HomeMy WebLinkAboutLazaro Alonso, MD - 2021-04-01 PROPESSONAL.SERVICES CONTRACT lil"TWEEN
THE CITY OF 1 UNTINGMN BEACII AND
19 Z.a r_0_aL0 au-,_mD ..
FOR
INDEPENDENT'MEWCAL EVALUATIONS WITH
RESPfiC'I"I'O WORKERS' COMPENSATION CLAIMS
THIS A(iRfil?MEN'I'("Agreement") is made and entered into by and between the City of
I Itmtington Beach, n municipal corpondion of the Stale of California, hereinafter referred to as
"CITY,"find whp b " 1] , an individual, hereinafter referred to as"PI IYSICIAN."
WHEREAS, CITY desires to L'Ilgage the service's Of a physician to provide indel)Clldem
medical evaluations Willi n'especl to worker's' compensation claims; and
Pursuant to docuntentntion on file in the office of the City Clerk, the provisions of the
I lunlington Beach Municipal Code, Chapter 3.03, relating to procurement of professional service
contracts have been Complied with;and
PHYSICIAN has been selected to perfonn said services,
NOW,THEREFORE, it is agreed by CITY and PHYSICIAN as follows:
1. SCOPE 01 SERVICI?.S
PHYSICIAN shall provide all services as described in Kxhibit "A," which is
attached hereto and incorpmntcd into this Agreement by this reference. These services shall
sometimes hercinnfter be referred to as the"PRO.ILCT."
III IYSICIAN hereby designates__ J e _ , who shall represent it
and be its sole contact and agent in all consultations with CITY during the performance of this
Agreement.
APPROVED AS TO FORM/Mc
11CHAEe B.GATES
CITY ATTORNEY
17.-3187/IMF. Standard COIltlIC1 - Revisal I CITY OF HUNTINGTON BEACH
2. CITY STAPF ASSISTANCE
CITY shall assign a staff coordinntor to work directly with PI IYSICIAN in the
performance of this Agreement.
3. "fIME of PERFORMANCE
'time is of the essence of this Agreement. The services of PHYSICIAN are to
continence on 'ApdIA . 2 U2 I . ([he "Commencement Dale"), This Agreement shall
mitunlntically renew- three(3) years from the Commencement Date, unless terminated as provided
herein. 'file time for performance of the tasks identified in Exhibit"A" are gencially to be shown
in bnhibil "A." This schedule may be amended to benefit the PROJECT if mutually Agreed to in
writing by CITY and PHYSICIAN.
In the event the Commencement Date precedes the Effective Date, PHYSICIAN
shall be bound by all terms and conditions as provided herein.
4. COMPENSATION
In consldel7ltloll of the performance of the services (Icsciibcd herein, CITY agrees
to pay P11 YSICIAN, on it tine and materials basis at the rates specified in Exhibit "It," nitached
hereto and incorporated by reference into (his Agreement, n fee, including all costs and expenses,
aot to exceed Twenty-Iliac Thousand Ninc-I lundied Dollars ($29,900.00).
5. IATRA WORK
In the event CITY requires additional services not included in Exhibit "A", or
changes Ill file scope ofservlccs described Ill Exhibit"A," PHYSICIAN will undertake such work
only after receiving written authorization from CITY. Additional compensation for such extra
work shall be allowed only ifihe prior written approval of-CITY is obtained.
12.3187/IME Standard Contract - Revised 2
6. METHOD OP PAYMENT
PI IYSICIAN shall he paid pursuant to the terms of Exhibit "I3."
7. DISPOSITION 01; PLANS, ESTIMATES AND OTHER DOCUMENTS
PHYSICIAN ngrces tint title to all materials prepared hereunder, including,but not
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limited to: all original drawings, designs, reports, both field and office notices, calculations,
computer code, language, data or programs, maps, memoranda, letters and other documents, shall
belong to CffY, and PHYSICIAN shall turn those materials over to CITY upon termination of
this Agreement or upon PROJECT completion, whichever shall occur first. These materials may
be used by CITY as it sees lit.
