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('::vur, -e - T: e SC.i <br />;cr er`� ow::er's .:o:,:ccwner's ?'off ic,, <br />separate L� ,:,,/essoci.r_tion owned <br />.�i:_t the followin;; information: <br />name of insured <br />nante of insursnce carrier <br />name cf insarsince ogency <br />policy no. effective date of coverage <br />amount of coverage; i'ublic liatil'_t;, per person, per oc,_;urence 5 <br />Pub1'.e liability, :er occurence $ <br />1D' Security and _policing o, the jointly used dock and 1-roperty is provided by <br />(check eppl.iceble items): <br />_ fencing. _ security lighting. proper,;; owner's presence. <br />contract security, service. other (specify) <br />DOCK IIVCWTIOX <br />11. List Dock Use Area Specificatiuns: <br />Width <br />of shoreline; <br />ft. :..matt; <br />of main <br />dc(sic from shore; <br />ft. <br />Dock <br />setbacks <br />from side <br />pr-)Dert;/ lines at <br />shore; <br />ft. and <br />ft. <br />12• Dock Construction (check applicable items): <br />_ seasonal dock (relocated or replaced each year). <br />permanent piling With seascnel deck. permanent piling and decking. <br />Wooden decking. _ metal deckirg. <br />13. List Dock Accessor!es: <br />Number of fire extinguishers evaileb.e at tie deck <br />Number of life preservers available Rt the dock <br />19' List number of slips in each category ("slips" includes boat lifts): <br />Transient (day use only) slips Transient(da;; use) off -shore buoys <br />Permanent moorage slips Permanent moorage off -shore buoys <br />Dry storage (rack) slips Maximum number of boats at the dock <br />' 5. List number of off-street Narking spaces available for users of the joint use <br />dock. Parking, '.f ;provided must not be selarsted from the dock by any public <br />rood. daces. <br />3 of 5 <br />