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ADDITIONAL REMARKS SCHEDULE Page of <br />Intermediary <br />Insured <br />Ellensburg Family Medicine <br />Policy Number <br />U54661 <br />Insurer <br />MEDICAL PROTECTIVE COMPANY- MPC <br />Effective Date: 11 /29/2021 <br />ADDITIONAL <br />This Additional Remarks form is a schedule to ACORD form, <br />Form Number: Acord 25 Form Title: CERTIFICATE OF LIABILITY INSURANCE <br />This Policy includes coverage for the professional services rendered under the First Named Insured listed above by the following professionals: Zach <br />Deffinbaugh, NP and Aaron Long, NP <br />