S. 1101,1) 11ARMLESS
III IYSICIAN hereby agrees to protect,defend, indemnify and hold harmless CITY,
its officers, elected or apixriuted officials, employees, agents and volunteers from and against any
and all claims,damages, losses,expensesJudgments,demands and defense costs(including without
limitation, costs and fuss of litigation of every nature or liability of any kind or natu(e) arising out
of or in connection with PHYSICIAN's (or PHYSICIAN's subcontractors, if any) negligent (or
alleged negligent)perfornlmrce of this Agreement or its failure to comply with any of its obligations
contained in this Agreement by 111-IYSICIAN, its officers, agents or employcos except such loss or
damage which was caused by the sole negligence or willful misconduct of CITY. PI IYSICIAN will
conduct till defense al its sole cost rind expense and CI'I'Y shall approve selection of PHYSICIAN's
counsel. This indemnity shall apply to all claims and liability regardless of whether any insurance
pol icier me applicable. The policy Iinlits do not act as limitation upon the amount of indunnification
to be provided by PHYSICIAN.
I2-3187/IME Stondatti Contract- Revised 3
9. PROFESS IO AL LIABILITY INSURANCE
PHYSICIAN shall obtain and furnish to CITY a professional liability insurance
policy covering the work performed by it hereunder. This policy shall provide coverage for
PHYSICIAN'S professional liability in film anmount not less than One Million Dollar
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($1,000,000.00) per occurrence find in the aggregate. The above-mcminned insurance shall not
contain a self-insured retention without the express written consent of CITY;however an insurance
policy "deductible" of Tell Thousand Dollars ($10,000.00) or less is permitted. A claims-made
policy shall be acceptable if the policy dallier provides that:
A. The I>olicy retroactive date coincides with or precedes the initiation of the
scope of work (including subsequent politics purohused as renewals o
replacements).
13. PHYSICIAN shall notify CITY of circumstances or incidenls that nmight
give rise to filtme claims.
PHYSICIAN will make every effort to maintain similar insurance during the
rcquircd extended period of coverage following 1'RO713Cf completion. If insurance is terminated
for any reason, PHYSICIAN agrees to purchase an extended reporting provision of al least two(2)
years to report claims arising from work performed in connection with this Agreement.
If PI IYSIC1AN fails or refuses to produce or maintain the insurance requited by
this section or ITnils or refuses to furnish the CITY with rcquircd proof that insurance has been
procured and is in force and paid for, the CITY shall have the right, at the CITY's election, to
forthwith terminate this Agreement. Such termination shall not affect PHYSICIAN's right to be
paid for its lime and materials expended prior to notification of termination. PHYSICIAN waives
12-319711W, Standard Contract - Revised 4
the right to receive compensation and agrees to indemnify the CITY for any work performed prior
to approval of insurance by the CITY.
10. CGICHFICATES OF INSIIRANCF.
Prior to commencing performance of the work hereunder, PHYSICIAN shall
furnish to CITY certificates of insoiancc subject to approval of the City Attorney evidencing the
foregoing insurance coverage as required by this Agreement; the certificate shall:
A. provide the name and policy number of each carrier and policy;
D. state that the policy is currently in force; and
C. promise that such policy shall not be suspended, voided or canceled by
either party, reduced in coverage or in limits except Out thirty (30) days'
prior written notice;however,ten(10)days' prior written notice in the event
of cancellation for nonpayment of premium.
PHYSICIAN shall maintain (he foregoing insurance coverage in force until the
work under this Agreement is fully completed and ncccpted by CITY.
The requirement trot carrying the foregoing insurance coverage shall not derogate
from PIIYSICIA`"s defense, hold harmless and indemnification obligations its set forth in this
Agreement. CITY or its representative shall al all litres have the right to demand the original or a
copy of the policy of insurance. PHYSICIAN shall pay, in it prompt and timely tmtuner, the
premiums on file insurance hereinabovc required.
11. INDL-PENDENT CONTRACTOR
PHYSICIAN is, and shall be, acting M all times in the performance of (his
Agreement its an ittdcpetdctrt contractor herein and not as an employee of CITY. PHYSICIAN
shall secure al its own Cost and expense, and be responsible for any and all payment of all laxcs,
12-7I87/1ME Standard Contract - Revised 5
social security, slate disability insurance compensation, unemployment compensation and other
payrol! dcdttctions for PHYSICIAN and its officers, agents and employees and all business
licenses, if any, in connection with the PROJGCT and/or the services to be performed hereunder.
