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�: .�� .. fit' ✓V r• �f .' - r�' .. .r '. :1� � i•C... � �`'. .. ... .li•'%li]•'^. 1 � L': it' _ V... C,. . <br />,I;,;.rce iu!i owned ; o' is y <br />-i ,t• the follovi.n�; in!'o;.rh',Jon: <br />name of insured-+emAk- Tt f,,ut,�, <br />name of' insurance carrier AL-t tjA <br />name of i nsur.,nce rtencv ` V (I <br />policy no. (_�`�-'> t.L �� effective dAte of coverage <br />amount of coverage; Yublie lieti.l`_ty, e'er person, per occurence $ <br />Fubl:c l:nbility, ler occurence $ v tLMc <br />10 • Securi';y and colic ing o, the jointl, usei dock a: d property is provided by <br />(check er,n)icable items): <br />_ fencin6. .� security lighting. I- property owner's presence. <br />contract securit.- Eerrice. other (specify) <br />DOCK INKPI-ItT10',7 <br />11• List Dock Use Area Stlecificativrs: <br />Widtil of shore'l: ne; -I, 'I -' ft. Le lat'r. of r;.ain dcc:c from shore; l Est' ft. <br />Dock setbacks from side property lines at shore; 2,1, ft. and ft. <br />12• Dock Cer.,truetion (check applicable items): <br />`4 seasc,nal dock (relocAted or rep-jaced each year). <br />permanent piling With seaccnel deck. permanent pi'_inG and decking. <br />wooden decking. mete! decking. <br />13. Lis': I)_-.ck Accessories: <br />Number of fire extingu'shers evPi'eble et t:ie dc—k (-• <br />Number cf Life presei-vers avai.lnble r't the dock �t <br />14• Liat n-wnber of slips in eer_ii crtej,ory ("sli? s" includes boat .lifts): <br />Transient (da. use onl,�) slii s Transient (de;; use) off-siiore buoys <br />Permanent moorage slip n ��l 1ermanent moorr,ge off -shore buoys <br />D:y storage (rack) slips � Knximum nuirber of b:)ats at the dock < if <br />15. List number of off-st eet ►.ark',;g s;;•Aces nvailnble for users of the joint use <br />dock. 1,Firlcirtr, -f pruv'del mist riot be se;'arAt.ed from the dock by any plic'.ic <br />Med . s,,aces . <br />3 0f 5 <br />