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COVERAGES <br />CERTIFICATE OF LIABILITY INSURANCE <br />REVISION NUMBER: <br />CANCELI-A <br />@ 1988-2016 ACORD CORPORA <br />The ACORD name and logo are registered marks of ACORD <br />HOLDER <br />DA"IE aMit xx)rYYftl <br />11t10t2821 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY <br />CERTIFICATE DOES T.IOT AFFIRMANVELY OR NEGATIVELY AMEND, <br />AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOI/V. THIS CERTIFICATE OF INSURANCE DOES NOT COHSTITUTE A CONTRACT BETWEEN THE |SSU|NG TNSURER(S), AUTHORTZED <br />REPRESENTATIVE OR PRODUCER, Al{D THE CERTIFICATE HOLDER. <br />IMPORTANT:the cerliticate an lilsuRED,the must ItTISURED provisions or <br />SUEROGANON ls VI'AIVED,subject to the terms and conditlons of the pollcy c9fiain policies may requirE an endorsement.A Etatement onthisdoesnotcontertotheholderlnlieuolsuch <br />PRODUCER <br />CM&F Group lnc. <br />1 10 Vvest 40th Street <br />1Oth F,oor, Suite 1000/1001 <br />NewYork, NY 10018 <br />CM&F <br />1"800-2214904 <br />r: MEDICAL <br />INSUREO <br />Ellensburg Family Medicine <br />2,I56 PAYNE RD <br />ELLENSSURG, WA98S26.7898 <br />INSURER B . <br />INSURER C <br />INSURER D: <br />INSURER E : <br />INSURFR F: <br />THIS IS TO CERTIFY THAT THE POLICIES OF BELOW HAVE BEEN ISSUED TO THE IN5URED NAMED ABOVE FOR THE POLICY PERIOOINDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERII' OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WTH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PSRTA|N, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUSJECT TO ALL <br />'HE <br />TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHO\AN MAY HAVE BEEN REDUCED 8Y PA|D CLAIMS. <br />INSKITR TYPE OF INSURANCE POUCYilUMSFR UMITIi <br />A X COMIIIERCIAL GENERAL LIABILITY <br />CLAIMS.MAOE OCCUR <br />LIMITAPPLIES <br />PRO-JECI I I <br />PgR: <br />LOCXPOLICY <br />X <br />u54661 11t29t2021 11129t2022 EACH OCCURRENCE e 1,000,000 <br />UAMAgtr I9FCNIEU <br />PRFMISFS lF tr r,rFn El s 1,000,000 <br />MED EXP (Any ms peGon)! <br />PERSONAL & ADV INJURY 5 1,000,000 <br />GENEMLAGGREGAIE o 6,000,000 <br />PRODUCTS. COMP'OF ACG $ 6,000,000 <br />AUTOMOSILE UASILITY <br />ANY AUTQ <br />OV\[.IEO <br />AUIOS ONLY <br />HIRED <br />AUTOS ONLY <br />SCHEDULED <br />ATJIOS <br />NON-OI rNEO <br />AUTOS ONLY <br />wn <br />IFA s <br />BODILY INJURY (P€r p6rson)s <br />BOOILY INJURY {Per a€cid6nt)5 <br />UMBREIiALIAE <br />EXCESSUAg <br />OCCUR <br />CLAIMS.MAOE <br />EACH OCCURREIICE I <br />ACGREGATE t <br />ntrn RETENTION 5 $ <br />$toRt(ERs COMPENSAITOiT <br />ANYPROPR IETORJPARTNER/EXECUTIVE <br />OFFICERfI'EMS€R EXCLUOED? <br />(Mandatory ln NH! <br />lf y63, de8cribe und€r <br />DESCFIPTION OF OPERATIONS bslM <br />Y'Nn It tA <br />HEK <br />STATI ITF <br />(J I t"t-FP <br />E-1. EACH AC'IOEN'$ <br />E.L DISEASE . EA EMPLOYET $ <br />E,L DISEASE. POLICY LIMIT $ <br />A Probssional Liability X u54661 11125t2021 11t29t2022 Per lncidenl <br />Aggregate <br />1,000,000 <br />6,000,000 <br />DESCRIPIIONOFOPERAnoilSILOCAIONSTVEHICLES iACORDl0l,Add[ionilRem{rt!schedulermrybealtached,fmonEprcetsEqutrudl <br />Occunence Coverage Professional Liability Additional lnsured: <br />Kittitas County <br />Nur$e Praclitioner Group 205 W ith Ave <br />Ellensburg, WA98926 <br />SHOULD ANV OF THE ABOVE DESCRIBEO POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION BATE THEREOF, NOTICE WILL gE OELIVERED IN <br />ACCORDAT{CE W|TH THE pOLlCy pROVtSlOr{S. <br />Kitlitas Coung <br />205 W slh Ave <br />Ellensburg,WA98926 <br />e.-z-ffi1-AUIHOREEO REFRESENTATIVE <br />ACORD 25 (2016/03) <br />All rights reserved.