12. TERMINATION OF AGREEMENT
All work required hereunder shall be performed in a gomi and workmnnlike
manner. CITY may terminate l'I IYSICiAN's services hereunder art any time with or without cause,
and whether or not the PROJhCT is folly complete. Any termination of this Agreement by CITY
shall be made in writing, notice of which shall be delivered to PHYSICIAN as provided herein.
In the event of termination, all finished and unfinislied documents, exhibits, report, end evidence
shall, at the option of the CITY, become its properly and shall be promptly delivered to it by
PHYSICIAN.
13. ASSIGNMENT'AND DELEGATION
Agreement is it personal service contract and the work hercunder shall not be
assigned, delegated or subcontracted by PHYSICIAN to any olhcr person or entity without the
prior express written consent of Cfl'Y. [Fiat assignment, delegation or subcontract is approved,
all approved assignees, delegates and subcontractors must satisfy the hismance rcyuucments as
set forth in Sections 9 and 10 hereinabove.
14. COPYRIG!ITS/1'A'I'IN'f5
CITY shall own all rights to any patent or copyright on any work, item or a:aterial
produced as a result of this Agreement.
15. CITY Li,K4PLOYI:PS AND OFFICIALS
PHYSICIAN shall employ no CITY official nor any regolar CITY employee in the
work performed pursuant to this Agreement. No officer or employee of CITY shalt have any
12-3187/IMP.Standard Conaact - Revised 6
Financial interest in this Agreement in violation of the applicable provisions of the California
Government Code.
16. MOTICUS
Any notices, certificates, or other communications hereunder shall be glvell either
by personal delivery to PHYSICIAN's agent(as designated in Section I hereinabove)or to CITY
I the situation shall wal-lant, or by enclosing llle saole Ill a scaled envelope, postage prepaid, and
depositing the same in the United Stites Postal Service, to the addresses specified below. CITY
and Pl IYSICIAN may designate different addresses to which subsequent notices, certificates or
other conmiu Ili cat ions will be sent by notifying the other party via personal delivery, a reputable
overnight carrier or U.S. certified mail-return receipt requested:
TO CITY: TO PHYSICIAN:
City of I lumington Beach LA I A- — (1
ATrN: Risk Manager _I�
2000 Main Sirect S k US--- -
Huntington Bench, CA 92648 UPitJ 0015 ZA qty a�
17. CONSEM' l
When Crl'Y's consent/approval is required under this Agreement, its
consenUNpproval for one transactloll oi eveni shall not be decilled to be it conscill/approval to Ally
subsequent occurrence of the same or any other transaction or event.
18. MODIFICATION
No waiver or modification of any language in this Agreement shall be valid unless
in writing and duly executed by both parties.
12-7187AME Standarrd Contract - Revised 7
19. SECTION HGADMOS
'file titles, captions, section, paragraph and subject headings, and descriptive
phrases at the beginning of the various sections in this Agreement tuc nlc!ely descriptive and are
inclodcd solely for convenience of reference only and are not representative of nllnters included
or excluded from such provisions, and do not interpret, define, limit or describe, or construe the
intent of the parties o affect the construction or interpretation of nny provision of this Agrcentcllt.
20. INTIRpR1 CATION OF THIS AGREEMENT
The language of all parts of this Agreement shall in all cases be consoled as n
whole, aCCOrdlng to Its fair meaning, and not strictly for or against any of the parries. If any
provision of (his Agreement is held by en arbitrator or court of connpetent jurisdiction to be
unenforceable, void, illegal or invalid, such holding shall not invalidate or affect the remaining
covenants and provisions of this Agreement. No covenant of provision shall be deemed dependent
upon any other unless so expressly provided here. As used in this Agreement, the masculine or
neuter gender and singular or plural number shall be decnted to include the other whenever the
context so indicates or requires. Nothing contained herein shall be construed so as to require the
commission of any act contrary to haw, and wherever there is any conflict between any provision
contained hel'cill and ally present OI' f ltnl'C statute, law, ordinance or regulaliol contrary to which
tile, parties have no right to ContraCl, their the latter shall prevail, and the provision of this
Agreement which is hereby affected shall be curtailed and limited only to the extent necessary to
bring it within the requirements of the haw.
