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PROOF OF INSURANCE (2010) CLOSEDACORD CERTIFICATE OF LIABILITY PRODUCER (800) 955 -5578 FAX: (800) 530-5725 Palos Verdes insurance Agency 314 Vista Del Mar, PO Box 636 DATE IMMIDWYYYY) INSURANCE 1 11/29/2008 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, Redondo Beach CA 90277 -0636 INSURED INSURERS AFFORDING COVERAGE NAIC [1N5URERA Maryland Casualty Co Westchester Medical Group INSURER p 360 N Sepulveda Blvd #3000 INSURER El Segundo Ca 90245 1NstjRVR I �T INW5URER E' COVERAGES 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 ATE LIMITS SHOWN MAY HAVE L A1PAS.__ HYSR ADD'! POUCY EFFECTIVE POLICY EXPIRATION LIMITS TYPE OF INSURANCE POLICY NUMBER DATE M1D DATE MMIDDIYY A % GENERAL LLAB/UTY % P[TArMEHCIAL GENERat_ LIABxLiTY -71 CLAiMSMAOE 5% OCCUR PA837248433 1/2/2009 1/2/2010 .E&Qk' Dw� %rti RRP CE_.___ 5 1,000,000 DAMAGE TO RENTED nR LIE_ scF� :Ea 292=rs' 1,000,000 $ ME6Exi�lar•nra crwn' b _ 10,000 PERSONAL 11 AOV INJURY, -- b_ _ 1 r 000 , 000 -- --- ,_--- -. .�y NEHAL AGGREGA7E b 2,000,000 GFN1,A5GRECiAIEL RAP APPLIES PER . PRf II C IS- rQ'-w— G 3 ___ 1,000,000 PRO- P POL.CY T Lou AUTOMOBILE LIABILITY ANY AUTO 1 COUBINED SINGLE uUiT IEa accxfeMj 3 1 '0 00,000 06DILY akJUHY IT'a" PN'bcn% i ALL OWNEDAU705 SCREDULEU AUTOS PAS37248433 1/2/2009 1/2/2010 X 5 A X HIRED AI %TOS NUN- OWNEOAUTOS BODILY INJI', 41"awden 1) X PROPERTYDA.MAGE (Per accidard) 3 GARAGE LIABILITY AUTO) ONLY - EA ALCIIJENT b OTHER `HAN EA A .' ANV Al IlU S AUTO ONLY EXCESSIUMBRELLA LIABRJTY EA'-H AGGREGATE OCC:JR L] CLAIMSNWA t DEDUCTIBLE 3 RE7ENTI.., WORKERS COMPENSATION AND EMPLOYERS' LIASIUTr T'C: :iTAI L _ ..._._- _..__..._ ANY PROPRIF,ORIPARTNER)EXE('.IJTi,.r, E.- EA.°.)tdCC:IDENI 5 6 L UNEASE - EA. ESCELOYE:E _ b — ...,�.........._ C)r I;K,FRNLMITER EXCLUL*U? iTTen de- nbe inlar SPE :I L PRCVL51QNS be+ w E E PCLKIY LIMIT It , OTHEA DESCRIPTION OF OPERATIONS )LOCA1 "1044SrVEHN:LESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS The Certificate holder is hereby named as additional insured with respects to general liability City of El Segundo, Officials and Employees Attn: Administration Services 350 Main Street El Segundo, CA 90245 ACORD 2S (2001108) INS025 {woe} oen SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL XNBKAUM" MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICAT "E HOLDER NAMED TO THE LEFT, *X AUTHORIZED REPRESENTATIVE 0 .1,1; 1,. �IN 1988 Pays i W2 DATE (M/WDD/YYYY ACORDTM, CERTIFICATE OF LIABILITY INSURANCE 8/122008 PRODUCER ( 619) 683-9990 FAX : ( 619) 683-9990 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Michael Ehrenfeld Company HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 2655 Camino Del Rio North ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. San Diego CA 92108 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Employers Compensation 11512 Westchester Medical Group INSURER B: 360 N. Sepulveda Blvd INSURER C: Suite 3000 INSURER D: E1 Segundo CA 90245 INSURER E: VFRAGES 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. AGGREGATE LIMIT H WN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFFECTIVE POLICY EXPIRATION INSR ADD'L TYPE OF INSURANCE POLICY NUMBER DATE MM /DD/YY DATE MM /DDIYY LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE F__1 OCCUR EACH OC .URRENCE $ DAMAGE TO RENTED PREMISE Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS-CO PI OP AG $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY 7 PRT O - 17 LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO ALL OWNED AUTOS BODILY INJURY (Per person) $ SCHEDULED AUTOS HIRED AUTOS BODILY INJURY (Per accident) $ NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC AUTO ONLY: AGG $ $ EXCESS /UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR FI CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION WORKERS COMPENSATION AND EMPLOYERS' LIABILITY VJC *ACCIDENT OTH- X A E.L. EAC $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? If yes, describe under EIG104821201 8/1/2008 81/2009 E.L. DISEASE - POLICY LIMIT $ 1,000,000 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS /LOCATIONS/VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS *10 Day Notice of Cancellation for Non Payment of Premium II r TE City of El Segundo City Clerk Admin Services Director 350 Main Street Room 5 El Segundo, CA 90245 -3813 ACORD 25 (2001/08) INS025 (olo8p8a SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL )Se)Gi4JkU)w MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, XXX �i��c► �C��ac�cl�i ►��ac.