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The Medical Protective Company@ <br />A gTOCK IIISURAIICE COMPAT{Y <br />5814 Rsed Road, FortWayne, Indiana 46835 <br />Strength. Defense. Solutions. Since 1899. <br />MALTI-S PECALTY HEALTH CARE PROF ESSI ONAL <br />MASTER POUCY <br />SCIIEDALE OF INSAREDS ENDORSEMENT <br />Item 1(a) of the CERTIFICATE is as follows: <br />Ellensburg Family Medicine <br />Each gmployee, shareholder. partner, voluntoers or <br />independeni contractor Heallhcaro Profsssional of <br />Ellensburg Family Medicins but only while providiflg <br />professlonal seMces on behal{ or under the direction or <br />conltol of El{ensburg Family Medlcine oxcluding any <br />physician, pdiakist, chiropraclor, optometrist, nurse <br />midwlfe, csrtified rogistered nurse anesth€tist or denlist <br />unless designated as an lnsured undar your Csrlificate <br />or by endorsement llsted on you. Cerlilicale. <br />Item l(b) of the CERTIFICATE is as follows: <br />Kittitas County <br />Kittitas County <br />All other terms and conditions of the Policy remain unchanged. <br />E Not Applicable <br />Not Applicable <br />AII 1{a) Named lnsureds Listed Above <br />All 1(a) Named lnsureds Listed Above <br />lncluded <br />lncluded <br />lncluded <br />lncluded <br />ITEM 1(a) NAMED INSURED PROFESSIONAL SERVICES <br />SPECIALTY <br />CLASS <br />RETROACTIvE <br />DATE* <br />flf Applicable) <br />TYPE <br />I) Individual <br />E) Entity <br />S) Student <br />MODIFIED <br />COVERAGE <br />ENDORSEMENT <br />NI]MBER <br />PREMIUM <br />SURCIIARGE <br />TAXES <br />flf Apolicable) <br />rTEM l(b) ADDTTIONAL INSURED AFFILIATED ITEM 1(a) NAMEI) <br />INSURED <br />PREMIUM <br />SURCHARGE <br />TAXES <br />(lf Applicable) <br />18505 08/1 3