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(�O `nmir,2� Ono (,f Lx c,: <br />Ast the folllov'n­ inl'orm;il..ion: <br />U <br />name of Insured <br />name of insurance carrier <br />name of insurance v6ency 1c J; 4, <br />policy no. 410,A1- JUu 1-U i effective date of coverage U, <br />emount of coverage; Public rer person, per occurence $ <br />Fubl,'c If.ribility, rer occurence Y+ I ;^^- , <br />10. Sect)-rity wid policing of the jointly used dock and Tprwperty is provided <br />(check eppliceble items) <br />f enc. 'In security li(Lhting. pro-rerty ovaer's presence. <br />contract securit., service. oth,_­, 07pecif�,,' <br />DOCK iNKIRMATION <br />1 7 �+ Do I- " 11 C 4' t <br />is1. %_ 5e rea 1)ecj �CM..LLjns: �_ay .11 <br />W.-AAtri of shorei,.ne; ft. 7,enwth of main dock fxnm shore; ft. <br />Dock setbacrzs from side prcjeriu-y lines at shore; ft- anj ft. <br />12. Dock Construction (check applicable -items): <br />seasonal dock (relocnted or replaced each year). <br />r,ermanent pilinC, wit'i seasonal deck. permanent pilinZ; x7.nd dt,:ckinL,-. <br />wooden deckinC. metal <br />13. List D-)ck Accessories: <br />Nwriber cf fire extinCuLshers at t`ie dcck <br />Nwi:ber of irf?,,;ervers nvriilri%;_Ic V. e ch:,O: <br />19 List nlimt-er of _> ilr. er:-!; includes boat lifts): <br />Transient (d;iy use on-),') TranEiunt(dity use) off,hore buo,­s <br />Fermnnent, <br />!',ry storage (rack) 61.1ps <br />1crwinent ,,i)urrice off -shore but-Yr, <br />Maximiim ,urT.1r,!Y- of beats at the docK <br />15. Lirt nurn"ber of off-street pr.rKini-. nvailabl_(- fcr users of the Joint uee <br />clock. 1'nrkint,, If providel rnai3t ric-A be ve,�nrste,. 4'r,,M the dock by eny public <br />I -i � <br />rued. v Spaces. <br />3 of <br />