�x�rD�c�l�i��ac,ac�►Y�C AUTHORIZED REPRESENTATIVE ��- 3abe Erle /CH i�Gz- n ArnR❑ CORPORATION 1988 Page 1 of 2 COOPERATIVE OF AMERICAN PHYSICIANS CERTIFICATE OF COVERAGE AND CLAIMS HISTORY Coverage through December 31, 2009 Member: Allen Pachtman, MD Address: 360 N. Sepulveda Blvd., #3000 El Segundo, CA 90245 This certificate confirms that, on the 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 5908 Medical Specially Internal Medicine Coverage Date September 1, 1990 Retroactive Coverage Date January 1, 1986 Subspecialty Coverage (Claims made and paid) Current Limits of Liability $1,000,000 for all Claims based Medical Professional Liability Coverage 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 is displayed on the next page. SAN DIEGO I ORANGE 1 LOS ANGELES I SAN JOSE I SACRAMENTO COOPI:RAI'IVE 01 AMERICAN 1111)SICIAN..S. INC. 1a:1 S. II„ri Si.. `iiu Pi„�,R. L�„ A��,iii�. (':A 90071 1 11tw\i ZIa 17:5 li(io c) I I'\\ 213 -173 ,'577:5 Membership # 5908 Page 2 of 2 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 also includes payments for emergency or other remedial expenses that exceed $30,000 that were made to patients through MPT's Patient Assistance Services program. Cooperative of American Physicians, Inc. w'ft 't5 January 29, 2009 Hammon P. Acuna Vice President, Membership Services Mutual Protection Trust Date COOPERATIVE OF AMERICAN PHYSICIANS CERTIFICATE OF COVERAGE AND CLAIMS HISTORY Coverage through December 31, 2009 Member: Robert A. Reiss, MD Address: 360 N. Sepulveda Blvd., #3000 El Segundo, CA 90245 This certificate confirms that, on the 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 5906 Medical Specialty Internal Medicine Coverage Dab September 1, 1990 Retroactive Coverage Date January 1, 1986 Subspecialty Sports Medicine, Primary Care Coverage (Claims made and paid) Current LhoNa of Liability $1,000,000 for all Claims based Medical Professional Liability Coverage 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 riot MPT undertake any obligation to advise any party, other than the named member, of any changes to or termination of this coverage. Claims history is displayed on the next page. SAN DIEGO 1 ORANGE 1 LOS ANGELES I SAN JOSE I SACRAMENTO ('00PERAI-IVE )f AMERICAN PHYSICIANS. INC. 333 S. lhwl Si.. ',In I i ... )H. L,,, A\(,iir,. U\ 90071 1 PtIo\1 213-.173 hi601 1 1 \s 213 173 hi773 Membership # 5906 Page 2 of 2 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 also includes payments for emergency or other remedial expenses that exceed $30,000 that were made to patients through MPT's Patient Assistance Services program. Cooperative of American Physicians, Inc. 'Ci ,�.,,., 'C:5 January 29, 2009 Hammon P. Acuna Date Vice President, Membership Services Mutual Protection Trust COOPERATIVE OF AMERICAN PHYSICIANS CERTIFICATE OF COVERAGE AND CLAIMS HISTORY Coverage through December 31, 2009 EMISSION- Member: David M. Weiss, MD Address: 360 N. Sepulveda Blvd., #3000 El Segundo, CA 90245 This certificate confirms that, on the 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 8525 Medical Specialty Internal Medicine Coverage Date November 1, 1997 Retroactive Coverage Date None Subspecialty Coverage (Claims made and paid) Current Limits of Liability $1,000,000 for all Claims based Medical Professional Liability Coverage 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 is displayed on the next page. SAN DIEGO I ORANGE I LOS ANGELES I SAN JOSE I C001'ERA1'1VE OE AMERICAN 1111)SIC'IANS. INC. 3;1:3 S. IIi�PI SI.. R�II I�Itv�a. E,,, 1��rii�. (':A 90071 1 Pilo l 213 173(T600 I I�\\ 213 - 173 -�i773 SACRAMENTO Membership # 8525 Page 2 of 2 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 also includes payments for emergency or other remedial expenses that exceed $30,000 that were made to patients through MPT's Patient Assistance Services program. Cooperative of American Physicians, Inc. I: J January 29, 2009 Date Hammon P. Acuna Vice President, Membership Services Mutual Protection Trust