HomeMy WebLinkAboutSeymour Levine, MD - 2021-04-01 Jun 02 2021 11:18 Seymour Levine, M.D. 3106577433 page 2
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PROFESSO'NAL SERVICES CONTRACT BETWEEN
THE. CITY OF IIUNTINGTON BEACH AND
—5.eq_rnour Levia - mD
FOR
INDEPENDENT MEDICAL EVALUATIONS WITH
RBSPECf TO WORKEMS' COMPENSATION CLAIMS
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THIS AGRI:;EMEN"1'("Agreement"} is made and entered into by and between the City of
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Huntington 13cach, a nnuiicipal corporation of the State of California, hereinafter referred to as
"CITY;" arid-- Hrn A. t_4t + au indiviclual, hereinafter referred to es "PHYSICIAN."
WHEREAS, CITY desires to engage the services of a physician to provide indepctident
medical evnluatlons with respect to workers' compensation claims; and
pursuant to documentation on file in the office of the City Cierk, the provisions of the
Huntington Beach Municipal Code, Chapter 3.03,relating to procurement of professional service
contracts have been complied with;and
PHYSICIAN has beelr selected to licrfarvisaid services,
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NOW, THEREFORE, it is agreed by CITY and PI•IXSICIAN as follows:
i. SCOPE OF SERVICES
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PHYSICIAN shall provide all services as described in Exhibit "A," which is
iattached hereto and incorporated into this Agreement by this reference. 'these services shall
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sometimes hereinafter be referred to as the "PROJECT."
III IYSICIAN hereby designates_dk`l V LE at i'C MJ, who shall represent it
and be its sole contact and agent in all consultations with CITY during the Performance of this
Agreement.
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APPROVED AS TO FORM/(Ct IA- Aa tit a4i
Y' G
ICHAEL E. GATES
CM ATTORNEY i
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2. CCCY STAFF ASSISTANCE
CITY shall assign a staff coordinator to work directly with PHYSICIAN in the
performance of this Agreement.
3. TIME OF PERFORMANCE
Time is of the essence of this Agreement. The services of PHYSICIAN are to
commence on April 1 2 M (the "Commencement. Date"). This Agreement shall
automatically renew three(3) years from the Commencement Date, unless terminated as provided
herein. The time for perforrnmtce of the tasks identified in Exhibit"A" are generally to be shown
in Exhibit"A." This schedule may be amended to hene(it the PROJECT if mutually agreed to in
writing by CITY and PHYSICIAN.
In the event the Commcnecntcnt Date precedes the Effective Date, PHYSICIAN
sliall be bound by all terms and conditions as provided herein.
4. COMPENSATION
In consideration of the performance of the services described hereic, CITY agrees
to pay PHYSICIAN,on a time and materials basis at the rates specified in Exhibit "Il," attached
hereto and incorporated by reference into this Agreement, a fce, including all costs and expenses,
not to exceed Twenty-nine Thousand Nine-Hundred Dollnrs ($29,900.00).
5. EXTRA WORK
hi the event C11'Y requires additional services not included in Exhibit "A", or
changes in the scope of services described in Exhibit "A," PHYSICIAN will undertake such work
only tiller receiving written authorization from CITY. Additional compensation For such extra
work shall be allowed only if the prior written approval of CITY is obtained.
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6. MLTH0J7 OP PAYMENT
PHYSICIAN' shall be paid pursuant to the terms of Exhibit 'B."
7. DISPOSITION ON PLANS, ESTIMATES AND OTHER DOCUMLNTS
PHYSICIAN agrees that titlo to all materials prepared hereunder, including, but not j
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 CITY, and PHYSICIAN shall turn these materials over to CITY upon termination of
this Agreement or upon PROJECT completion, whichever shall occur first. Thesc materials may
be used by CITY as it secs fit.
