PROOF OF INSURANCE (2024 - 2025)DATE (MMIDD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE
04/15/2024
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER CONTAC. Xanh Tran
NAME:
IQ Risk Insurance Services, LLC 'AJCPHONE Ext ^ (949) 679-3700 FAt No (949) 679-3701
8881 Research Dr E=MAUL xtran@igrisk.com
ADDRESS'
_.....
INSURER(S) AFFORDING COVERAGE NAIC #
Irvine CA 92618 INSURERA: Travelers Casualty Insurance Company ofAmerica 19046
....... ..........
INSURED INSURER B : Travelers Property Casualty Company ofAmerica 25674
Pacific Harbor Medical Group INSURER C :
360 N Pacific Coast Hwy INSURER D
Ste 3000 INSURER E :
ElSegundo CA 902454430 INSURER F :
rnvGoer_Gc r`FRTIFI! ATF NIIMRFR• CL2431212352 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
ILTR
TYPE OF INSURANCE
INSD
WVD
POLICY NUMBER
MMMI�D/YYFYY)
TTR
LIMITS
X COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 2,000,000
PRE rcc'turvenue
300,000
CLAIMS -MADE � OCCUR
$
MED EXP (Any one person)
$ 5,000
A
Y
6809XO86391
03/01/2024
03/01/2025
PERSONAL & ADV INJURY
$ 2,000,000
GENERAL AGGREGATE
$ 4,000,000
11 GEN'LAGGREGATE LIMIT APPLIES PER:
• POLICY D ' Coi LOC
PRODUCTS - COMP/OP AGG
4 000 000
$ '
Info Security Llab
$ 100,000
OTHER:
AUTOMOBILE LIABILITY
C ''W4MI4 09t0LE LIMIT
f'Ers arcide.nt
$ 2,000,000
W
ANYAUTO
BODILY INJURY (Per person)
$
A
OWNED SCHEDULED
Y
6809XO86391
03/01/2024
03/01/2025
BODILY INJURY (Per accident)
$
AUTOS ONLY AUTOS
XHIRED NON -OWNED
PROPERTY DAMAGE
Per accPs'denU
•••
$
_.
AUTOS ONLY AUTOS ONLY
'
X UMBRELLALIAB X' OCCUR
EACH OCCURRENCE
$ 1,000,000
AGGREGATE
$ 1,000,000
A
EXCESS LIAB CLAIMS -MADE
Y
CUP2Y794830
03/01/2025
03/01/2025
DED RETENTION $
$
WORKERS COMPENSATION
X STATUTE '... ER PER OR
"""'�
AND EMPLOYERS' LIABILITY YIN
1,000,000
B
ANY PROPRIETOR/PARTNER/EXECUTIVE
NIA
UB9X08750A
03/01/2024
03/01/2025
EL EACH ACCIDENT
•••••
$ -
OFFICERIMEMBEREXCLUDED?
1,000,000
(Mandatory in NH)
E1. DISEASE - EA EMPLOYEE
$
E.L. DISEASE - POLICY LIMIT__T
1,000,000
•$ '
.. ........
If yes, describe under
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
*10 Days Notice of Cancellation for Non -Payment of Premium.
The City of El Segundo, Elected Officials, Agents, Employees and Volunteers (collectively City of El Segundo and its Agents) are included as Additional
Insureds as respects to General Liability.
CERTIFICATE HOLDER
City of El Segundo
350 Main Street
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
ElSegundo CA 90245,
rr
@ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
COOPERATIVE OF
AMERICAN PHYSICIANS
CERTIFICATE OF COVERAGE AND CLAIMS HISTORY
Covergage through December 31, 2024
Member: Paz P. Eilat, MD
Address: 360 N Sepulveda Blvd #3000
El Segundo, CA 90245
This certificate confirms that, effective on the coverage date below, the above -named physician is a member of the Cooperative of
American Physicians, Inc. (CAP) and a participant in the Mutual Protection Trust (MPT), MPT is an unincorporated
interindemnity arrangement organized under California Insurance Code section 1280.7. This certificate confers no rights upon the
member and does not amend, extend or alter the coverage afforded under the terms, conditions and exclusions of the MPT
AgrcemenL
Membership Number Medical Specialty Coverage Date Retroactive Coverage Date
23332 Internal Medicine November 1, 2013 None
Subspecialty
Urgent Care Medicine
Coverage (Claims made and paid) Current Limits of Liability
Medical Professional Liability Coverage S1,000,000 for all Claims based
upon an Occurrence
$3,000,000 each calendar year
aggregate
The member must remain a Member in good standing or arrange for Tail Coverage for any open or potential Claim that may arise
during the Coverage Period. Neither CAP nor MPT undertake any obligation to advise any party, other than the named member,
of any changes to or termination of this coverage.
