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i <br />Attachment number I <br />Paee 34 of 43 <br />PROPOSED SPONSORED ACTIVITY ACCIDENT POLICY <br />Quotation Pending, Awaiting New Application <br />Premium indicated as per expiring only <br />Insurer: <br />One Beacon America Insurance Company <br />A XII <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 <br />Maximum Medical Benefit <br />Accident Medical Deductible (Corridor) <br />Loss Period <br />Benefit Period <br />Accidental Death & Specific Loss <br />Loss of Life Principal Sum <br />Single Dismemberment Principal Sum <br />Double Dismemberment Principal Sum <br />Loss Period <br />Rider OLJ8MS / 913OMS <br />$25,000 <br />$100 <br />Initial treatment received within 90 days <br />of injury <br />Benefits payable for 52 weeks from <br />accident date <br />Rider 1359MS -EZ <br />$10,000 <br />$5,000 <br />$10,000 <br />Loss within ISO Days of Injury <br />Agenda Item No. IOA <br />33 140 <br />