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Appendix 4 <br /> `' . . <br /> TRIANGLE YOUTH HOCKEY ASSOCIATION, INC. <br /> SEPTEMBER 29, 1992 <br /> LIABILITY QUOTE: <br /> LIMIT: 1, 000, 000. COMBINED SINGLE LIMIT <br /> OCCURRENCE FORM <br /> INCLUDES PRODUCTS <br /> 1,000. DEDUCTIBLE ON <br /> BODILY INJURY <br /> RATE: 16. 00 PER $100 SALES-PUBLIC SKATING <br /> $250. 00 FLAT RATE FOR $25, 000 SALES- <br /> FOOD, DRINK, & CONCESSIONS <br /> NO COVERAGE FOR HOCKEY GAMES AS THEY <br /> ARE COVERED BY ISIA AND US HOCKEY <br /> $5,050.00 PREMIUM <br /> 75.00 POLICY FEE <br /> 256.25 TAX <br /> $5, 381.25 TOTAL ANNUAL PREMIUM <br /> `wy/ ABOVE PREMIUM IS BASED ON $30,000. RECIEPTS FOR PUBLIC SKATING <br /> AND $25, 000. RECEIPTS FOR CONCESSIONS. <br /> TO BE WRITTEN THROUGH WESTERN WORLD A+ NON-ADMITTED CARRIER. <br />