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DATE (MM'DD'YYYY} <br />11nU2021 <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 CERTIFTCATE 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 INSUREO, the policy(ies) must have ADDITIONAL INSURED provisions or be endorced. <br />lf SUBROGATION lS WAIVED, subject to the terms and conditions of the policy, certain policies may requiro an ondo.lsement. A statement on <br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />CM&F Group lnc. <br />1 10 \A/est 40th Street <br />1Oth Floor, Suite 1000/1001 <br />NewYork, NY 10018 <br />CM&F <br />1-800-221-4904 <br />info@cmfgroup.com <br />INSURERISI AFFORDING COVERAGE NAIC# <br />INsURERA: 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 />INSIIRER F : <br />CERTIFICATE OF LIABILITY INSURANCE <br />CERTIFICATE NUMBER:REVISION NUMBER <br />@ 1 988-201 6 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of AGORD <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 />tNstttTp TYPE OF INSURANCE POLICY NUMBER <br />POLICY EFFIMM'DDffiI LIMITS <br />EACH OCCURRENCE s 1,000,000 <br />UAMAGE IUHtNIbU <br />PRFMISFS /Fe 6.fl rran.Ft s 1,000,000 <br />l\rED EXP (Anv one D€rson)$ <br />PERSONAL & ADV INJURY s 1,000,000 <br />GENERAL AGGREGATE E 6,000,000 <br />PRODUCTS - COIUP/OP AGG s 6,000,000 <br />A COMMERCIAL GENERAL LIABILITY <br />GEN'L AGGREGATE LIMIT APPLI <br />X <br />X f__l pno- <br />I I JECT <br />X <br />POLICY <br />CLAIMS-MADE OCCUR <br />PER: <br />LOC <br />u54661 11t29t2021 11t29t2022 <br />cI $ <br />BODILY INJURY (P€r p€rson)$ <br />BODILY INJURY (P€r accid6nt)$ <br />$ <br />AUTOMOBILE LIABILITY <br />ANYAUTO <br />ovl ED <br />AUTOS ONLY <br />HIRED <br />AUTOS ONLY <br />SCHEDULED <br />AUTOS <br />NON.OVVNIED <br />AUTOS ONLY <br />$ <br />EACH OCCURRENCE $UMBRELLA LIAB <br />EXCESS LIAB <br />OCCUR <br />CLAIIUS-IUADE AGGREGATE $ <br />DED RETENTION S $ <br />Ptt{STATI ITF <br />UIH. <br />ER <br />E.L, EACH ACCIDENT $ <br />E L DISEASE - EA EMPLOYEE $ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANYPROPRIETOR/PARTNERYEXECUTIVE <br />OFFICERYMEMBER EXCLUDED? <br />(Mandatory in NH) <br />lf yes, d€scribe under <br />DESCRIPTION OF OPERATIONS belN <br />Y'N <br />N/A <br />E.L. DISEASE - POLICY LIMIT s <br />A Professional Liability u54661 11t29t202',1 11t29t2022 Per lncident <br />Aggregate <br />1,000,000 <br />6,000,000 <br />DESCRIPTIONOFOPERATIONSTLOCATIONSTVEHICLES (ACORDl0l,AddltlonalRomatlcSchedule,maybeattachedlfmorcspacsirEquir€d) <br />Occurrence Coverage <br />Nurse Practitioner Group <br />SHOULD ANY OF THE ABOVE DESCRIBEO POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE wlLL BE DELIVEREO IN <br />ACCORDANCE WTH THE POLICY PROVISIONS. <br />Kittitas County <br />AUTHORIZED REPRESENTATIVE <br />ACORD 25 (2016/03)