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EMPLOYEE <br />CERTIFICATE OF PROFESSIONAL LIABILITY COVERAGE <br />THROUGH MUTUAL PROTECTION TRUST (MPT) <br />Name of Worker: Janene Arteche <br />Type of Worker: Physician Assistant <br />Employed by or related to the practice of the Member/Covered Entity: <br />Cheshire Medical Corporation <br />Membership # or Entity #: 5077 <br />Effective Date: April 1, 2020 through December 31, 2020 <br />DBA(s): Procare Medical Walk In Inc <br />Procare Onsite Solutions <br />Procare Physical Therapy And Acupuncture Inc <br />Procare Urgent Care & Work Injury <br />Procare Work Injury & Urgent Care <br />Procare Work Injury Center Inc <br />Mutual Protection Trust (MPT) will provide to the above -named Worker, the medical professional liability <br />coverage described the MPT Agreement, Part 1, subject to all terms, conditions, and exclusions therein, <br />and subject to payment of all obligations required thereby, for any Occurrence upon which the Claim is <br />based, arising on or after the above -mentioned Effective Date, in the conduct of Professional Services <br />by such Worker, provided that such Worker was acting within the course and scope of his or her duties <br />and licensure as an actual employee of such Member/ Covered Entity at the time of the Occurrence. <br />This Certificate of Professional Liability Coverage is not a contract of insurance or of liability protection <br />services as between MPT and the above -named Worker and does not afford membership in the <br />Cooperative of American Physicians, Inc. (CAP) to such Worker. This Certificate of Professional Liability <br />Coverage does not amend, extend or alter the professional liability protection services afforded by the <br />MPT Agreement to the above -named Member/Covered Entity. Notwithstanding any requirement, term or <br />condition of any contract or other document with respect to which this Certificate of Professional Liability <br />Coverage may be issued or pertain, the medical professional liability coverage afforded by the MPT <br />Agreement described herein are subject to all terms, conditions, and exclusions of the MPT Agreement. <br />The limit of liability through MPT is $1 Million per Occurrence/$3 Million Aggregate. Such limit of <br />liability is shared with the Member/Covered Entity. <br />A shared limit of liability means that the Member/Covered Entity shares his/her limit of liability with the Worker for any Occurrence upon <br />which a Claim against the Member/Covered Entity and the Worker is based. <br />This Certificate shall remain in force unless cancelled or amended by MPT or the Member/Covered <br />Entity. This Certificate of Professional Liability Coverage is incorporated by this reference into the MPT <br />Agreement. <br />MPT does not track Claims asserted against employees or Other Related Physicians <br />The above -named Member/Covered Entity is responsible for notifying MPT and all recipients of <br />this Certificate of Professional Liability Coverage in the event of the termination of the <br />employment of or other relationship with the above -named Worker. Such Member/Covered Entity <br />is also responsible for notifying all recipients of this Certificate of Professional Liability <br />Coverage in the event that any term (RUVIEW§ fYt&-AFPR( -Psional Liability Coverage is <br />modified. By Risk MANAGEMENT DivisioN <br />AP 0 g O29 <br />ANGiE ACEVEdo <br />