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SH21-044 - ELLENSBURG FAMILY MEDICINE PSA 2 SIDED - FULLY EXECUTED
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2022-06-21 10:00 AM - Commissioners' Agenda
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SH21-044 - ELLENSBURG FAMILY MEDICINE PSA 2 SIDED - FULLY EXECUTED
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Last modified
6/16/2022 1:20:05 PM
Creation date
6/16/2022 1:18:33 PM
Metadata
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Template:
Meeting
Date
6/21/2022
Meeting title
Commissioners' Agenda
Location
Commissioners' Auditorium
Address
205 West 5th Room 109 - Ellensburg
Meeting type
Regular
Meeting document type
Supporting documentation
Supplemental fields
Alpha Order
g
Item
Request to Approve the Professional Services Agreement between Kittitas County and Ellensburg Family Medicine (Modification of the Existing Agreement)
Order
7
Placement
Consent Agenda
Row ID
90804
Type
Agreement
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The Medical Protective Company® <br />A STOCK INSURA (CE COMPAriYSEli,I Reed Rand,Fort M.myne,Indiana 4faS35strengtinDefense.50utions,since 1899. <br />MULTI-5PECIALTY HEALTHCARE *ROFESSIONAL-CERTIFICATE <br />PolicV 2021-11-29 TO:2022-11-29 certificate Number:US4661Pedod:at 12:01 a.rn.Standard Time at the address of the First Named Insured, <br />Item 1(a)Named Insured:N/A Student Non-Insured acting in the capacity of an Administrative <br />First Named Insured <br />Ellensbura Familv Medicine <br />Professional Services Specialty,NP Gmup <br />Classification:N/A Iti....1(f.)Addit;ù..¿.I I..su.uds. <br />First Named Insured Address: <br />2156 PAYNE RD <br />ELLENSBURG.WA 98926-7898 New Busine s X Renewal Business <br />P=ILICY TYi E*RETROACTIVE LIMITS OF LIABILITYCOVERAGES:Standard ConvertibleOccurrenceOaimsMadeClaimsMade DATE Per Gaim /Aqqregate <br />PROFESSIONAL LIABILny $1,000,000 $6,000,000 <br />A.Professional Liabilty (PL)&Included Included <br />B.Good Samaritan Acts $25,000 $25,000 <br />C.Assault Upon You $15,000 $15 000 <br />D.First Aid $25,000 5100,000 <br />E.Medical Payments <br />F.Deposition Fees X $10,000 510 000 <br />-Administrative Hearing Expense $25,000 5100,000 <br />-Sexual Misconduct Expense $25,000 525,000 <br />-Loss of Earnings $2,500 535,000 <br />-HIPAA Proceeding Expense 525,000 $25,000 <br />-Biomedical Waste Hearing Expense $10,000 $10,000 <br />WORKPLACE LIABILTTY <br />A.Healthcare Professional Premises <br />Liability & <br />B.Personal Injury Liability <br />Workplace Lisalility dans narapplyit the deneral Uahifîly insuring A greemenf la sua part of your cou rage. <br />EMPLOYMENT PRACTICES LIABILITY" <br />CYBER LIABILITY <br />BILLING PRACTICES ®ULATORY <br />COMMERCÎAL GENERAL LIABILITY <br />-Each Occurrence Limit $1,000 000 <br />-Damages to Premises Rented $1,000,000 <br />to an Insured Business $1,000,000 <br />-Personal &Advertising Injury X <br />-General Aggregate Limit $6,000,000 <br />-Product Completed Operations Aggregate $6,000,000 <br />-Hired and Non-Owned Auto <br />GenerufLiebiHtrduesrrorappIrifthuWurkplacrUabillryinsuringAyrtementismad=partoryoureuvvage. <br />FORMS &ENDORSEMENTS:Master Policy Number:|MMPOC19190 <br />[N WITNESS WHEREDF,The Medfæl Protective Company has caused this <br />policy to be signed by ils Prestdent afid Corporate Secretary (andSEEPOLICYFORMS&ENDORSEMENTS SCHEDULE countersignedbvilsduivAuthanzedRecresentative.whereneœssary) <br />Premium:$4.932.00 For Service or questions,please call:President <br />Surcharges: <br />CM&F Group,Inc.1-800-221-4904 LG RACACLawl ) <br />FOTAL:$4.932.00 Secretary <br />*THIS POLICY CONTAINS CLAIMS-MADE COVERAGE,C untersgnatureiAultiertzedRepresentative:**CLAIM EXPENSE IS PAID WITHIN THE LIMITS OF LIABILITY,NOTICE LIMITS MAY CHANGE BY COVERAGE PROVISION OR ENDORSEMENT. <br />PLEASE READ YOUR POLICY AND ENDORSEMENTSCAREFULLY. <br />DISCUSS WITH YOUR INSURANCE AGENT IF NEEDED. <br />18011 01/14
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