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h. Atsoclotlor. is (checic »ppllc«fcle iters): <br />___ uaiccoTTcrsted hoaeovncr's group. <br />IncoiT«r«ted Bcceovner's Association <br />5. <br />6. <br />unincorporated club or recrestlon group. <br />Incorporated club or i^reation group. <br />Frincipal rorpose of Joint ’use dock is (check applicable iteas): <br />^ rtovid® beat -oDorlng laks accesa for realdentlsl propert:* <br />frovide sviasii.ng tccess, leach, or offshore docs, <br />profile s C.1U3 or astcclatlon gathering piece for activities. <br />6. Decs la located on (check epplicac-* Ite*): <br />s private prorerty <br />easerfint or outlet cvned in corron. <br />prorerty leesed by tne group/asscciation. <br />property ovnedl by the group/easociatioa. <br />Lift Doc's location and ovr.eranlp infoi~".atIon; <br />.dir?,. •? ? Kl. SKoir.,^ Dr.—Qrpr\B---[MJlZ <br />P^oi- Lr>~ ^ r^-»»s<r A <br />pio ♦ 17-1 1-7 -a.no- <br />ll,t«d prepert/ o-T.er(») f -V ■ ft Cm\ P CA I C <br />Insurance CoYirage - The Jointly used dong It Insured by ona of the follovlng: <br />l/ee <br />p i *® rioiLCoWiii* ^ s <br />separate g-g&UB/iBBOQiatiieu uwatkl" puliay. <br />list the folloving infonnaticn: <br />name of insured ^ >l \tf ^ *3* ■ ]^Ao*iC ---------------— <br />name of Inaurance carrier I’Xi fV ^ ^ ^ ‘ <br />name of insurance agency ----------------------------- <br />policy no. ^______________ effective date of coverage 3// <br />amount of coverage; Public liability, per person, per occurence J <br />Public liability, per occurence --------