21. DUIjjj A Ii ORIUINAL
The original of this Agreement and one or more topics hereto have been prepared
and signed in couuterpalls as duplicate originals, each of which so executed shall, irrespective of
12-11 SWIM Ii Standard Contract - Revised 8
the date of its execution and delivery, be deemed an original. Loch duplicate original shall be i
deemed an original instrument as against any party who has signed it.
22. IMMIGRA,rION
PHYSICIAN shall be responsible for fall compliance with the immigration and
naturali-ralion laws of the United States and shall, in particular, comply with the provisions of the
Untied Stales Code regnrding employment verification.
23. LEGAL SLRVICES SUBCONTRACTING PROI11BITE.D
PHYSICIAN and CITY agree that CITY is not liable for payment of any
subcontractor work involving legal services, and that such legal services are expressly outside the
scope of services contemplated Ilcrounder. PHYSICIAN understands that pursuant to Nunringnm
(tench City Charler Section 309, the City Attorney is the exclusive legal counsel for CITY and
CITY shall not be liable for payment of any legal services expenses incurred by Ill IYSICIAN.
24. ATTORNEY'S PEHS
In the event suit is brought by cithcr party to construe, interpret and/or enforce the
terms and/or provisions of this Agreement or to secure file performance hereof, each party shall
beat its own attorney's fees, such that the prevailing party shall not be entitled to recover its
attorncy's fees from the non-prevailing Marty.
25. SURVIVAL
'I'crnts and conditions of this Agreement, which by their sense and context survive
the termination of this Agreement, shall so survive.
26. GOVERNING LAW
This Agreement shall be governed mtd construed in necordance with the laws of the
State of California.
1 2-3 1 8 711MH Slandard Contract-Revised 9
27. SIGNATORIES
Each undersigned represents and wfirronts that its signfiutrc herein bCIOW has the
power, fiulhority and right to bind their respective padics to each of the terms of this Agreement,
and shall indemnify CITY fully for filly injuries or damages to CITY in the event that such
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authority or power is not, in fact, held by the signatory or is witht tMI..
PHYSICIAN's initials
28. F.NfIRyyy
The parties acknowledge and agree that they are catering into this Agreement Freely
and voluntarily following extensive arm's length negotintion,and that each has had the opportunity
to consult with legal counsel prior to executing this Agreement. The parties also acknowledge and
agree that no representations, induccutcnts,promises,agreements or warranties,oral or otherwise,
have been made by that party or anyone acting on that party's behalf, which are not embodied in
this Agreement, and that that party has not executed this Agreement in reliance on any
rcImesctltation, inducement, promise, agreement, wnrrunty, fact or circumstance not expressly set
forth in this Agreement. This Agreement, and the attached exhibits,contain the entire agreement
between the parties respecting the subicet matter of this Agreement and supersede fill prior
understandings laid agreements whether oral or in writing between the parties respecting the
subject matter hereof.
29. EFFECTI E DATE
I
This Agreement shall be effective on the date of its approval by the City Attorney.
This Agreement shall expire when terminated its provided hereof.
IN WITNESS W1113MOF, the parties hereto have caused this Agreement to be executed
by find through their authorized ofliccrs.
