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^RD CERTIFICATE OF LIABILITY INSURANCE °^¾ñ2°o <br />THIS CERTIFICATEIS ISSUED AS A MATTER OF [NFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFlCATEHOLDER,THISCERTIFICATEDOESNOTAFFIRMATIVELYORNEGATIVELYAMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW.THIS CERTIFICATEOF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZEDREPRESENTATIVEORPRODUCER,AND THE CERTIFICATEHOLDER. <br />iMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAlVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on <br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br />PRODUCER NTACT CM&F Group <br />CM&F Group Inc o.Ext);1-800-2214904 C,No}:110 West 40th Street info@cmfgroup.com10thFloor,Suite 1000/1001 <br />NewYork,NY 10018 IN'jiURER(S)AFFORDINGCOVERAGE NAIC# <br />INSURERA:MEDICAL PROTECTIVE COMPANY-MPC <br />INSURED INSURER B: <br />Ellensburg Family Medicine NSURER c: <br />2156 PAYNE RO <br />lNSURER DELLENSBURG,WA98926-7898 <br />INSURER E <br />I[NSURER F :i <br />COVERAGES CERTIFICATE NUMBER:REVISIONNUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITlON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATEMAYBEISSUEDORMAYPERTAIN,THE INSURANGE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONSOF SUCH POLICIES LlMETS SHOWN MAY HAVE BEEN REDUCED BY PA1D CLAIMS. <br />ÏNŠR dADDL|SUBR POLICYEFF <br />|PGLICYEXPLTRTYPEOFIN$URANCE <br />|INSU i M i POLICY NUMBER MMIOD/YYYY)(MMIDDIYYYY)LIMITS <br />A X COMMERCIAL GENERAL LIABILITY US4661 11/29/2021 11/29/2022 EACH OCCURRENGE s 1,0DD,000 <br />||f5KRFÆGETðld-NII-0CLAIMSMADEXOCCURPREMISES(Ea occurrence)s 1,000,000 <br />MED EXP (Any one person)5 <br />PERSONALAADVlNJURY $1,ÛQÜ,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE S Û.ÛÛÜ,000 <br />POLËCY JERC LOC PRODUCTS-COMPIOPAGG S 6.OOÛ.ÜOÛ <br />OTHER:S <br />AUTOMOBILELIABILITY MS En t)SINGLEUMIT <br />g <br />ANY AUTO 80DJLY INJURY (Per person)5 <br />U <br />OSDONLY TH ULEO BODILY INJURY (Per acciderrt)S <br />HIRED I NON OWNED PROPERTY DAMAGEAUTOSONI.Y ALFTOS ONLY (Per accitient)1 <br />I , <br />UMBRELLALIAB OCCUR EACHOCCURRENCE 5 <br />EXCESS LIAB CLAIMS-MADE AGGREGATE 5 <br />OE RETENTION S 5 <br />WORKERS COMPENSATION PER OTH- <br />ANDEMPLOYERS'LIABILITY YIN STATUTE ER <br />ANYPROPRIETORIPARTNERIEXECUTIVE EL EACH ACCIDEMT $OFFfCERIMEMBEREXCLUDEDT NIA <br />(Mandatory in NN)E.L.OISEASE -EA EMPLOYEE 5 <br />If yes,describe under <br />DESCRIPTION DF OPERATIONS DeϤw E I_DISEASE -POLICY LIMIT 5 <br />A Professional Liability X LI54661 11/29/2021 11/29/2022 Per Incident 1,000,000 <br />Aggregate 6,000,000 <br />DESCRIPTION OFOPERATLONS I LOCAT10NS IVEHICLES (ACDRD 101,Additional Remarks Schedule,may be attachedif more space is required) <br />Occurrence Coverage Professional Liability Additional Insured: <br />Kittitas County <br />Nurse Practitioner Group 205 W 5th Ave <br />Ellensburg,WA98926 <br />CERTIFICATEHOLDER CANCELLATlON <br />Kittilas County <br />205 W 5th Ave SHOULO ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF,NOTIGE WILL BE DELIVERED INEllensburg,WA98926 ACCORDANCE WITH THE POLICY PROVISIONS. <br />A RE NTAT <br />©1988-2016 ACORD CORPORATION.All rights reserved. <br />ACORD 25 (2016/03)The ACORD name and logo are registered marks of ACORD