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ACORO® CERTIFICATE OF LIABILITY INSURANCE <br />CERTIFICATE <br />DAM <br />11/101 <br />11/10/202211 <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 INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <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 endomement(s). <br />PRODUCER <br />NAME: CONTACT CM&F Group <br />CM&F Group Inc. <br />IPML, Ert: 1-800-221-4904 uc No: <br />nDDS mLL53: info@cmfgroup.com <br />110 West 40th Street <br />10th Floor, Suite 1000/1001 <br />New York, NY 10018 <br />INSURE S AFFORDING COVERAGE NAIC0 <br />INSURERA: MEDICAL PROTECTIVE COMPANY -MPC <br />EACH OCCURRENCE $ 1,000,000 <br />INSURED <br />INSURERB: <br />INSURER C, <br />Ellensburg Family Medicine <br />2156 PAYNE RD <br />ELLENSBURG, WA98926-7898 <br />INSURER o <br />PREMISES Ea occurrence S 1,000,000 <br />INSURERE: <br />INSURERF: <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />ILTR <br />TYPE OF INSURANCE <br />ADOL <br />SUER <br />POUCYNUMBER <br />POLICY EFF <br />MMIDOrfyyy) <br />POLICY EXP <br />IMM1DDIYYYY1 <br />UNITS <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />U54661 <br />11/29/2021 <br />11/29/2022 <br />EACH OCCURRENCE $ 1,000,000 <br />CLAIMS -MADE 1571 OCCUR <br />PREMISES Ea occurrence S 1,000,000 <br />MED EXP (Anyone Person) $ <br />PERSONAL &ADV INJURY $ 1,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />GENERALAGGREGATE $ 6,000,000 <br />X POLICY PRO- LOC <br />ECT <br />PRODUCTS-COMP/OPAGG $ 6,000,000 <br />$ <br />OTHER: <br />AUTOMOBILEUABILITY <br />COMBINED SINGLE UNIT $ <br />Ee .WdImi <br />BODILY INJURY (Por pemon) $ <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />BODILY INJURY (PerawlOeM) $ <br />PROPERTY DAMAGE $ <br />Per accident <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />UMBRELALIAR <br />H <br />OCCUR <br />EACH OCCURRENCE $ <br />AGGREGATE $ <br />EXCESS UAB <br />CLAIMS MADE <br />DED RETENTION$ <br />$ <br />WORKERSCOMPENSATION <br />ANDEMPLOYERS'LUIBIUTY YIN <br />PER OTH- <br />STATUTE ER <br />EACH ACCIDENT $ <br />ANYPROPRIETOWPARTNEWEXECUTIVEEL <br />OFFICERIMEMBEREXCWDEDT F-1 <br />NIA <br />EL -DISEASE EA EMPLOYEE $ <br />(Mandatory In NH) <br />If Yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />EL DISEASE - POLICY LIMIT $ <br />A <br />Professional Liability <br />X <br />U54661 <br />11/29/2021 <br />11/29/2022 <br />Per Incident 1,000,000 <br />Aggregate 6,000,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more apace Is required) <br />Occurrence Coverage Professional Liability Additional Insured: <br />KiBitas County <br />Nurse Practitioner Group 205 W 5th Ave <br />Ellensburg, WA98926 <br />CERTIFICATE HOLDER CANCELLATION <br />205 County <br />205 WHOULD <br />5th AveAVB <br />Ellensburg, WA98926 <br />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 />AUT/HORREDREPRESENTATIVE <br />© 1988-2016 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />