 1000/1001 <br />New York, NY 10018 <br />INSURE S AFFORDINGCOVERAGE NAIC0 <br />INSURERA: MEDICAL PROTECTIVE COMPANY -MPG <br />11/29/2022 <br />INSURED <br />INSURERS: <br />INSURERC: <br />Ellensburg Family Medicine <br />INsuRERo: <br />2156 PAYNE RD <br />ELLENSBURG, WA98926-7898 <br />INSURER E: <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />LTR <br />OF INSURANCE <br />ADDILSUBIType <br />J02 <br />vivo <br />POUCYNUMBER <br />MMIDBYEFF <br />NINVIDDU� <br />LIMITS <br />A <br />J( <br />COMMERCIALGENERALUABILITY <br />U54661 <br />11/29/2021 <br />11/29/2022 <br />EACH OCCURRENCE $ 1,000,000 <br />CLAIMS -MADE Fx] OCCUR <br />PREMISES Eaaccunenre $ 1,000,000 <br />MED EXP (Any one pwson) $ <br />PERSONAL&ADV INJURY $ 1,000,000 <br />GEN -L AGGREGATE LIMIT APPLIES PER: <br />GENERALAGGREGATE $ 6,000,000 <br />X POLICY 0 PRO-JECT 1-1LOC <br />PRODUCTS-COMP/OPAGG $ 6,000,000 <br />IS <br />OTHER: <br />AmOMOBILE LUU$IDTY <br />COMBINED SINGLE UNIT $ <br />Ea accident <br />BODILY I NJURY(Per person) $ <br />ANY AUTO <br />OWNED BCHEOULED <br />AUTOS ONLY AT <br />BODILY INJURY (Peraccident) $ <br />PROPERTY DAMAGE $ <br />Per acdtlenl <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />UMBRELLA LUIS <br />OCCUR <br />EACH OCCURRENCE $ <br />AGGREGATE $ <br />EXCESS LIAB <br />CLAIMS -MADE <br />DED RETENTION $ <br />$ <br />WORNERSCOMPENSATION <br />AND EMPLOYERWLMBILITY YIN <br />PER OTH- <br />STATUTE ER <br />ANYPROPRIETOTPARTNEWEXECUTIVEE.L. <br />EACH ACCIDENT $ <br />OFFICERIMEMSEREXCLUDED9 F-1 <br />NIA <br />E.L. DISEASE EA EMPLOYEE $ <br />(Mandatory In NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONSItelm <br />E.L. DISEASE -POUCY LIMIT $ <br />A <br />Professional Liability <br />U54661 <br />11/29/2021 <br />11/29/2022 <br />Per Incident 1,000,000 <br />Aggregate 6,000,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if mom space is required) <br />Occurrence Coverage <br />Nurse Practitioner Group <br />CERTIFICATE HOLDER CANCELLATION <br />Vittltas County <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUT�HORVEDDREPR�tEESSENTATIVE <br />©1988-2016 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />