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<br />AMERICAN NATIONAL INSURA.NCE COMPANY <br />QUALIFICATIONS OF THE OFFER <br /> <br />APPLICANT: San Marcos, City of <br /> <br />OTHER REQUIREMENTS: <br /> <br />IT IS EXPRESSLY AGREED THAT THE INSURANCE BROKER AND/OR TPA ARRANGING FOR <br />YOUR APPLICATION IS YOUR AUTHORIZED AGENT AND IS FOR NO PURPOSE THE LEGAL <br />AGENT OF THE MANAGING UNDERWRITER, AMERICA~ INSURANCE MANAGERS, INC., OR <br />FOR THE REINSURER, EXCEPT AS REQUIRED FOR LICENSING. YOU HEREBY APPOINT THE <br />BROKER AND/OR TPA AS YOUR AUTHORIZED AGENT FOR ALL PURPOSES CONCERNING <br />THE INSURANCE APPLIED FOR HEREUNDER. YOU, THE APPLICANT, ARE NOT ENTITLED <br />TO RELY UPON THE ORAL OR WRITTEN REPRESENTATIONS OF THE BROKER OR TPA AS <br />BINDING. <br /> <br />SPECIFIC EXCESS COVERAGE: <br /> <br />I. Minimum Annual Specific Premium, Fees, and Taxes: $172,621.00 <br />2. Minimum Number of Specific Lives: 366 <br />3. Paid within the Treaty year. Claims are limited to those incurred 12 months prior to the Treaty <br />effective date and to $nla per covered person. <br />4. Extended Payment Option was not elected by the Insured. <br /> <br />AGGREGATE EXCESS COVERAGE: <br /> <br />1. Minimum Annual Aggregate Premium, Fees, and Taxes: $ 22,245.00 <br />5. Minimum Number of Aggregate Lives: 366 <br />2. Paid within the Treaty year. Claims are limited to those incurred 12 months prior to the Treaty <br />effective date and are limited to $n/a. <br /> <br />OTHER MODIFICA nONS: <br /> <br />Treaty Number: <br /> <br />SLOOI <br /> <br />Expiration Date: <br /> <br />08/01/2001 <br /> <br />Endorsements to the Treaty: <br /> <br />Actively at Work <br />Mental Health <br /> <br />All other terms and conditions of the Treaty remain unchanged. <br /> <br />The attached Schedule and Application are an integral part of this contract. <br /> <br />3 <br />