8. HOLD HARMLESS
PHYSICIAN hereby agrees to protect,defend, indemnify and hold hanuless CITY,
its officers, elected or appointed officials, employees, agents and volunteers from and against any
and all claims,damages, losses,expenses, iudgments,demands and defense costs(including without
lintitntion, costs and fees of litigation of every nature or liability of nny kind or nature) arising out
of or in connection with PHYSICIAN's (or PHYSICIAN's subcontractors, if any) negligent (or
alleged negligent)performance of this Agreement or its failure to comply with any of its obligations
contained in this Agreement by PHYSICIAN, its officers, agents or employees except such loss or
damage which was caused by the sole negligence or willful misconduct of CITY. PHYSICIAN will
conduct atl defense at its sole cost and expense and CITY shalt approve selection of PHYSICIAN's
counsel. This indcuutity shall apply to tilt claims and liability regardless of whether any insurance
pol icics are applicable. The policy limits do not aot as limitation upon the amount of indemuifiention
to be providod by PHYSICIAN.
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9. PROFESSIONAL LIABILITY ItiSU1tAIy-QB
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PHYSICIAN shall obtain and furnish to CITY a professional liability insurance J
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policy covering the work perfoaned by it hereunder. This policy shall provide coverage for
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PHYSICIAN's professional liability in an amount not less than One Million Dollars
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($1,000,000.00) per occurrence and in the aggregntc. The above-mentioned insurance shall not
contain a self-insured retention witlreut the express written consenlof CITY,however an instrance
policy "deductible" of Ten Thousand Dollars ($10,000,00) or less is permitted. A claims-made
policy shall be acceptable if the policy further provides that:
A. The policy retroactive date coincides with or precedes the initiation of the
scope of work (including subsequent policies purchased as renewals or
replacements).
13. PHYSICIAN shall notify CITY of circumstances or incidents that might
give rise to future claims.
PHYSICIAN will make every effort to maintain similar insurance during the
required extended period of coverage following PROJECToompletioa If insurance is terminated
for any reason, PHYSICIAN agrees to purchase an extended repuding provision of at least two(2)
years to report claims arising Font work performed in connection wide this Agreement.
If PHYSICIAN fnils or refuses to produce or maintain the insurance required by
this section or fails or refuses to ftrruish the CITY with required proof that ipauraneo lies been
procured aixl is in force and paid for, file CITY shall have the righl, at the CITY's election, to
forthwali terminate this Agreement. Such termination shall not affect PHYSICIAN's right to be
paid for its time and materials expended prior to notifrcation of lcrroinalion. PHYSICIAN waives
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the right to receive compensation and agrees to indemnify the CYCY for any work performed prior
to approval of insurance by the cITY.
10. CERTIFICATES OF rNSURANCE
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Prior to commencing performance of the work hereunder, PHYSICIAN shall
furnish to CITY certificates of insurance subject to approval of the City Attorney evidencing the
foregoing insurance coverage.as required by this Agreement; the ccaiificate shall:
A. provide the name and policy number of each carrier and policy;
B. 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 after thirty (30) days'
prior written notice;however,ten(10)days' prior written notice in the event
of cancellation for uonpayunant of premium.
PHYSICIAN shall maintain the foregoing insurance coverage in force until tile.
work under this Agreement is fully completed and accepted by CITY.
The requirement for carrying the foregoing insurance coverage shall not derogate
from PHYSICIAN's defense, hold harmless and indenu:ificalion obligations as set fortis in this
Agreement. CITY or its n:presmnative shall at all limes have the right to demand the original or a
copy of the policy of insurance. PHYSICIAN shall pay, in a prompt and timely manner, the
premiuurs on the insurance hercinabove required.
11. INDEPENDENT CONTRACTOR
PHYSICIAN is, and sliall be, acting at all times in the performance of this
Agreement as an independent contractor herein and not as an employee of CITY. PHYSICIAN
shall secure at its own cost and expense,and be responsible for any and all payment of all taxes,
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social security, state disability insurance compensation, unemployment compensation and other
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payroll deductions for PJIYSICTAN and its officers, agents and employees and all business f
licenses, if any, in connection with the PROJECT and/or(lie services to be performed hereunder. it
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12. TERMINATION OP AGREEMENT
All work required hereunder shall be performed in a good and worknteulike
manner. CITY may terminate PHYSICIAN's services lioreunder at any time with or without cause,
and whether or not the PROJECT is hilly complete. Any termination of this Agreeancnt 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 unfinished documents, exhibits, report, and evidence
shall, at the option of the CITY, become its property and shall be promptly delivered to it by
PHYSICIAN.
