SUNRISE MULTISPECIALIST MEDICAL CENTER

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EMPLOYEE CERTIFICATE OF PROFESSIONAL LIABILITY COVERAGE THROUGH MUTUAL PROTECTION TRUST (MPT) M Name of Worker: Dennis Wang Type of Worker Physician Assistant Employed by or related to the practice of the Member/Covered Entity: William H Nuesse MD And Mary Ann Nuesse DO A Medical Corporation Membership # or Entity #: 1906 Effective Date: June 22, 2018 through December 31, 2020 DBA(s): Sunrise Multispecialist Medical Center Inc Mutual Protection Trust (MPT) will provide to the above -named Worker, the medical professional liability coverage described the MPT Agreement, Part 1, subject to all terms, conditions, and exclusions therein, and subject to payment of all obligations required thereby, for any Occurrence upon which the Claim is based, arising on or after the above -mentioned Effective Date, in the conduct of Professional Services by such Worker, provided that such Worker was acting within the course and scope of his or her duties and licensure as an actual employee of such Member/ Covered Entity at the time of the Occurrence. This Certificate of Professional Liability Coverage is not a contract of insurance or of liability protection services as between MPT and the above -named Worker and does not afford membership in the Cooperative of American Physicians, Inc. (CAP) to such Worker. This Certificate of Professional Liability Coverage does not amend, extend or alter the professional liability protection services afforded by the MPT Agreement to the above -named Member/Covered Entity. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this Certificate of Professional Liability Coverage may be issued or pertain, the medical professional liability coverage afforded by the MPT Agreement described herein are subject to all terms, conditions, and exclusions of the MPT Agreement. The limit of liability through MPT is $1 Million per Occurrence/$3 Million Aggregate. Such limit of ✓ liability is shared with the Member/Covered Entity. A shared limit of liability means that the Member/Covered Entity shares his/her limit of liability with the Worker for any Occurrence upon which a Claim against the Member/Covered Entity and the Worker is based. This Certificate shall remain in force unless cancelled or amended by MPT or the Member/Covered Entity. This Certificate of Professional Liability Coverage is incorporated by this reference into the MPT Agreement. MPT does not track Claims asserted against employees or Other Related Physicians The above -named Member/Covered Entity is responsible for notifying MPT and all recipients of this Certificate of Professional Liability Coverage in the event of the termination of the employment of or other relationship with the above -named Worker. Such Member/Covered Entity is also responsible for notifying all recipients of this Certificate of Professional Liability Coverage In the event that any term of this Certificate of Professional Liability Coverage is modified. Date: January 7, 2020 MUTUAL PROTECTION TRUST By � - REVIEWED & APPROVED Alfred De Leon y Risk MANAq&ENT DivisION Vice President, Membership Services APR B 20200 ANGIE ACEVEdD