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COOPERATIVE OF <br />AMERICAN PHYSICIANS <br />CERTIFICATE OF COVERAGE AND CLAIMS HISTORY <br />Coverage through December 31. 2021 <br />Member: Kenneth E. Grubbs, DO <br />Address: 867 S Tustin Ave, Orange, CA 92866 <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 />interiudemnity arrangement organized under California Insurance Code section 1280.7. 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 <br />for all Claims based <br />Medical Professional Liability Coverage <br />upon an Occurrence <br />$3,000,000 <br />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 Period. Neither CAP nor MPT undertake any obligation to advise any pity, other than the named member, <br />of any changes to or termination of this coverage. <br />Claims History <br />No Claims Reported <br />The Claims history listed above includes all Claims that are currently open and those that were closed within the last five years. <br />The Claims history does not include payments for emergency or other remedial expenses that may have been made to patients <br />through MPT's Patient Assistance Services program. <br />Cooperative of American Physicians, Inc. <br />December 30, 2020 <br />Alfred De Leon Date <br />Vice President, Membership Services <br />Mutual Protection Trust <br />RlskManagmreutDivieion , <br />REVIEWED&APPRovm BY: <br />A'"M Risk Management Analyst <br />