13. ASSIGNMENT AND DELEGATION
This Agreement is a personal service contract and the work hereunder shall not be
assigned, delegated or subcontracted by PHYSICIAN to any other person or entity without the
prior express written consent of CITY. if an assignment, delegation or subcontract is approved,
all approved assignees, delegates and subcontractors must satisfy the insurance requirements as
set forth in Sections 9 and 10 Itereinabove.
14. COPYRIGATSIPATENTS
CITY shall own all rights to any patent or copyright on any work, item or uraterial
produced as a result of this Agreement.
15. 'I( TY EMPLOYRES AND OFFICIALS
PHYSICIAN shall employ no CITY official nor any regular CITY employee in the
wort performed pursuant to this Agreement. No officer or employee of CITY shall have any
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financial interest in this Agreement in violation of the applicable provisions of the California
0overtuncnt Code.
16. NOTICES
Any notices, certificates, or other conmiunications hereunder sliall be given either
by personal delivery to PHYSICIAN's agent(as designated in Section I lncreinnbove) or to CITY
as the situation shalt warrant, or by enclosing the same In a scaled envelope,postage prepaid, and
depositing the same in the United States Postal Service, to the addresses specified below. CITY
and PHYSICIAN may designate different addresses to which subsequent notices, certificates or
other conirnunicalions will be sent by notifying the other party via personal delivery, a reputable
overnight carrier or U.S. certified nail-return receipt requested:
TO CITY: TO PHYSICIAN:
City of Huntington 13cach ficTY r�w4 t-E V r Ur r
ATTN: Risk Manager On .
2000 Main Street
Huntington Reach,CA 92648
17. CONSENT
When CITY's Conselrtlapprovni is required under this Agreement, its
consent/approval fa'One Iransnelion or event sliali not be deemed to he ❑consent/approval to any
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 wilting and duly executed by both parties,
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19. SECTION HEAIDINGa
The titles, captious, section, paragraph and subject headings, and descriptive
phrases at the beginning of the various sections in this Agreement are niciely descriptive and are
included solely for convenience of reference only and are not representative of matters included
or excluded finni such provisions, and do not interpret, define, limit or describe, or construe the
intent of the parties or affect the construction or interpretation of any provision cf this Agreement.
20. INTERPRETATtON OF THIS AGREP.MENT
The language of all parts of this Agreement shill] in all cases be construed as n
whole, according to its fair meaning, and not strictly for or against any of the parties. If any
provision of this Agreement is held by an arbitrate: or court of competent 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 or provision shall be deemed dependent
upon any other unless so expressly provided here. As used in this Agrecnicnl, the numsculiuc or
neuter gender and singular or plural nunibcr shall be deemed to include line odier whenever the
context so indicates or rrquires. Nothing contained hereiu shall be construed so as to recitrirc the
couunission of any act contrary to law, and wherever their, is any conflict between any provision
contained herein slid ally present or future statute, law,orAinnnee or regulation contrary to which
the parties have no right to contract, then 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 law.
21, QUPLICATEORIGINAL
'rhe original of this Agreement and one or more copies hereto have been pr'epat'ed
and signed in counterparts as duplicate originals, each of which so executed shall, irrespective of
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the date of its execution and delivery, be deemed an original. Each duplicate original shall be i
deemed an original inslnllnent as against any party who has signed it.
22, JMMlC MTlON
PHYSICIAN shall be responsible for full compliance with the immigration and
naturalization laws of the United States and shall, in particular, comply with the provisions of the
Untied Slates Cade regarding employment verification.
23. LEGALUIMCESSUBCONTRACTINOPROHIHITFA
PHYSICIAN and CITY agree that CITY is not liable for payment of ally
subconh-neto•work involving legal services, and da,t such legal services are expressly outside the
scope of services contalliplated hereunder. PHYSICIAN understands that pursuant to Hunlinglon
[leach Clty Chorter Section 309, the City Attorney is the cxclusivc legal counsel for CITY and
CITY shall not be liable for payment of any iegal services expenses incurred by PHYSICIAN.
24, ATTORNEY'S FEES
In the event suit is brouglit by either party to construe, inteapret and/or enforce the
terms and/or provisions of this Agreement or to secure the performance hereof, each party shall
bear its own attorney's fees, such that the prevailing party shall not be entitled to recover its
attorney's fees from ilre non-prevailing party.
25. SURVIVAi,
Terms and conditions of(Iris Agreemeut, which by their sense and context survive
(lie terruina(ion of this Agreenren(, shall so survive.
