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o-/Ir.sur3r.ce Zzverz.ze -The Jcincl ’ usei ioci is ir^sur?! zy ore ci •-a *Wk. w — —' — <br />10- <br />property c’-ner's 'nor.ecvner*s po-i?y. <br />separ3t3 grc'.:r/?s20ci3"i-3 ovr.ed "c_icy <br />lisx "ne foiicwin:; iai'orna’ion: <br />of insured —/^. _ _ _ __ <br />_e of insurance carrier <br />) name of insurance agency X <br />I policy no. effective date of coverage '/^J/9'' <br />I anioimt of coverage; Public liability, per person, per occurence <br />Public liability, per <br />Security and policing of the Jointly 'cned <br />(c.deck applicable items): <br />occurence _______ <br />dock and property is provided by <br />fencing.security lignting. X property owner's presence. <br />contract security ser’-'lce. other (specify) <br />DOCK IIIPCRMATION <br />ll. List Dock Use Area Specifications: <br />12. <br />Width of shoreiirjj; X^C> ft. Length of main dock from shore; ft. <br />Dock setbacks from side propeixy lines at snore; 9- <br />/X. s/^ s. S/^e <br />Dock Construction (check applicable items): <br />X seasonal dock (relocated or replaced each year). <br />_ _ permanent piling vita seasonal deck. _ _ permanent piling and decking. <br />y wooden decking. _ _ metal decking. <br />^4.X u • <br />13. List Dock Accessories: <br />Number of fire extinguishers available at the deck <br />Number of life preservers available at the dock / <br />14. List number of slips in each categor;/- ("slips" Includes boat lifts); <br />Transient (day use only) slips _____. Transient (day use) off-shore buoys <br />______. Permanent moorage off-shore buoysPermanent moorage slips <br />Dry storage (rack) slips Maximum number of boats at the dock <br />15.I,i8t 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. O spaces. <br />3 of 5