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The Medical Protective Company@ <br />A sTOCK IHSURA]ICE COT,IPANY <br />5814 Reed Road, FortWayne, Indiana 46835 <br />Stren$h. Defense. Solulions. Since 1899. <br />MULTI-SPECIALTY HEALTHCARE PROFESSIONAL <br />MASTER POUCY <br />CE RTI FI CAT E O F I NS A RANCE <br />SCHEDALE OF POLICY FORMS & ENDORSEMENTS <br />Forms and Endorsements of your Certificate are as follows: <br />Farm# Description <br />+--------------- +------------- <br />lFom No I Title <br />lCover Letter <br />IMPS !',lulL!-Special.ty tlealtheara Ptof,ess:ona.ls policy Certificate <br />,t1?S l',lu1ti-Specialty Healthcare profesaionals Eoru t Endorsenent Schedute <br />IMFS l'tu1li-SFecj.aLty HealLhcare Professionals Palicy Schedule of fnsuredg <br />lGenersl Defin:tions <br />lceneraf Condiiians <br />I General Exclusions <br />lProfessional Ltabillty Insu:ing Agreemeni - Occuftence <br />lComerc1al General Llabiliiy Insuring Agreesenl - Occurrence <br />lDisclosure $otj.ce of Terrorism Insulance Coverage <br />jCap on Lo6ses Frofi CetCified Acts of ?erotj.sm Endorsenent <br />lAddj.tional lrsured - Lessors of Prenises 6 Leased Equipment <br />,M95 Econonic Sanclions Exclusion Andorsemesl <br />lEcononic Sarclions ExcluEions Endorsenent {GL} <br />lM?S Blankel Separate l,-imic Endorsenent - pL Only <br />lBj.omedj,cal t{aste ilearing Expense Endorsement - Occurrenee <br />lReuse or Multidose Supply Procedure exclusion Endorsenent <br />I Procedures Exclusion EndorEemen! <br />lWashj,ngton Amendalory EndorseRenl <br />I <br />----+ <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />i <br />I <br />I <br />i <br />I <br />I <br />t <br />I <br />I <br />I <br />I <br />I <br />i Mct <br />I 1801r. <br />| 1 8507 <br />I 1 8s05 <br />| 18511 <br />I 1S51 9 <br />I rB52Z <br />| 18528 <br />| 18560 <br />I 18517 <br />t78620 <br />t18569 <br />,19720 <br />i 19121 <br />I 1 9098 <br />I 1 9187 <br />119218 <br />| 19631 <br />t18152 <br />+---- -- * - - --- ---+' <br />18507 All other terms and conditions of the Policy remain unchanged,08/13