26. GOVERNING LAW
This Agreement shall be governed and construed in accordance with the laws of the
State of cHhfor'nia.
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27, SIGNATORIES {
Each undersigned represents and warrants tbat ils signature herein below has the
power, authority and right to bind their respective patties to each of the terms of this Agreement, I
and shall incle nnify CITY fully for any 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 withdrawn. i
PHYSICIAN's initinls
28. ENTIRETY
The parties acknowledge and agree that they are entering into this Agreement freely
and voluntarily following extensive arm's length negotiation,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, inducenrcatts, promises,agreements or warranties,oral or otherwise,
have been made by that party or anyone acting on that party's behnlf, which are not embodied is
this Agreement, and that that party has not executed this Agreement in reliance on any
representation, inducenieul, promise, agreement, wnrranty, fact or circumstance not expressly set
forth in this Agreement. This Agreetent, and the attached exhibits, contain the entire agreemeot
between the parties respecting the subject matter of this Agreement and supersede all prior
understandings and agreements whother oral or in writing between the parties respecting the
subject uratter hereof.
29. EFFECTIVE DATE
This Agreement shall be effective on the date of its approvol by the City Attorney,
This Agreement small expire when lerminaled as provided hereof.
IN WITNESS WHEREOF, the patties hereto have caused this Agreement to be executed
by and through their authorized officers.
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PHYSICIAN
;•�ti,__&
u& v 1 Nt k _ CITY OF HUN'IINOTON BRACK s
�" ivwn�wrrursinn srwK municipal corpomlion of the State of California
Slgnalum 4
nip ctor of Human Resawces '
APPROJ AS TO FORM:
City Attorney
Receive and File
/o7�k 7�Q�uGzl�cJ
City Clerk
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PROFESSIONAL SL'RVICNS CONTRACT BETWEEN
THE CITY OF HUNTINOTON BFACIi AND
Sgvmour Hvine, In D
FOR
INDEPENDIiNT MEDICAL EVALUATONS WITH
RESPECT TO WORKERS' COMPENSATION CLAIMS
"Table of Cmuents
IScope of Serviccs.....................................................................................................1
2 City Staff Assistance................................................................................................2
3 Time of Performance...............................................................................................2
4 ConiMisation ..........................................................................................................2
5 Extra Wotic............ ..................................................................................................2
6 Method of Payinent..................................................................................................3
7 Disposition of Plans, Pstimates and Other Documents ...........................................3
8 Hold Harmless .........................................................................................................3
9 Professional Liability Insurance.......................................................... ...................4
10 Certificates of Insurance..........................................................................................5
11 independent Contractor............................................................................................5
12 Termination of Agreement.......................................................................................6
13 Assignment and Subcontracting ............................................................. ................6
14 Copyrights/Patents...................................................................................................6
15 City Einployces and Officials..................................................................................6
16 Nolices .....................................................................................................................7
17 ConseN ....................................................................................................................7
18 Modification.............................................................................................................7
19 Section Iieadings .....................................................................................................8
20 Lrterpretation of this Agreement..............................................................................8
21 Duplicute Oeiginal....................................................................................................8
22 Immigration..............................................................................................................9
23 Legal Services Subcontracting Prohibited...............................................................9
24 Atlorncy's Pces.........................................................................................................9
25 Survival....................................................................................................................9
26 Governing I.aw .......................................................................................................9
27 Signatories................................................................................................................10
28 P.trtircty.....................................................................................................................10
29 Effective Date ..........................................................................................................10
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EXHIBIT "A"
STATEMENT OF WORK:
1) ACE—COE EXAMS (exams for the determinatiotr of iud.tstrial causation).
2) Evaluation for necessity of appropriate medical treatment. I
3) Assessment of employee's present ability to return to work, whether full duty or
modified.
