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/--A,coRi)' <br />COVERAGES <br />CERTIFICATE OF LIABILITY INSURANCE <br />CERTIFICATE NUMBER REVISION NUMBER: <br />DATE (MIVI/DD/YYYY) <br />12/02t2021 <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 POLICIESBELOW THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE 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 ADDITTONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.lf SUBROGATION lS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement onthis certificate does not confer to the certificate holder in lieu of such <br />PRODUCER <br />CM&F Group lnc. <br />1 10 West 40th Street <br />1Oth Floor, Suite 1000/1001 <br />NewYork, NY 10018 <br />CONTAGI <br />NAME:CM&F Grou p <br />PHONE 1-800-221-4904 <br />tn roup,com <br />INSURER(S) AFFORDING COVERAGE NAIC # <br />TNSURERA: MEDICAL PROTECTIVE COMPANY- MPC <br />INSI,JRED <br />Ellensburg Family Medicine <br />2156 PAYNE RD <br />ELLENSBU RG, WA98926-7898 <br />INSURER B : <br />INSURER C : <br />INSURER D <br />INSURER E: <br />INSURER F <br />TH e S TO L,ERTI FY T HAT THE POLtCt ES OF NS U RANCE LI STED BELOW HAVE BEEN ss UED TO TH E NSURED NAMED ABOVE FOR THE P OLICY P ERI o DINDICATED-NO TWTH STA N DIN AN Y REQUI REM E NT TER M o R coN DITI ON OF ANY CONTRACT o R OTH E R D OCUM ENT WITH RESPECT TO WH IC H TH SCERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE NSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERM S,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIM TS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSRtaF TYPE OF INSURANCE SUtsX <br />POLICY NIJMBER POLICY EFF <br />rMM/DD/YYYYI <br />POLICY EXP <br />rMM/DD/YYYYI LIMITS <br />A X COIVMERCIAL GENERAL LIABILIry <br />CLAIMS-MADE OCCUR <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />X ,o.,." fl !F.t [-l .o. <br />X <br />X u54661 11129t2021 11t29t2022 EACH OCCURRENCE s 1,000,000 <br />UAMAUI IUHhNIEU <br />PREMISES f Ea occurrencel s 1 ,000,000 <br />l\ilED FXP (Anv one oerson)$ <br />PERSONAL & ADV INJURY s 1 ,000,000 <br />GENERAL AGGREGATE s 6,000,000 <br />PRODUCTS . COIIIPlOP AGG s 6,000,000 <br />$ <br />AUTOMOBILE LIABILIry <br />ANY AI.JTO <br />O\l/l'lED <br />AUTOS ONLY <br />HIRED <br />AUTOS ONLY <br />SCHEDULED <br />AUTOS <br />NON-OWNED <br />AUTOS ONLY <br />$ <br />BODILY INJURY (Per person)$ <br />BODILY INJURY (Per accident)$ <br />$ <br />$ <br />UMBRELLA LIAB <br />EXCESS LIAB <br />OCCUR <br />CLAIMS.I\1ADE <br />EACH OCCURRENCE $ <br />AGGREGATE $ <br />DFD RETENTION $$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANYPROPRIETOR/PARTNER/EXECUIIVE <br />OFFICER/MEMBER EXCLUDED? <br />(Mandatory in NH) <br />lf yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />Y/N <br />N/A <br />PTR <br />STATI ITF f,TH. <br />:R <br />E.L EACH ACCIDENT $ <br />E,L DISEASE . EA EI\,4PLOYEE $ <br />E,L. DISEASE - POLICY LIMIT $ <br />A Professional Liability u54661 11t29t2021 11t29t2022 Per lncident <br />Aggregate <br />1,000,000 <br />6,000,000 <br />OESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be aftached if more space is required) <br />Occurrence Coverage <br />Nurse Practitioner Group <br />Professional Liabilitv Additional lnsured <br />Kittitas County <br />230 Grant Rd Ste 827 <br />Ellensburg, WA98926 <br />General Liability Additional lnsured <br />Kittitas County <br />230 Grant Rd Ste 827 <br />Ellensburg, WAg8926 <br />CATE HOLDER CANCELLATION <br />@ 1988-2016 ACORD CORPORATTON. Ail rights reserved. <br />The ACORD name and logo are registered marks of AGORD <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF, NOTICE WLL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Kittitas County <br />__--} <br />AUTHORIZEO REPRESENTATIVE <br />ACORD 25 (2016103)