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Attachment number I <br /> Page 31 of 42 <br /> PROPOSED SPONSORED ACTIVITY ACCIDENT POLICY <br /> Quotation Pending Per New Application <br /> Insurer: <br /> One Beacon America Insurance Company <br /> Rated A XI By A. M. Best <br /> Named Insured: <br /> City of Sunny Isles Beach <br /> Type of Form: <br /> Sponsored Activity Accident <br /> Please refer to policy for exclusions, terms and conditions <br /> Limits of Liability: TBD—Expiring Terms As Per Below <br /> Accident Medical Expense: Full Excess Rider OLJ8MS / 9130MS <br /> ® Maximum Medical Benefit $25,000 <br /> Accident Medical Deductible (Corridor) $100 <br /> Loss Period Initial treatment received within 90 days <br /> of injury <br /> Benefit Period Benefits payable for 52 weeks from <br /> accident date <br /> Accidental Death & Specific Loss Rider 1359MS-EZ <br /> Loss of Life Principal Sum $10,000 <br /> Single Dismemberment Principal Sum $5,000 <br /> Double Dismemberment Principal Sum $10,000 <br /> Loss Period Loss within 180 Days of Injury <br /> Agenda Item No 10A <br /> 31 <br /> 95 <br />