4) Advise ou condition of maximum medical improvement status. i
5) Determine nature and extent of pernianent disability, including factors of apporlionuicut j
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and need for future 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 evahation in i3dl accordance with the standards defined by the
Division of Workers' Compensation of the State of California and the AMA Guides to the
Evaluation of Pet7r:aucnt Impairncnt,Fifth Edition. '['his requires a report of the injury, prior
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status, clinical chronology, current stattiti, and past medical history. The physical examination
will document till portinerrt positive, negative, and non-physiological findings. For exhrenity i
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injuries, measurements must be documented bilaterally. Additionally, PHYSICIAN agrees to:
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(i) provide that medical exams will be set within thirty (30) days of(lie date of appointment j
request, and (ii) prepnrt a written report of findings within thirty (30) days of the date of exam a'
evaluation and provide a copy to the parties within said tine frauie. I
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EXHIBIT "B"
PaymmentSchedule
I. Missed Appointments
• Fee: $503.75
• Code: ML200
Applies when:
• 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: M1,201
• Applies to the initial evaluation or the first evaluation in an I8-month period,
• The evaluation includes review of up to 200 pages of records.
• It nwst 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. hollow-up Medical-Legal Evaluations
• Fee: $1.316.25
• Ccdc: ML202
• Applies to any subsequent comprehensive evaluation within 18 months of the initial
evaluation.
• This 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 tote of$3.00 per page.
4. Supplemental Medical-Legal Evaluations
• Fee: $650.00
• Code: M203
• Does not involve an examination of the 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.
• Fccs for a supplemental report are not allowed if:
o Records reviewed were provided to the physician for review before the initial or
follow-up evaluations.
c Supplemental report addresses an issue the parties asked the physician to address
in a prior med-legal evaluation.
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5. Medical-Legal Testimony
• Fee: $455.00 per hour (or physician's usual and customary fee, if lower)
• Code: ML204
• Physician is entitled to bill a minimum of 2 hours for deposition,
• If the deposition is canceled within fewer than 8 calendar days prior notice,physician is
entitled to bill I hour of time.
G. Medical-Legal Review of Sub Rosa ]Evidence
• Fee: $325.00 per hour(or physician's usual and customary fee, if lower)
• Code: ML205
• No minimum time allotment.
• Physician must captw a time spent reviewing evidence to the nearest quarter-hour,
verified under penalty of perjury.
• The fee does not include production of a medical-legal report. The fee for time spent
reviewing the recording will be included in the billing for the initial, follow-up or
supplemental medical-report.
7. Court-Ordered Evaluations
• When a medical-legal evaluation is ordered by a Workers' Compensation Judge, the
Judge has authority and discretion to apply the appropriate modifier to that evaluation.
R. 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. PIIYSICIAN 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 PIIYSICIAN within forty-five (45) days following receipt from
PHYSICIAN of invoices for services rendered and for which payment has not previously
been made, provided that PIIYSICIAN shall submit all invoices within ninety (90) days
after the date of service.
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COOPERATIVE OF
AMERICAN PHYSICIANS
CERTIFICATE OF COVERAGE
Coverage through December 3l,2021
Member: Seymour Levine, MD
Addresr. ! 125 S Beverly Drive#425
Los Angeles,CA 90035
This cer:ifirate con5rms diet, efiecuve ea he coverage date below, the abov>nsmed physician is a mcmbc of the Cooprsaisc
of American Physicians, Inc. (CAP) and a panicipaM m the M4taal Protection Trust (MPT). MPT is an uprncorpotated
marrimlemadty arrangement organized ursder California, Insurance Code sconce 12ao.7. This ceniftcate confers no rights upon
the member and does not amend, extend or alter the coverage afforded under [be terms, eonditiens sod esclusiars of the MP7
Agreement
Mwnborship Numbar Medical apaelaay Coverage Onto Retroactive Cave rape Oate
20075 Rheumatology October I,2010 October I, 1977
Subspecialty
Internal Mad one
roverage(Claims made and paid) Current Limas of Llabli ty
S 1,000,000 for all Claims based
Medical Professional Liability Coverage upon an Occuaence
S3,000,000 each calendar year
aggregate
The member must remain a Member m good a"ing or arrange for Tail Coverage for any open or poteruial Claim that may ansc
during the Coverage Period Neither CAP nor Nuwr undertake u.y obligation to advise ary party, other than the named memba,
of any change to or icrninauon of this coverage.
Cooperative of American Msicians. Inc.
November 11,2020
Alfred De Leon Date ---
Vice President,Menbership Services APPROVED AS TO FORM
Mutual Protection Trust
gYt
MICHAEL E.GATES
CITY ATTORNEY
CITY OF HUNTINGTON BEACH