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COVERAGES <br />CERTIFICATE OF LIABILITY INSURANCE <br />CERTIFICATE NUMBER REVISION NUMBER: <br />DAIE (MM/DO/YYYY} <br />11t10t2021 <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 COVEMGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTTTUTE A CONTRACT BETWEEN THE |SSU|NG TNSURER(S), AUTHORTZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: lf the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or bo endomed. <br />lf SUBROGATION lS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorcement. A siatomont on <br />this certificate does not confer rights to the certificate holder in lieu of such endosement(s). <br />PRODUCER <br />CM&F Group lnc. <br />110 \Abst 40th Sheet <br />1oth Floor, Suite 1000/1001 <br />NewYork, NY 10018 <br />CM&F <br />1-800-221-4904 <br />INSURERISI AFFORDING COVERAGE NAIC# <br />TNSURERA: MEDICAL PROTECTIVE COMPANY- MPC <br />INSURED <br />Ellensburg Family Medicine <br />2156 PAYNE RD <br />ELLENSBURG, WA98926-7898 <br />INSURER B : <br />INSURER C : <br />INSURER D : <br />INSURER E <br />INSURER F: <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. NOTWTHSTANDING 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 />INSRlTo TYPE OF INSURANCE tNch POLICY NUMEER LIMITS <br />A X COMMERCIAL GENERAL LIABILITY <br />CLAIMS-MADE OCCUR <br />LIMITAPPLIES PER: <br />3F8; f-l,-o"X <br />X <br />u54661 11t29t2021 11t29t2022 EACH OCCURRENCE s 1,000,000 <br />L <br />F s 1,000,000 <br />MED EXP (Any one person)$ <br />PERSONAL & ADV INJURY e 1,000,000 <br />GENERAL AGGREGATE s 6,000,000 <br />PRODUCTS - COMP/OP AGG s 6,000,000 <br />$ <br />AUTOMOBILE LIABILITY <br />ANY AUTO <br />OVVNED <br />AUTOS ONLY <br />HIRED <br />AUTOS ONLY <br />SCHEDULED <br />AUTOS <br />NON.OVVI\ED <br />AUTOS ONLY <br />I <br />BODILY INJURY (P€r person)$ <br />BODILY INJURY (Per a6idont)$ <br />$ <br />$ <br />UMBRELLA LIAB <br />EXCESS LIAB <br />OCCUR <br />CLAIMS-MADE <br />EACH OCCURRENCE $ <br />AGGREGATE u <br />DED RETENTION S U <br />WORKERS COMPENSANON <br />AND EMPLOYERS' LIABILITY fl <br />OPERATIONS belM <br />N/A <br />PERSTATI ITF <br />UIH-FR <br />E,L. EACH ACCIDENI $ <br />E.L, DISEASE - EA EMPTOYEE $ <br />E.L. OISEASE - POLICY LIMIT $ <br />A Professional Liability X u54661 11t29t2021 11t29t2022 Per lncident <br />Aggregate <br />1,000,000 <br />6,000,000 <br />DESCRIPTIONOFOPEMTIONSTLOCATIONSTVEHICLES (ACORDl0l,Addltional RemartsSchodul€,maybeatt chedif monspacelsEquircd) <br />Occurrence Coverage Professional Liability Additional lnsured: <br />Kittitas County <br />Nurse Practitioner Group 205 W sth Ave <br />Ellensburg, WA98926 <br />CERTIFICATE HOLDER ELLATION <br />@ 1988-2016 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />Kittitas County <br />205 W Sth Ave <br />Ellensburg,WA98926 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION OATE THEREOF, NOTICE WLL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />ACORD 25 (2016/03)