Claims History
No Claims Reported
The Claims history listed above includes all Claims that are currently open and those that were closed within the last five years
The Claims history does not include payments for emergency or other remedial expenses that may have been made to patients
through MPT's Patient Assistance Services program.
Cooperative of American Physicians, Inc.
December 28, 2023
Alfred De Leon Date
Vice President, Membership Services
Mutual Protection Trust
COOPERATIVE OF
AMERICAN PHYSICIANS
CERTIFICATE OF COVERAGE AND CLAIMS HISTORY
Covergage through December 31, 2024
Member: Joseph N. Mikhail, MD
Address: 360 N Sepulveda Blvd #3000
El Segundo, CA 90245
This certificate confirms that, effective on the coverage date below, the above -named physician is a member of the Cooperative of
American Physicians, Inc, (CAP) and a participant in the Mutual Protection Trust (MPT). MPT is an unincorporated
interindemnity arrangement organized under California Insurance Code section 1280.7_ This certificate confers no rights upon the
member and does not amend, extend or alter the coverage afforded under the terms, conditions and exclusions of the MPT
Agreement.
Membership Number Medical Specialty Coverage Date Retroactive Coverage Date
23331 Family Medicine, With Minor November 1, 2013 None
Surgery
Coverage (Claims made and paid) Current Limits of Liability
Medical Professional Liability Coverage $1,000,000 for all Claims based
upon an Occurrence
$3,000,000 each calendar year
aggregate
The member must remain a Member in good standing or arrange for Tail Coverage for any open or potential Claim that may arise
during the Coverage Period. Neither CAP nor MPT undertake any obligation to advise any party, other than the named member,
of any changes to or termination of this coverage.
Claims History
No Claims Reported
The Claims history listed above includes all Claims that are currently open and those that were closed within the last five years
The Claims history does not include payments for emergency or other remedial expenses that may have been made to patients
through MPT's Patient Assistance Services program.
Cooperative of American Physicians, Inc.
December 28, 2023
Alfred De Leon Date
Vice President, Membership Services
Mutual Protection Trust
COOPERATIVE OF
AMERICAN PHYSICIANS
CERTIFICATE OF COVERAGE AND CLAIMS HISTORY
Covergage through December 31, 2024
Member: Peter N. Mikhail, DO
Address. 360 N Sepulveda Blvd 93000
El Segundo, CA 90245
This certificate confirms that, effective on the coverage date below, the above -named physician is a member of the Cooperative of
American Physicians, Inc. (CAP) and a participant in the Mutual Protection Trust (MPT). MPT is an unincorporated
interindemnity arrangement organized under California Insurance Code section 1280.7. This certificate confers no rights upon the
member and does not amend, extend or alter the coverage afforded under the terms, conditions and exclusions of the MPT
Agreement.
Membership Number Medical Specialty
16235 Family Medicine, With Minor
Surgery
Subspecialty
Sports Medicine, Primary C
Coverage (Claims made and paid)
Medical Professional Liability Coverage
Coverage Date Retroactive Coverage Date
September 1, 2006 None
Current Limits of Liability
$1,000,000 for all Claims based
upon an Occurrence
$3,000,000 each calendar year
aggregate
The member must remain a Member in good standing or arrange for Tail Coverage for any open or potential Claim that may arise
during the Coverage Period. Neither CAP nor MPT undertake any obligation to advise any party, other than the named member,
of any changes to or termination of this coverage.
Claims History
No Claims Reported
The Claims history listed above includes all Claims that are currently open and those that were closed within the last five years
The Claims history does not include payments for emergency or other remedial expenses that may have been made to patients
through MPT's Patient Assistance Services program.
Cooperative of American Physicians, Inc.
December 28, 2023
Alfred De Leon Date
Vice President, Membership Services
Mutual Protection Trust