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PROPOSED SPONSORED ACTIVITY ACCIDENT POLICY <br /> Insurer: <br /> One Beacon America Insurance Company <br /> A XII <br /> Named Insured: <br /> City of Sunny Isles Beach <br /> Tyne of Form: <br /> Sponsored Activity Accident Policy—Premium Basis Per Expiring and Attached <br /> Activity and Participant Schedule <br /> Please refer to policy for exclusions,terms and conditions <br /> Limits of Liability: <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 /> 34 <br />