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¥■ <br />9.Insurance Coverage - The Jointly used dock Is Insured by one of the folloving: <br />j( property ovner's hocecwner’s policy. <br />separate group/association ovmed policy, <br />list the following Information: <br />name of insured -n _ <br />name of insurance carrier <br />of Insurance agency <br />policy no.effective date of coverage <br />•mount of coverage; Public liability, per person, per occurence _$ <br />Public liability, per occurence <br />Security and policing of the Jointly used dock and property Is provided by <br />(cheek applicable Items): <br />fencing. ^ security lighting. property owner's presence, <br />contract security service, other (specify) <br />DOCK inroRMATI^ <br />11. List Dock Use Area rpeciflcatlona: <br />Width of shoreline; ft. Length of main dock from shore; - - -ft. <br />Dock setbacks from side property lines at shore; ^ ^---- <br />12* Dock Construction (check applicable items): <br />ft. <br />___seasonal dock (relocated or replaced each year). <br />___persanant piling with seasonal deck. ^ permanent piling and decking. <br />^ wooden decking. metal decking. <br />13. List Dock Accessorle«!: <br />Humber of fire extinguishers available at the dock <br />Humber of life preservers available at the dock _ f <br />14. List number of slips In each category ( slips includes boot lifts). <br />Transient (day use only) slips <!/ ♦ Transient (day use) off-shore buoys C? <br />permanent moorage sUpe It Permanent moorage off-ahore buoys ..Q—> <br />Dry itorM. (««») (C ** <br />IS. U« Durtwr of off-.tr..t p.riao« .p.c.. .r.ll.bl. ftr <br />dock. Parking, if provided must not be separated from the > <br />zoad. /!> spaces . (tuK'ci\ SACi - A,S^<5C.«a-t <br />i <br />Page 3 of 5 UrxJi-^