12-315711ME, Standtu'd Contract - Revised 10
PHYSICIAN
CI I'Y OF HUNITNGTON BEACH,a
aumicipal aorparntion of the State of California
T Wf IIYSK AN SMA It
IN, ctorof Human Resources
APVRO,Vlp AS TO FORM:
y Attonic
Receive and File
City Clerk --/ /
12J187/IME Standard Contract - Revised 11
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PROFESSIONAL SERVICES CON'TRACI'131 "I'WEEN
THE, CITY 01" HUNl'INO TON BEACH AND
L 9 z9 ro_al_w5-a _m D
FOR
INDI?PENDL'NT MEDICAI. 1-WALUATONS WITH
RESPECT"TO WORKERS' COMPENSATION CLAIMS
'fable of Contents
1 Scope of Services.....................................................................................................I
2 City Staff Assistance................................................................................................2
3 Time of Performance............................................... .................2
4 Compensation ..........................................................................................................2
5 Extra Work...............................................................................................................2
6 Method of Payment..................................................................................................3
7 Disposition of Plans, 139timates and Other Documents ...........................................3
8 Hold Flarmless .........................................................................................................3
9 Professional Liability Insuramce..............................................................................4
10 Certificates of InSllrallee..........................................................................................5
11 Independent Contractorr............................................................................................5
12 Termination of Agreement.......................................................................................6
13 Assignment and Subcontracting..............................................................................6
14 Copyrights/Patents....................................................................-.............................6
15 City Employees and Officials..................................................................................6
16 Notices .....................................................................................................................7
17 Consent ....................................................................................................................7
18 Modification.............................................................................................................7
19 Section Headings .....................................................................................................8
20 Interpretation of this Agreement..............................................................................8
21 Duplicate Original......................................................... ..........................................8
22 Immigration..............................................................................................................9
23 f.egal Services Subcontracting Prohibited...............................................................9
24 Attorney's Fees.........................................................................................................9
25 Survival....................................................................................................................9
26 Govuming Law ........................................................................................................9
27 Signatories................................................................................................................10
28 Entirety.....................................................................................................................to
29 Effective Date..........................................................................................................10
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12-3187/75880
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EXHIBIT "A"
S'I'A'1'I'iMEN'I' UP VJORIC:
1) AOL;—COP. EXAMS (exams for the determination of industrial causation).
2) i:valua(ion for necessity of appropriate medical Ifcohucuu. j
3) Assessment of employee's present ability to return to work, whether frill duly or
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modified.
4) Advise on condition of maximum medical improvcmcnt stales.
5) Determine nature and extent of permanent disability, including factors of apportionment
and aced for Iiuture medical care.
6) Resolve utilization review disputes.
7) Determine the need for spinal surgery pursuant to Labor Code section 4062(b).
PHYSICIAN shall perform the evaluation in fill accordance with the standards defined by the
Division of Workers' Compensation of the State of California and ilie AMA Guides to the
Evaluation of Permaicnl Impairment,hinli Exhlion. This requires a report of the injury, prior
status, clinical chronology, current status, and past medical history. The physical examination
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will document all pertinent positive, negative, and non-physiological findings. For extremity
injuries, measurcnients must be documented bilaterally. Additionally, PHYSICIAN agrees to:
(i) provide that medical exams will be set within thirty (30) days of the date ofappointment
request, and (ii) prepare a written report of findings within thirty (30) days of the date of exam or
evaluation and provide it copy to the parties within said time frame.
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12.31V/75880
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Ea111131'1' <B"
Payment Schedule
I. Missed Appointments
• Fec: $503.75
• Code: M1.200
Applies wherr.
• Interpreter does not appear for evaluation.
• Injured worker leaves before completion of the evaluation.
• Cancellation within 6 business days of the scheduled appointment.
2. Comprehensive Medical-Legal Evaluations
• Fee: $2,015.00
• Code: MI.,201
• Applies to the initial evaluation or the first evaluation in an 18-month period.
• The evaluation includes review of up to 200 pages of records.
It must involve an examination of the employee.
• Review of records in excess of 200 pages is reimbursed at a rate of$3.00 per page.
3. Follow-up Medical-Legal Evaluations
• Pee: $1,316.25
• Code: M1.202
• Applies to any subsequent comprehensive evaluation within 19 months of the initial
evaluation.
• 'Phis fee includes review of up to 200 pages of records that were not reviewed as part of
the initial evaluation.
• Review of records in excess of 200 pages (records not reviewed at initial evaluation)
reimbursed at a rate of$3.00 per page.
4. Supplemental Medical-Legal Fvahrations
• Fee: $650.00
• Code: M203
• Does not involve an examination oftlhc patient.
• Results in preparation of a narrative medical report.
• Review of records in excess of 50 pages reimbursed at a rate of$3.00 per page.
• Fecs fora supplemental report are not allowed if:
o Records reviewed were provided to the physician for review before the initial or
follow-up evaluations.
o Supplemental report addresses an issue the parties asked the physician to address
in a prior ntcd-legal evaluation.
