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<br />\ <br />J <br /> <br />SPONSORED ACTIVITY ACCIDENT POLICY <br /> <br />FOR A FULL DESCRIPTION OF TERMS, DEFINITIONS AND CONDITIONS PLEASE REFER TO THE <br />POLICY DOCUMENT <br /> <br />INSURER <br />Mutual of Omaha Insurance Company, A.M. Best's Rated A+ XV <br /> <br />COVERAGE LIMITS <br /> <br />Accident Medical Expense: Full Excess <br />Maximum Medical Benefit <br />Accident Medical Deductible (Corridor) <br />Loss Period <br /> <br />Benefit Period <br /> <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 /> <br />Brown & Brown of Florida - Miami Division <br /> <br />Rider OLJ8MS /9130MS <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 /> <br />Rider 1359MS-EZ <br />$10,000 <br />$5,000 <br />$10,000 <br />Loss within 180 Days of Injury <br /> <br />34 <br /> <br />Proposal No. 11-08-01 <br />