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07/14/2010 10 32 FAIT 714 836 3087 TIMG TUSTIN <br />0 <br />COOPERATIVE OF <br />AMERICAN PHYSICIANS <br />CERTIFICATE OF COVERAGE AND CLAIMS HISTORY <br />Coverage Ibrou=h Deeeaabar31, 2010 <br />low? <br />Member) John G. Alevizos, DO <br />Address: 800 N. Tustin Ave Suite A <br />Santa Ana, CA 92705 <br />IA 002/004 <br />This certificate confirms that, on the date below, the above-namcd physician is a member of the Cooperative of Amen(., n <br />Physicians, Inc. (CAP) and a participant in the Mutual Protection Trust (Nf m. MPT is an unincorporated interindeenni 1, <br />arrangement organimd under California Insurance C7de section 1280.7. This certificate confers no rights upon the member at :1 <br />does not amcnd, extend or alter the coverage afforded undrr the terms, conditions and exclusions of the MPT Agreement <br />Membership Number Medical specialty Coverage Data Retroactive Covsrepe Data <br />9275 Family Medicine, Wh April I, 1999 October 1, 1993 <br />Surgical Assist <br />Subspecialty <br />COVenye (Claims made and Will <br />Medical Professional Liability Coverage <br />Current Limits of Liability <br />$1,000,000 <br />$3,000,000 <br />for all Claims based <br />upon an Occurrence <br />each calendar year <br />aggregate <br />The member must remain a Member in good standi 16 or arrange for Tail Coverage for any open or Potential Claim that mr, <br />arise during the Coverage Period Neither CAP nor MPT undertake any obligation to advise any parry, other than the names <br />member, of any changes to or termination of this coverage <br />Claims History <br />No Claims Reported <br />'rbs Claims hlstOry listed above includes all Claims that are currently open and those that were closed within the last five <br />years the Claims history dos not include paymeriN for emergency or other remedial expense, that may have been made to <br />patients through MPT's Patient A99istance Services program, <br />Cooperative of American Physicians, Inc, <br /> <br />Hammon P Aeuna <br />Vice President, Membership Scrvicos <br />Mutual Protection Trust <br />December 28. 2009 <br />Date <br />AP COVED TO FO <br />Joseph Straka <br />Assistant City Attorney