HomeMy WebLinkAboutSH17-040 2018 INMATE MEDICAL - 2018 Insurance PoliciesPhysicians 13015econdAveeanue S e 00
Insurance °°
A MUTUAL COMPANY
F (206)343-7100
PHYSICIAN &SURGEON PROFESSIONAL LIABILITY POLICY
DECLARATIONS PAGE
Policy Number:241181000
Named Insured/Mailing Address
John R Walters,MD
Family Health Care of Ellensburg
107 E Mountain View Ave Ste 1
Ellensburg,WA 98926
POLICY PERIOD:January 1,2018 to January 1,2019 at 12:01 a.m.Pacific Standard Time
The limit of the Company's liability shall be as stated subject to all provisions of the policy.
LIMITS OF
COVERAGES LIABILITY PREMIUM
A.Medical Professional Liability $1,000,000 Each Medical Incident $10,373
$5,000,000 Aggregate
Retroactive Date:September 1,2007
B.Reserved
C.Reserved
LIMITS OF
INSURANCE
D.Disciplinary Proceeding Defense $50,000 Per Investigation Included
Reimbursement $50,000 Aggregate
2018 Total Premium $10,373
This policy is issued for the period stated above and may be renewed at the option of the Company.The terms and
conditions of the policy shall remain unchanged for succeeding policy years unless endorsed by the Company or a new
policy is issued at the time of renewal.
To the extent permitted by law and subject to the approval of the Washington State Insurance Commissioner,the Company
has a right to increase its surplus by issuing a capital call on its members.
DEC-PISTD.010110 11/16/17 Rate Code:WA Class:12 241181
Physicians s.Insurance
A MUTUAL COMPANY
CONFIRMATION OF INSURANCE COVERAGE
PROFESSIONAL LIABILITY INSURANCE POLICY
CLAIMS-MADE
Named Insured:Elkhorn Valley Corp dba Family Health Care Policy Number:002258000
of EIIensbura
Paramedical Employee:Aaron David Long,ARNP Reference Number:376778
Mailing Address:107 E Mountain Vw Ave Ste 1
Ellensburg,WA 98926
POLICY PERIOD:January 1,2018 to January 1,2019
at 12:01 a.m.local time at the address shown above
RETROACTIVE DATE:September 1,2012
This document will confirm that Physicians insurance A Mutual Company (the
Company)provides professional liability insurance to Aaron David Long,ARNP,
subject to the Company's minimum liability limits of $1,000,000 each medical
incident and $5,000,000 aggregate.
The certificate of insurance is issued as a matter of information only and confers
no rights upon the certificate holder.This confirmation does not amend,extend or
otherwise alter the terms,conditions or limits of the insurance afforded by the
policy.If the Policy,or coveragefor any person,is canceled for any reason or if
the terms of the policy are changed,we will notify the Named Insured only.
This confirmation was issued on November16,2017.
To our Insureds:This confirmation of coverage is provided for your use for hospital privilege requirements,
HMOs,PPOs,etc.You are authorized to photocopy and distribute as needed without further permission
from or notification to the Company.
376778 72 376778 002258
COI-Pl.080712
Physicians
Insurance |°°°
A MUTUAL COMPANY
F (206)343-7100
CONFIRMATION OF INSURANCE COVERAGE
PROFESSIONAL LIABILITY INSURANCE POLICY
CLAIMS-MADE
Named Insured:Elkhorn Valley Corp dba Family Health Care Policy Number:002258000
of Ellensbura
Paramedical Employee:Ryan Beachy,PA-C Reference Number:240453
Mailing Address:107 E Mountain Vw Ave Ste 1
EIIensburg,WA 98926
POLICY PERIOD:January 1,2018 to January 1,2019
at 12:01 a.m.local time at the address shown above
RETROACTIVE DATE:February 4,2009
This document will confirm that Physicians Insurance A Mutual Company (the
Company)provides professional liability insurance to Ryan Beachy,PA-C,
subject to the Company's minimum liability limits of $1,000,000 each medical
incident and $5,000,000 aggregate.
The certificate of insurance is issued as a matter of information only and confers
no rights upon the certificate holder.This confirmation does not amend,extend or
otherwise alter the terms,conditions or limits of the insurance afforded by the
policy.If the Policy,or coverage for any person,is canceled for any reason or if
the terms of the policy are changed,we will notify the Named Insured only.
This confirmation was issued on November 16,2017.
To our Insureds:This confirmation of coverageis provided for your use for hospital privilege requirements,
HMOs,PPOs,etc.You are authorized to photocopy and distribute as needed without further permission
from or notification to the Company.
240453 73 240453 002258
COI-PI.080712