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--ACORD-\--' <br />KITTCOU.Ol <br />CERTIFIGATE OF LIABILITY INSURANCE DATE (MM/DDiYYYY) <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 POLICIES <br />BELOW. THIS CERTIFICATE OF TNSURANCE DOES NOT CONSTTTUTE 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 ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. <br />policy, certain policies may require an endorsement. A statement on <br />endorsement(s). <br />If SUBROGATION IS WAIVED,subject to the terms and conditions of the <br />this certificate does not confer to the cedificate holder in lieu of such <br />Hor'(866) 332-7487 <br />e l.com <br />PRODUCER <br />Hub lnternational Northwest LLG <br />391'l Castlevale Rd Ste 201 <br />Yakima, WA 98902 <br />tNsuRERA: MedChoice Risk Retention Group. lnc.15738 <br />INSIJRER B : <br />INSURER C <br />INSIJRER D <br />Kittitas Gounty Public Hospital District #1 <br />603 S Ghestnut St <br />Ellensburg, WA 98926-3875 <br />INSURED <br />INSURER E : <br />INSURER F : <br />THIS IS TO CERTIFY 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 CONDITION OF ANY CONTMCT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREINISSUBJECTTOALLTHETERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSRtTo TYPE OF INSURANCE ADDLtNsn SUBR POLICY NUMBER POLICY EFF <br />IMM'hh/w| <br />POLICY EXP LIMITS <br />A x COMMERCIAL GENERAL LIABILITY <br />X CLAIMS-MADE OCCUR <br />LIMIT APPLIES PER: <br />tFSi [-1r-o" <br />s00005046 3t'1t2023 3t1t2024 <br />EACH OCCURRENCE $1,000,000 <br />DAMAGE TO RENTED <br />PRFMISFS /Fa ncnrrrran.e\s -- l4o9r!99 <br />$ 5,000 <br />s 1,000,000 <br />MED EXP (Anv one Derson) <br />PERSONAL & ADV INJURY <br />GENERAL AGGREGATE s 5,000,000 <br />PRODI.JCTS - COMP/OP AGG $5,000,000 <br />$lncluded <br />AUTOMOBILE LlAAILITY <br />ANY AUTO <br />OWNED <br />AUTOS ONLY <br />HIRED <br />AUTOS ONLY <br />SCHEDULED <br />AUTOS <br />NON-OWNED <br />AUTOS ONLY <br />COMBINED SINGLE LIMIT s <br />BODII Y lN.ltlRY /Per nersonl s <br />BOnll Y lN.ll IRY /Per accirlent\g <br />PROPERW DAMAGE <br />UMBRELLA LIAB <br />EXCESS LIAB <br />OCCUR <br />CLAIMS-MADE <br />EACH OCCURRENCE $ <br />AGGREGATE $ <br />DED RETENTION $ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANY PROPRIETOFYPARTNER/EXECUTIVE <br />OFFICERYMEMBER EXCLUDED?(Mandatory in NH) <br />lf yes, describe under <br />DFSCRIPTION OF OPFRATIoNS hal6w <br />N/A <br />PER <br />STATI ITF OTH-FR <br />E L EACH ACCIDENT s <br />F I DISFASF - FA FMPI OYFF $ <br />F I DISFASF - POI ICY I IMIT $ <br />A <br />A <br />Medical Malpractice <br />Medical Malpractice <br />500005046 <br />500005046 <br />3t1t2023 <br />3t1t2023 <br />3t1t2024 <br />3t1t2024 <br />Each Claim <br />Aggregate <br />1,000,000 <br />5,000,000 <br />OESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space ls requlred) <br />Proof of lnsurance, <br />Proof of lnsurance <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />tlptwk;matw <br />@ 1988-2015 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />ACORD 2s (2016/03)