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PROOF OF INSURANCE (2025 - 2026)"' i DATE (MMIDDNYYY) .�►� 1Dl` CERTIFICATE OF LIABILITY INSURANCE 3/4/2025 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 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 IQ Risk Insurance Services, LLC NAME,.' Xanh Tran PHONE (949)679-3700 Nac (949)679-3101 8881 Research Dr Pg.xtran@igrisk.com AtrDR���: INSURERS AFFORDING COVERAGE NAIC # INSURERA:Travelers Casualty Insurance Co an of 19046 Irvine CA 92618 INSURED INSURER B: Travelers Property Casualt Coe an Of 25674 INSURERC: Pacific Harbor Medical Group INSURERD: 360 N Pacific Coast Hwy INSURER E: Ste 3000 INSURER F: El Segundo CA 90245-4430 COVERAGES GtKI lr'IGAIt NUMLSCK.� LGJJY IJV IJ r��n wrv,� .vm.. 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 CONTRACTOR 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. UBR POLICY EFF' POLICY F�(P INTR . TYPE OF INSURANCE AwsnOOL POLICY NUMBER MMI LIMBS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ A CLAIMS -MADE i u OCCUR X ( 16809XO86391 X I I COP2Y794830 11N/A OB9XO8750A 2.000,000 NHEMIS ;:. /W'urcroilmce X 6809XO86391 3/1/2025 3/1/2026 GEN'L AGGREGATE LIMIT APPLIES PER: .PRO X POLICY PRO- LOC OTHER:. AUTOMOBILE LIABILITY A ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X HIRED AUTOS X NON -OWNED AUTOS X UMBRELLA LIAR X OCCUR B EXCESS LIAB rl CLAIMS -A DED RETENTION WORKERS COMPENSATION AND EMPLOYERS' LUIBILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? B (Mandatory in NH) X ( 16809XO86391 X I I COP2Y794830 11N/A OB9XO8750A 2.000,000 I DAMA3L "'CO RENTED $ 300,000 MED EXP (Any one person) $ 5,000 PERSONAL BADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 4,000,000 PRODUCTS -COMP/OPAGG $ 4,000,000 COMBINED SING E UM,N I" accidentl $... 2,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ 3/1/2025 3/1/2026 PROPEFITY OAiMAAGE (Per . .I�.. p $ EACH OCCURRENCE $ 1 000,000 AGGREGATE $ 1,000,000 $ M. 3/1/2025 3/1/2026 E.L. EACH ACCIDENT $ 1 3/1/2025 3/1/2026 E.L.WDISEASE - EA EMPLOYEE $ 1 E L DISEASE - POLICY LIMIT $ 1 DESCRIPTION OF OPERATIONS / LOCATIONS / 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 E1 Segundo, Elected Officials, Agents, Employees and volunteers (collectively City of E1 Segundo and its Agents) are included as Additional Insureds as respects to General Liability. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE 1� Xanh Tran/XANH V _ ^, © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401) 0 1111111111-- . .... . . ..... COOPERATWE OF AMERICAN PHYSICIANS CERTIFICATE OF COVERAGE Coverage through December 31, 2025 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 interindernnity 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 23332 Internal Medicine November 1, 2013 None Subspecialty Urgent Care Medicine 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, Cooperative of American Physicians, Inc. w November 19, 2024 Alfred......_..... .._.......... De Leon Date Vice President, Membership Services Mutual Protection Trust