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COOPERATIVE OF <br />AMERICAN PHYSICIANS <br />CERTIFICATE OF COVERAGE AND CLAIMS IJISTORY <br />Coverage through December 31, 2020 / <br />MJ <br />Member: Herbert D. Jennings, MD <br />Address: 17232 Redhill Ave <br />Irvine, CA 92614 <br />This certificate confirms that, effective on the coverage date below, the above -named physician is a member of the Cooperative <br />of American Physicians, hic. (CAP) mid a participant in the Mutual Protection Trust (NTT). MPT is an unincorporated <br />interindemnnt arrangement organized under California Insurance Code section 1280.7. This certificate confers no rights upon <br />the member and does not amend, extend or alter the coverage afforded tinder the terms, conditions and exclusions of the MPT <br />Agreement. <br />Membership Number Medical Specialty Coverage Date Retroactive Coverage Date <br />17430 Occupational Medicine January 1, 2008 March 13, 2006 <br />subspecialty <br />General Practice, With Minor Surgery <br />Coverage (Claims made and paid) Current Limits of Liability <br />Medical Professional Liability Coverage <br />$1,000,000 for all Claims based f <br />upon an Occurrence <br />$3.000,000 each calendar year <br />aggregate <br />The member must remain a Member or good standing or arrange for Tail Coverage for any open or potential Claim that may <br />arise during the Coverage Period. Neither CAP nor MPT undertake any obligation to advise any party, other than Ore named <br />member, of any changes to or tennination of this coverage. <br />Claims History <br />No Claims Reported <br />The Claims history listed above includes all Claims that are currently open and those that were closed withim the last five <br />years. The Claims history does not include payments for emergency or other remedial expenses that may have been made to <br />patients through MPT's Patient Assistance Services program. <br />Cooperative of American Physicians, Inc. <br />-� cmber 26, 2019 <br />REVIEWED & APPROVE - <br />Alfred De Leon <br />Vice President, Membership Services <br />Mutual Protection Trust <br />AP 0 9 2020 <br />ANC{iE ACEVEdO <br />