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COVERAGES <br />CERTIFICATE OF LIABILITY INSURANCE <br />CERTIFICATE NUMBER:REVISION NUMBER: <br />DATE (MM'DD/YYYY} <br />11110t2021 <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 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 ADDlTlOltlAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endoFed. <br />lf SUBROGATION lS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorcement. A statement on <br />this csrtificate does not conler rights to the certificate holder in lieu of such endorcement(s). <br />PRODUCER <br />CM&F Group lnc. <br />110 M/est 40th Street <br />1oth Floor, Suite 1000/1001 <br />NewYork, NY 10018 <br />CM&F <br />1-800-221-4904 <br />INSURER(SI AFFORDING COVERAGE NAICf <br />INSURERA: MEDICAL PROTECTIVE COMPANY- MPC <br />INSURED <br />Ellensburg Family Medicine <br />2156 PAYNE RD <br />ELLENSBURG, WA98926-7898 <br />INSURER B : <br />INSIIRER 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 WTH 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 />INSRITR TYPE OF INSURANCE FOLICY NIIMRFR POLIGY EXP LIMITS <br />A X COMMERCIAL GENERAL LIABILITY <br />CLAIMS-MADE OCCUR <br />GEN'L AGGREGATE LI[IIT APPLIES PER: <br />X ror'"" f--l 55.oi f l ,o. <br />X <br />X u54661 't1t29t2021 '11t29t2022 EACH OCCURRENCE s 1,000,000 <br />E 1,000,000 <br />MED EXP (Anv one person)$ <br />PERSONAL & ADV INJURY E 1,000,000 <br />GENERALAGGREGATE s 6,000,000 <br />PRODUCTS - COMP/OP AGG s 6,000,000 <br />s <br />AUTOMOBILE LIABILITY <br />ANY AUTO <br />o\ n{ED <br />AUTOS ONLY <br />HIRED <br />AUTOS ONLY <br />SCHEDULED <br />AUIOS <br />NON.OVTJNED <br />AUTOS ONLY <br />$ <br />BODILY INJURY (P€r person)$ <br />BODILY INJURY (Per accident)$ <br />s <br />s <br />UMBRELLALIAB <br />EXCESS LIAB <br />OCCUR <br />CLAIMS-MADE <br />EACH OCCURRENCE s <br />AGGREGATE s <br />DFD RFTFNTION S $ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY r N/A <br />PERSTATI ITF <br />uth-FR <br />E.L. EACH ACCIDENT $ <br />E.L. DISEASE - EA EMPLOYEE $ <br />E.L. DISEASE - POLICY LIMIT $ <br />A Professional Liability u54661 11t29t2021 11n9t2022 Per lncidenl <br />Aggregate <br />1,000,000 <br />6,000,000 <br />OESCRIPTIONOFOPERATIONSTLOCATIONSTVEHICLES (ACORDl0t,Additional Rsmark!Schedule,mybeattrchedlfmoruspaceiBrequir€d) <br />Occurrence Coverage General Liability Additional lnsured: <br />Kittitas County <br />Nurse Practitioner Group 230 Grant Rd Ste 827 <br />Ellensburg, WA98926 <br />CERTIFICATE HOLDER CANCELLATION <br />Kittitas County <br />230 Grant Rd Ste 827 <br />205 W 5th Ave <br />Ellensburg,WAg8926 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WLL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />@ 1988-2016 ACORD CORPORATION. All rights reserved. <br />The AGORD name and logo are registered marks of ACORDACORD 25 (2016/03)