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ME <br />COOPERATIVE OF <br />AMERICAN PHYSICIANS <br />CERTIFICATE OF COVERAGE <br />Coverage through December 31, 2022 <br />Member: Kenneth E. Grubbs, DO <br />Address: 867 S Tustin Ave <br />Orange, CA 92866 <br />Samantha <br />an"M.lamMi <br />M. Lambert <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, Inc. (CAP) and a participant in the Mutual Protection Trust (MPT). MPT is an unincorporated <br />interindemnity arrangement organized under California Insurance Code section 12803. This certificate confers no rights upon <br />the member and does not amend, extend or alter the coverage afforded under the terms, conditions and exclusions of the MPT <br />Agreement. <br />Membership Number <br />21463 <br />Medical Specialty <br />Family Medicine, With Minor <br />Surgery <br />Coverage Date <br />February 1, 2012 <br />Retroactive Coverage Date <br />None <br />Subspecialty <br />Coverage (Claims made and paid) <br />Current Limits of Liability <br />$1,000,000 for all Claims based <br />Medical Professional Liability Coverage <br />upon an Occurrence <br />$3,000,000 each calendar year <br />aggregate <br />The member must remain a Member in good standing or arrange for Tail Coverage for any open or potential Claim that may arise <br />during the Coverage Penod. Neither CAP nor MPT undertake any obligation to advise any party, other than the named member, <br />of any changes to or termination of this coverage. <br />Cooperative of American Physicians, Inc. <br />Alfred De Leon <br />Vice President, Membership Services <br />Mutual Protection Trust <br />Date <br />November 11, 2021 <br />a� Rhlrhluvg�erltDtrl:ai <br />"„ Rta[weo6MVRovm Bv: <br />$.t.ntsit�s Ietn.r'-- <br />' Ruk Management Smpl,v, o <br />