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r <br />fp <br />1.h <br />V- <br />ir-K'.' <br />« ■ <br />‘•I.. <br />s rzsurance Ccver^se - Ths Jciz-ly '^ei doc> is insured sy ona of the fsllo-^n*: <br />property cvner’s honecvner's policy. <br />X separate group/associoticn ovnsd policy. <br />list the foilcwlng inr'orr.ation; <br />name of insured <br />name of insiirance carrier lAa»v»*psV»\^g. Usor^nAC^ Co <br />name of insurance agency <br />policy no.effective date of coverage A—| <br />amount of coverage; Public liability, per person, per occurence $^^|OoOjOOp <br />Public liability, per occurence $ OflOiftgB <br />Security and policing of the Jointly used dock and property is provided by <br />(check applicable items): <br />fencing, ji security lighting.property ovner's presence. <br />contract security service, other (specify) <br />DOCK IHPORMATION <br />ll. List Dock Use Area Specifications: <br />Width of shoreline; ft. Length of main dock from shore; ft. <br />Dock setbacks from side property lines at shore; SC> ft. and 30 ft. <br />12* Dock Construction (check applicable items): <br />a seasonal dock (relocated or replaced each year). <br />_ _ permanenn piling with seasonal deck. <br />jlC wooden decking. metal decking. <br />permanent piling and decking. <br />13. Llat Dock Accessories: <br />tfunber of fire extinguishers available at the dock \ <br />Number of life preservers available at the dock <br />14. List number of slips in each category ("slips'' Includes boat l^fts): <br />Transient (day use only) slips Q . Transient (day use) off-shore buoys O . <br />Pemaaent moorage slips _____T Pennanent moorage off-shore buoys O <br />Dry storage (rack) slips CL Maximum number of boats at the dock <br />15.List number of off-street parking spaces available for users of the joint use <br />dock. Parking, if provided must not be separated from the dock by any public <br />road. spaces. <br />3 of 5