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Physicians 13015econdAveeanue S e 00 <br />Insurance °° <br />A MUTUAL COMPANY <br />F (206)343-7100 <br />PHYSICIAN &SURGEON PROFESSIONAL LIABILITY POLICY <br />DECLARATIONS PAGE <br />Policy Number:241181000 <br />Named Insured/Mailing Address <br />John R Walters,MD <br />Family Health Care of Ellensburg <br />107 E Mountain View Ave Ste 1 <br />Ellensburg,WA 98926 <br />POLICY PERIOD:January 1,2018 to January 1,2019 at 12:01 a.m.Pacific Standard Time <br />The limit of the Company's liability shall be as stated subject to all provisions of the policy. <br />LIMITS OF <br />COVERAGES LIABILITY PREMIUM <br />A.Medical Professional Liability $1,000,000 Each Medical Incident $10,373 <br />$5,000,000 Aggregate <br />Retroactive Date:September 1,2007 <br />B.Reserved <br />C.Reserved <br />LIMITS OF <br />INSURANCE <br />D.Disciplinary Proceeding Defense $50,000 Per Investigation Included <br />Reimbursement $50,000 Aggregate <br />2018 Total Premium $10,373 <br />This policy is issued for the period stated above and may be renewed at the option of the Company.The terms and <br />conditions of the policy shall remain unchanged for succeeding policy years unless endorsed by the Company or a new <br />policy is issued at the time of renewal. <br />To the extent permitted by law and subject to the approval of the Washington State Insurance Commissioner,the Company <br />has a right to increase its surplus by issuing a capital call on its members. <br />DEC-PISTD.010110 11/16/17 Rate Code:WA Class:12 241181