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:�•:�C`.''S .:U:.'{.'C wfiC!''E ro:icj' <br />,,isa, ..l�.c .o''_�.4: •�t_ itt'.'o:'s•s',:?on: <br />noire of insured Z-(kvvy—^ ------ <br />name of ir,surnnce carrier big Av uca ty C ����..� ►�y <br />name of ins r:•s,nce r,,er,c• WK t R <br />effective dPte of c�Dverage <br />policy no. N$$� �.�tsS a �Z�1 — <br />ema,mt of coversE;e; i'ublie :ileLili r•:!r ,ems::^., ; er occurence 5 _ <br />1 <br />'v, i.er occurence y 1d�C�C <br />Jlb l.. C _.�ab i l i''..,, <br />10 SecixiFy ar.n r,niicinZ o: the jointly use-4 deck and ;e:. .s i'rovid'e.: <br />(cnecY n.m) i : ubl e iterr.$) : <br />_ fencing. security lighting. property owier's presence. <br />contract security service. other (specify) <br />DOCK INK ?M.r'.TION <br />11. List Dock Use Area S-�eci'':ca�iuns: <br />tili.3t.n of shoreline; 1Q,5,S 1'-.. Lengtt. of' rr:ein da;:c <br />from: shore; <br />SL, ft. <br />Dock setbacks from side pw::,erty lines at shore; <br />ft. em,t. <br />ft. <br />12. <br />Construction (check arpiiceble :Lens): <br />�Doock <br />]\ seasonal dock (relocated or replaced each year). <br />_rennenent pilinC with seescnel deck. _ permanent <br />rising end <br />dec .:n�;. <br />mioden decking. metal decKirg. <br />13. <br />List Dock Accesvories: <br />Number of fire extinguishers sw ileble at the doci: <br />Number of life c,resservers available at the dock <br />[� <br />14. <br />List number of slits in each ceteLory ("slims" includes <br />boat lifts): <br />Transient (day use only) slips C Transient(dey <br />use) off -shore <br />buoys d <br />1-'ermanent macrage slips Permanent muurE,Ee <br />off -shore <br />buoys 0 _. <br />Dry storage ( rack) slips iQ Maximum nurrsber <br />of bolts at <br />the dock _. <br />15. <br />List number of off-street psrkirlg spaces available for <br />users of the <br />join!. u:r <br />dock. 1,Pri ing, .'f provided must not be se;.arAted from.: <br />the dock by <br />my <br />rcrd. _ a,�ccer. <br />3 of 5 <br />