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<br />5.1A <br />Page 11 <br /> <br />d. X-ray and laboratory <br /> <br />e. Prescription drugs <br /> <br />f. Limited mental/nervous disorders <br /> <br />g. Limited substance abuse coverage <br /> <br />h. An annual deductible of no more than $250 charges per member <br /> <br />i. No more than $1,000 total annual out-of-pocket per member <br /> <br />j. A 20% co-payor a comparable fixed fee with the exception of a 50% <br />co-pay for mental and substance abuse care <br /> <br />k. A maximum benefit of at least $50,000 per occurrence or cause <br /> <br />IN WITNESS WHEREOF I the Parties have executed this Agreement as of <br />the date of year first written above. <br /> <br />By: <br />As Its: Public Allies Site <br /> <br /> <br />City of Redwood City/Fair Oaks Community <br />Center <br />2600 Middlefield Road, <br />Redwood City, CA 94063 <br />B : t..~, ,. 0 .c <br />As Its: Supervisor <br /> <br />Public Allies Silicon Valley <br />600 Valley Way, Suite C <br />Milpitas, CA 95035 <br /> <br />By: d---,e......> <br />As Its: Authorized Operating Partner <br />Representative <br /> <br />Bv; <br />As its: Executive Director <br /> <br />By: <br />As its: Controller/C.F.O <br /> <br />Public Allies Partner Organization Agreement 2008-2009 <br /> <br />11 <br />