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1:: er`; w:ier'r- 'nc,:,:c!cw►jer's , o'..ie; . <br />XV A t C Jam` /nr,rO,.if`i.�C�!t GVnr'l GliCy <br />moist the follows <br />name of insuredyir; `%VTATF-5 tloe(M u(�#jaAt4 kkr.I fU <br />Name of itisursnce carrier �)r')LL IFF I ltiC _ <br />name of insurance ot;er.cy &AUG"W utC.titbi. 4 S AV"I lUG <br />policy no. effective date of coverage aT- 1 <br />amount of coverage; Public liebil..;; , r'!r person, per occurence <br />Pub13c 1-ability, :er occurence Sr66 +000 <br />10• Security s,►d rolicing of the Jointly use- dock and property is provided by <br />(cheek eplA icable items): <br />fencing. security ].i, .tiny. X_ property owner's presence. <br />contr&ct security service. other (specify) <br />DOCK INDLRWITTON <br />11• List Dock Use Aree Srecs fica`_in . s: 0&me t-S QWV0Du.S <br />Widt.n c,f snorel!.ne; fA:, i't. enztL: of' rf:i!i dock fro;.i shore; 7'?60 ft. <br />Dock setracks from s"He prnperty lines aL shore; 2kc,ti ft. and _2�Q _ ft. <br />12. DDce. Construction (check applicable :terns): <br />seasonal. doe':,, ( relocated or rePleced a%cn year) . <br />_ rerranent i sling with sesscnel leek,. �L permanent piling and decking. <br />wooden decking. metal deckin6. <br />13. Litt Dcck Accestories: <br />Number of fire eictinLuis"ier!; s•vrilWe at the doer; 0 <br />Number of life Preservers availr,'Ae at the dock C_ <br />14. List number of sll,,s In each ceteL-o.,y ("sllre" inclules boat lifts): <br />Transient (day use only) slips Transient (day use) cFff-shore buoys <br />Permanent moorage sli;,s . l ermonent nuorrige off -shore buoys <br />Dry r,trrage (rack) slips _ Kiximum nun;Af r of 'boats at the dick <br />l.In. number of off-street i-nrki►:K Fvftcer. available for users of the joint use <br />dock. Parking, !.f provided must not be separnt•ed from the dock by any public <br />road. Q a;uaces . <br />3 of S <br />