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-ga CERTIFICATE OF LIABILITY INSURANCE °^ÌToÎ2°o <br />THIS CERTIFICATEIS [SSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RJGHTS 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 CERTIFICATEOF INSURANCE DOES NOT CONSTITUTEA 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 an <br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br />PRODUCER T CT CM&F Group <br />CM&F Group inc.ZNE <br />y <br />1-800-221-4904 No): <br />110 West 40th Street (MO <br />ESS:i fD®cmfgroup.com <br />10th Floor,Suite 1000/1001 <br />New York,NY 1DO18 INSURER(S)AFFORDING COVERAGE NAIC # <br />INSURERA:MEDICAL PROTECTIVE COMPANY-MPC <br />INSURED INSURER B : <br />Ellensburg Family Medicine INSURERC: <br />2156 PAYNE RD INSURERO:ELLENSBURG,WA98926-7898 i <br />INSURER E :I <br />INSURERF: <br />COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: <br />TH[S IS TO CERT1FY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONOITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHlCH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSEONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED By PAID CLAIMS. <br />[NSR |ADOL]SUBR I POLICY EFF I POUCY EXP <br />LTR I TYPE OF INSURANCE I INSD WVR PoucY NUMBER |(MMID0tYYYY}(MMí0DIYYYY)LIMITS <br />A X 1 COMMERCIALGENERALLIABILITY LIS4661 11/29/2021 11/29/2022 EACHOCCURRENCE 5 1,000,000 <br />CLAIMS-MADE OCCUR r <br />EubcNe rrDence) <br />s 1,000,000 <br />MED EXP (Any one person)$ <br />PERSONALAADVINJURY s 1,000,000 <br />GËN'L AGGREGATE LIM T APPUES PER GENERAL AGGREGATE s 6,000,000 <br />X POUCY ERC LOC PRODUCTS-COMPIOPAGG s 6,000,000 <br />i OTHER S <br />AUTOMOBILELIABILITY EOaMa dE SINGLELlMIT <br />g <br />ANY AUTO BODILY 1NJURY (Per person)5 <br />AU <br />OESDONLY THEDULED BODILY INJURY (Per accident)5 <br />HIRED NON-OWNED PROPERTYDAMAGE <br />gAUTOSONLYAUTOSONLY(Per âncidenn <br />UMBRELLALIAB OCCUR EACHOCCURRENCE S <br />EXCESS LIAS CLAIMS-MADE AGGREGATE 5 <br />OED RETENTIONS 8 <br />WORKERS COMPENGATION PER OTH- <br />AND EMPLOYERS'LIABILITY YlN STATUTE ER <br />ANYPROPRIETORIPARTNERIEXECUT1VE E.L EACH ACCIDENT $OFFICERIMEMBER EXCLUDED7 <br />(Mandatory In NH)EL DISEASE -EA EMPLOYEE S <br />if yes,describe under <br />DESCRIPTION OF OPERATIONS telow EL Ol5EASE -POUCY LLMIT S <br />A Professional Liability U54661 11/29/2021 11/29/2022 Per Incident 1,000,000 <br />Aggregate 6,000,DOD <br />I <br />DESDRIPT10N OFQPERATIONS /LOCATlONSIVEHICLES (ACORD 101,Additional Rettiarks Schedule,muy be attached ir mom space is required) <br />Occurrence Coverage <br />Nurse Practitioner Group <br />CERTIFICATEHOLDER CANCELLATION <br />Kittitas County SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELLVERED IN <br />ACCORDANCE WITH THE POLICY PROVISLONS. <br />A N <br />©1988-2015 ACORD CORPORATION.AII rights reserved. <br />ACORD 25 (2016/03}The ACORD name and logo are registered marks of ACORD