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The Medical Protective Companyo <br />A sTl'CK II{SURANCE COMPANY <br />5414 Resd Road, FortW-ync, Indirna <16815 <br />Strenqth. 9ef€nse. Solutlons, Since L899. <br />MULTI.SPECIALTY HEALTHCARE PROFESSIONAL - CERTIFICATE <br />POrtGy <br />Periodr <br />2021-11-29 rot2A22-11-29 <br />tt 12:01 a.m. Standad Time at the addffi ofthe Rct Nam€d lnsurcd.Certificate Numbdr:u54661 <br />Item 1(a) ilamed Insured:N/A Sfrrdent an <br />Ellensburq Familv Medicine <br />Services Specialty: NP Gmup <br />rvA <br />2156 PAYNE RD <br />ELLENSBURG. WA 98926.7898 <br />Item 1(b) Additional Insureds: <br />New Businss X Renewal Business <br />COVERAGES:RETROACTNIE <br />DATE <br />|JHITS OF LIABILITY <br />Per Qaim / AsqreqateOcoJn€nc€Sandad <br />6airc i4ade <br />Com.Bble <br />Chims lfdde <br />LIASIUTY <br />A. Professional Uability (PL) & <br />B. Good Samaritan Acts <br />C. Assault Upon You <br />D. First Aid <br />E. Medical Payments <br />F. Deposition Fees- Adrninistrative Hearing Expense- Sexual Misconduct Expense- l-oss of Earnings- HIPM Proceeding Expense- Biomedical Waste Hearing Expense <br />X <br />$1,000,000 <br />lncluded <br />$25,000 <br />$1 5,000 <br />$25,000 <br />$10,000 <br />$25,000 <br />$25,000 <br />$2,500 <br />$25,000 <br />$10,000 <br />$6,000,000 <br />lncluded <br />$25,000 <br />$15,000 <br />$100,000 <br />$10.000 <br />$100,000 <br />$25,000 <br />$35,000 <br />$25,000 <br />$10,000 <br />WORI(PIACE LIABIUTY <br />A. Healthcare Professional Premlses <br />Uability & <br />B. Personal Injury Liability lltMotol*. LJ6ifltu dos doa zort, it th.CesC Uzhititul,/dnc AM,ltffidc Mof wotFvfraa- <br />:MPLOYMENT PRACTICES LIABILITY" " <br />CYBER LTABILITY <br />BILTING PRASNCES & REGULATORY <br />:OMMERCIAL GTNERAL LIABILITY <br />- Each Occunence Umit- Damages to Premises Rented <br />to an Insured Business- Pemonal &Advertislng lnjury <br />- General Aggregate Limit- Product Completed operauons Aggregate- Hired and Non-0wned Auto <br />X <br />aqerd U.hilily daB nd ewly tl tht Wo,'pLca Uabltlty tietldg Agnffil l. ffida F& af yow aovaga <br />$1,000,000 <br />$1,000,000 <br />$1,000.000 <br />$6,000,000 <br />$6,000,000 <br />SEE POLICY FORMS & ENDORSEMENTS SCHEDULE <br />lilaster Pollcy ilumber: <br />IN WITNEsS WHiREOF, The iledlcl PrOt€CUw @fipany has @u*d tlis <br />pdicy b be 3gn€d by its ltegdent nd Co{porate saKtery (i/d <br />6JnE.sis.Fd bv its dulv Auhorized Rercsslbbve. whm nEessary), <br />rC'\rg*.,-rruJcf -o-r.',^{) <br />S€mlarv <br />Premium: $4.932.00 <br />Surcharges: $0.00laxes: $0.00IoTAL: S4.932.00 <br />For SeMce or questions, please call: <br />CM&F Group, lnc. 1{00-221-4904 <br />NOTICE <br />}TI.Ii5 POLICY C{}ruTA:Hs CLAIMS.IVTADE COVf RtG'.** clAti,l rxPEItsE t5?Al* wlTHIlI ?HE Llt4ITS AF LtAAtLr'y. <br />UMIIS MAY CIIANGE BYCOVERAGE PROVISION OR EI{DORSEMENT. <br />PLEASE READ YOUR POLICY A]{D ENDoRSEME'{TS CARER'LLY. <br />DISCUS' WTTH YOUR II{SURANCE AGEIIT IF NEEDED. <br />Counl€EignafuE / Auhorieed Reprer6ntalive: <br />1801 I Q1t14