IDEAL NATIONAL INSURANCE COMPANY Salt Lake City, Utah A Stock Legal Reserve Company (Herein called the Company) Student Accident GENERAL Commencing on the 1st day of regularly scheduled classes for the 1972-73 school year, and ending with the last day of regularly scheduled classes for said school year, and provided proper premium has been received by the Company, protection is hereby provided by the Company subject to the provisions, exceptions and limitations as herein contained, against loss caused solely by accidental bodily injury witnessed by or reported to an authorized school official within 72 hours of occurrence and incurred while this policy is in force— (b) When an insured is— 1. in or on school premises or other places of instruction used by the school during the time the insured is required to be therein or thereon on any day when regularly scheduled school classes are being conducted, or participating (except traveling, which is covered under the following Paragraphs 3 and 4), under direct supervision of an adult school authority in a group of 3 or more students, faculty or office personnel of the school (except as a spectator at an athletic event and except during scheduled vacation periods), in an activity sponsored solely by the school, or 3. traveling in a school bus visibly designated and identified as such and operated by a properly licensed driver, or being transported in a group of 3 or more students, faculty or office personnel of the school in a vehicle designated by the school and operated by a properly licensed adult driver to or from a school sponsored activity in which the insured is a duly designated participant, or > 2. involved in a motor vehicle collision or struck by a moving vehicle on any day when eagerly SCchaaled school classes c between returning from (a) regula of a student or (b) require faculty or office personnel. STUDENT ool duties in the case of LIFE PROTECTION Commencing on the date the school receives the application form and proper premium and terminating 12 months from that date and subject to the provisions, exceptions and limitations as herein contained, the Company will pay upon receipt at its Home Office of due proof of death of said Insured from any cause, the sum of one thousand five hundred dollars ($1,500.00) to the beneficiary named on the insureds application form. Life insurance is afforded hereunder to only those students who attend classes at the school building on a full-time basis. PROVISIONS Notice of Claim: WRITTEN NOTICE OF CLAIM MUST BE GIVEN TO THE COMPANY WITHIN 90 DAYS AFTER THE DATE OF ANY INJURY OR DEATH COVERED BY THIS POLICY, or as soon thereafter as is reasonably possible. Notice must be given by or on behalf of the Insured to the Company at its Home Office, 1415 South Main Street, Salt Lake City, Utah, with information sufficient to identify the Insured. Claim Forms: The Company, upon receipt of a notice of claim, will furnish to the claimant such forms as are usually furnished by it for filing proof of loss. If such forms are not furnished within fifteen days after such notice is received by the Company the claimant shall be deemed to have complied with the requirements of this policy for filing proof of loss, written proof covering the occurrence, the character and the extent of the loss for which claim is made. Proof of Loss: Written proof of loss must be furnished to the Company at its said office within 90 days after an injury for which benefits are payable. Failure to furnish such proof within the time required shall not invalidate nor reduce any claim if it was not reasonably possible to give proof within such time, provided such proof is furnished as soon as reasonably possible and in no event, except in the absence of legal capacity, later than one year from the time proof is otherwise required. Payment of Claims: Payment of claims that are determined by the Company to be payable shall be made, within 60 days of submission thereof, to the Principal of the School, in the event of injury and to the designated beneficiary in the event of death, provided within such period the Company is duly furnished written proof of loss including complete information concerning said claim and any necessary supporting physician’s statemenis. Entire Contract Changes: This Police, including the application, 3 ts and attached cS, i t (a) In an activity for which the individual is insured and . Protection lorse acne toS change the policy or to. Legal Actions: No action at law or in equity shall be brought to recover on this policy prior to the expiration of sixty days after written proof of loss has been furnished to the Company in accordance with the requirements of this policy. No such action shall be brought after the expiration of three years after the time written proof of loss is required to be furnished. Conformity with State Statutes: Any provision of this policy which, on its effective date, is in conflict with the jurisdiction in which the Insured resides on such date is hereby amended to conform to the minimum requirements of such Os SECRETARY BENEFITS UNDER THIS POLICY SHALL BE PAYABLE IN ADDITION TO ANY BENEFITS Lous PAID BY OTHER Se INSURANCE POLICIES. Senior High School Student coverage and Athletic coverage during regular class hours. (Extracurricular activities are not covered) $1.50 Plan 1 benefits are doubled except Diagnostic X-rays and Accidental Death and Dismemberment. $3.00 Student coverage and Athletic coverage during and after regular class hours. School dances, cheerleaders, drama, and other extracurricular activities. (Inter-school football not covered). The same coverage as Plan 3, including Inter-school football. $12.00 LIFE INSURANCE OPTIONAL $1,500 STUDENT LIFE INSURANCE (Optional $3.50) PLAN 24 Hour full-time coverage may be purchased on an individual basis. It provides protection “round the clock” at home, weekends, holidays, at camp, little league, during the school year and the entire summer—anytime, anywhere. Life Insurance will be for 12 months upon receipt of application and premium by the school. Provides protection against Loss of Life for any cause. BENEFITS SHALL BE PAYABLE UNDER THIS POLICY IN ADDITION TO ANY BENEFITS PAID BY OTHER INSURANCE POLICIES. STUDENT’S NAME PARENT’S SIGNATURE RECEIPT