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^D CERTIFICATE OF LIABILITY INSURANCE °^1°2°o <br />THIS CERTIFICATEIS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATEHOLDER.THISCERTIFICATEDOESNOTAFFIRMATIVELYORNEGATLVELYAMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW.THIS CERTLFICATE OF INSURANCEDOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED <br />REPRESENTATIVE OR PRODUCER,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 WAIVED,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 LO T CT CM&F Group <br />CM&F Group inc.(Tc NEu,En):1-800-221-4904 A C,Nol: <br />110 West 40th Street geMD Ess:info@cmfgroup.com <br />10th Floor,Suite 1000/1001 <br />NewYork,NY 10018 INSURER(B)AFFORDINGCOVERAGE NAIC# <br />fNSURERA:MEDICAL PROTECTIVE COMPANY-MPC <br />INSURED (NSURER B <br />Ellensburg Family Medicine INSURERC: <br />2156 PAYNE RO <br />ELLENSBURG,WA98926-7898 <br />FNSURERE: <br />FNSURER F : <br />COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUREO NAMED ABOVE FOR THE POLICY PERIODINDICATED.NOTWETHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERT1FICATEMAYBEISSUEDORMAYPERTAIN,THE INSURANCE AFFORDED BY THE POLPCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDíTIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLA1MS. <br />INSR|IADOLSUBR POUCYEFF \POLICYEXPLTRITYPEOFINSURANCEggggPOLICYNUMBER(MMIDDIYYYYll[MM10DIYYYY LIMITS <br />A X COM#IERCIALGENERALUABIUTY X U54661 11/29/2021 11/29/2022 EACHOCCURRENCE s 1,000,000 <br />DÄNIAGE TO RENTEDCLAIMSMADEXoccuRPREMISES(Ea accurrence)s 1,000,000 <br />MEO EXP (Any one person)5 <br />PERSONAL&ADVINJURY S <br />1,000,000 <br />GEN L AGGREGATE UM IT APPLIES PER:GENERAL AGGREGATE a 6,000,000 <br />X POLICY ERG LOC PRODUCTS-COMPIOPAGO s 6,000,000 <br />i OTHER: <br />AUTOMDBfLE LLABILITY <br />En <br />80ydE SINGLE LlMIT <br />5 <br />ANY AUTO BCDILY INJURY (Per pam¡on)5 <br />AO ES <br />ONLY <br />I OULED BODILY INJURY (Per accident)S <br />HIRED NON WNED PROPERTY DAMAGEAUTOSONLY_AUTOSONLY (Peraccident) <br />UMBRELLALIAB OCCUR EACHOCCURRENCE S <br />EXCESS LIAB CLAIMS-MADE AGGREGATE s <br />DED RETENTlON S $ <br />WORKER$COMPENSATION |PER (|OTH- <br />ANDEMPLOYERS'LLABILITY YlN i STATUTE I i ER <br />ANYPROPRIETORIPAATNERIEXECUTIVE E.L EACH ACCIDENT 5OFFICER/MEMEIER EXCLUDED9 N i A <br />(Mandatory in NN)E.L DISEASE -EA EMPLDYEE S <br />If yes,describe under <br />DESCRIPTION OF OPERATIONS below EL DISEASE -POUCY UMIT 5 <br />A Professional Liability U54681 11/29/2021 11/29/2022 Per Incident 1,000,000 <br />Aggregate 6,000,000 <br />DESCRIPTlON OF OPERATIONS ?LOCATIONS /VERICLES (ACORD 101,Add[tlanal Remarks Schedule,may be attachedir more space is required) <br />Occurrence Coverage General Liability Additional Insured: <br />Kittitas County <br />Nurse Practitioner Group 230 Grant Rd Ste B27 <br />Ellensburg,WA98926 <br />CERTIFICATEHOLDER CANCELLATION <br />Kittitas County <br />230 Grant Rd Ste B27 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPERATION DATE THEREOF,NOTICE WILL BE DELIVERED IN205W5thAveAccCRDANCEWITHTHEPOLICYPROVISIONS,Ellensburg,WA98926 <br />AUTHORIZEDREP EN <br />©1988-2016 ACORD CORPORATLON.AII rights reserved. <br />ACORD 25 (2016/03)The ACORD name and logo are registered marks of ACORD