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The Medical Protective Company@ <br />A STOCK INSURAI{CE CO}IPA]IY <br />5814 Reed Road, Fort Wayne, Indiana 46835 <br />Strength. Defense, Solutions. Since 1899. <br />M ULTI-SPECIALTY HEALTHCARE PROFESSIONAL <br />MASTERPOLICY <br />CERTI FICATE OF INSURANCE <br />SCHEDULE OF POLICY FORMS & EAIDORSEMENTS <br />Forms and Endorsements of your Certificate are as follows: <br />Form # Description <br />lForm No. lTitle I <br />+---------------+-------- - ----------+ <br />|MCL lcover Letter I <br />118011 IMPS Multi-Specialty Healthcare Professionals Policy Certificate I <br />118507 IMPS Multi-Specialty Healthcare ProfessionaLs Form & Endorsemen! Schedute I <br />118505 IMPS Multi-Specialty Heafthcare Professionals Policy Schedule of lnsureds I <br />118511 lceneral Definitions I <br />| 18519 lceneral Conditions I <br />178522 lceneral Exclusions I <br />118528 lProfessionaL Liability Insuring Agreement - Occurrence I <br />118560 lcomerciaf ceneral tiabili-ty Insuring Agreement - Occurrence I <br />118617 lDisclosure Notiee of Terrorism Insurance Coverage I <br />11,8620 lCap on Losses Fron Certified Acts of Terrorism Endorsement I <br />118565 lAdditional Insured - tessors of Premises & Leased Equipmen! I <br />1191,20 IMPS Economic Sanctions Exclusion Endorsement I <br />11,9L27 lEconomic Sanctions Exclusions Endorsement (cL) | <br />119098 IMPS Blanket Separate Limit Endorsement - pL Only I <br />119187 lBiomedical Waste Hearing Expense Endorsement - Occurrence I <br />\I92LB lReuse or Muftidose Supply Procedure Exclusion Endorsement I <br />119631 lProcedures Excfusion Endorsement I <br />11,8152 lwashington Amendatory Endorsement I <br />+- --------------+-- ------- -----------+ <br />18507 All other terms and conditions of the Policy remain unchanged.08/13