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s . I 1 A is Insur-d bv one of the following;Insurance Coverage - The Jointly used docSc is Insur. .property c-.-ner's hocecwner’s policy. <br />X separate group/associetioa _ certificate of insurance to dock at <br />(Note: Each member is required to fu facility.) <br />list the follcving inforr.ation: <br />name of Insured Bio island._ <br />of insuronc, carrier . 4/e/Zr^ <br />of Insurance agency jne..>--.ncp rnnsiiir;nq Ser-nc.ias <br />.aount of coverage; Public liability, per person, per occurence $ 500,000. <br />1 snn.nnn.QQpublic liabUity, per occt rence <br />Security and policing of the Jointly ’used doclc and property is piovl e j <br />taacln*. _JL <br />contract security service, other (specify) <br />125. <br />500+ <br />POCK IWFOHWTION <br />II. List Dock Use Area Specifications: <br />width of aboraunc, 1.500*— f- <br />Dock aetback. fro. aide ptcparty Una. at shore; __500i_ ft. abd ------ <br />IJ. Bock Conatructlob (check eppUcable items): <br />Mssobal dock (relocated or replacad each year). <br />_ peimuient plUo* with ae.«>na deck. _ peraaent plllb* abd dacking. <br />___wooden decltlng. ____natal decking. <br />13. List Dock Accessories ; <br />ffiesber of fir. erelogwlabera arelleble et the dock Po.r. rf<lMlrf«l W MVg_ <br />go^r of life preaereer. arella-l. at tb. dock ■ boat. rew»iif><» <br />14. uat «»b.r Of .Up. «r -••l. <br />xran.l.ht (day use only) allpa X- Tr.n.l..t(d.y ua.) off-abcre buoy. ^ <br />ft. <br />^ ti* • <br />Permnant noorage Flips <br />Dry storage (rack) slips <br />Pexaaneat ■>orage off-shore buoye ------0 ----• <br />aunber of boats et the ^££]LJ^ <br />road. _0__ spaces. <br />Page 3 of 5