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<br />SECTION l-SCHEDULE OF EXCESS LOSS INSURANCE <br />(hereinafter referred to as the "Schedule") <br /> <br />POLICYHOLDER: City of LaPorte <br /> <br />ADDRESS: LaPorte, TX 77571 <br /> <br />ADMINISTRATOR: Texas Municipal League <br /> <br />ADDRESS: 1821 Rutherford Lane, Suite 300 <br />Austin, TX 78754 <br /> <br />ALL AMOUNTS AND NUMBERS SHOWN IN THIS SCHEDULE APPLY ONLY TO THE POLICY <br />PERIOD IN EFFECT. A NEW SCHEDULE WILL BE ISSUED FOR EACH NEW POLICY PERIOD. <br /> <br />A. [Xl AGGREGATE EXCESS LOSS INSURANCE: <br /> <br />1. BENEFITS COVERED: <br /> <br />X Medical Dental <br />X Prescription Drugs <br /> <br />_ Weekly Income <br /> <br />Vision <br /> <br />2. POLICY BASISIBENEFIT PERIOD: <br /> <br />EligIble Expenses Incurred from January 01, 2002 through March 31, 2003; and <br /> <br />EligIble Expenses Paid from April 01, 2002 through March 31. 2003 <br /> <br />If this Policy terminates prior to the Expiration Date. no Aggregate Excess Loss Benefits <br />will be payable and premium paid will not be refundable. <br /> <br />3. INITIAL AGGREGATE ATTACHMENT POINT: $3,597.831 <br /> <br />4. MINIMUM AGGREGATE ATTACHMENT POINT: $3,597,831 <br /> <br />5. BENEFIT PERCENTAGE PAYABLE IN ACCORDANCE WITH SECTION 3: 100% <br /> <br />6. MAXIMUM AGGREGATE BENEFIT (WHILE COVERED, AND WHILE THIS <br />POLICY IS IN FORCE): $1,000,000 <br /> <br />7. AGGREGATE MONTHLYFACTOR(S): Composite: $772.73 <br />Covered Units/enrollment: <br />Composite: 388 <br /> <br />8. AGGREGATE MONTHLY PREMIUM (PER EMPLOYEE): $4.30 <br /> <br />9. AGGREGATE LOSS LIMIT: $115,000 <br /> <br />10. PAYMENT MODE: Monthlv <br /> <br />SL-2001 <br /> <br />3 <br /> <br />(6/01) <br />