12-3187/75880 1
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5. Medical-Legal Testimony
• Fee: S455.00 per hour(or physician's usual and customary fee, if lower)
• Code: ML204
• Physician is entitled to bill a minimum of hours for deposition.
• If the deposition is canceled within fewer than 8 calendar days prior notice, physician is
entitled to bill l hour of time.
6. Medical-Legal Review of Sub Rosa IP,viderce
• Fee: S325.00 per hour(or physician's usual and customary fee, if lower)
• Code: M1.205
• No minimum time allotment.
• Physician must capture time spent reviewing evidence to the nearest quailcr-hour,
verified under penalty of perjury.
• The fee does not include production of a medical-legal report. The fee for tine spent
reviewing the recording will be included in the billing for the initial, follow-up or
supplemental medical- report.
7. Court-Ordered Evaluations
• When it medical-legal evaluation is ordered by it Workers' Compensation Judge, the
Judge has authority and discretion to apply the appropriate modifier to that evaluation.
8. The parties agree that the City is not obligated to pay compensation to the PHYSICIAN
except for agreed upon medical services and care. Failure of' PHYSICIAN to provide a
written medical report within 30 days of the date of the exam subjects PHYSICIAN to non-
payment for services rendered.
9. PHYSICIAN billing shall conform to the requirements listed in section 9795 of Title 8 of
the California Code of Regulations. Charges for services rendered will be reviewed in
accordance with section 9795 to determine appropriate level of service.
10. City shall pay PHYSICIAN within forty-five (45) days following receipt from
PHYSICIAN of invoices for services rendered and for which paymeit has not previously
bee) made, provided that PHYSICIAN shall submit all invoices within ninety (90) days
after the date of service.
12-3187/75880 2
p E ,/
/\THEDOCTORSCOMPANY
CERTIFICATE OF INSURANCE Issue Date: 02M72021
Effective Date: 010012021 A Claims-Made Professional Liability Policy
First Named Insured: IMPORTANT NOTICE: This document is issued as
Lazaro Alonso MD a matter of information and does not confer rights
15216 Vanowen Street. Suite 16 to any recipient. This document Is not binding, is
Van Nuys. CA 91405 not part of the Policy described below, and does
not change or extend the coverage provided by that
Policy.
Insured: Lazaro Alonso MD
er
Specialty: INT01 -Internal Medicine MICHAEL E.GATES
CITY ATTORNEY
Policy Number: Policy Peri4.
0425651 From: 01/01/2021 To: 01/01/=
Retroactive Date: Departure Period:
OW1/1983 From: WA To: WA
The Insured above is. Agency and Address
❑X A Named Insured The Doctors Company Insurance
❑ A Locum Tenens Services
❑ An Additional insured 15260 Ventura Boulevard. Suite 200
Sherman Oaks, CA 91403
(B00)852-8872
LIMITS OF LIABILITY
Claim Limit: $2,000,000
Aggregate Limit: $5.000,000
I. Locum Tenens and Additional Insureds share Limits of Liability with the applicable Named Insured.
II. Individuals who occupy a"slot" share Limits of Liability with all others who occupy the same"slot' during the
Policy Period.
III. Photocopies of this document are deemed as valid as the original.
IV. The Policy. including Endorsements, determines the coverage provided. Some Claims may not be covered
by the terms of the Policy, or may be subject to restrictions such as lower Limits of Liability.
V. If the Policy, or coverage for any person, is canceled for any reason or it the terms of the Policy are
changed, we will notify the First Named Insured (and any additional Named Insureds as required by
applicable state law). Coverage is not in effect unless and until all payments are received when due.
VI. If a Departure Period is indicated, the Policy will not respond to Probable Claim Events arising from
Professional Services Incidents or Review Incidents that take place during the designated period. however,
the Policy will respond if we receive a Claim Report during this period.
MPL003 (04/15) 100 Page 1 of 1 MCO2003 31262560-00 Insured
185 Greenwood Road:P.O.Box 2900:Napa,CA 94558-0900:(707)226-0100:(800)421.2368 :www thedoctors corn