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J. <br />JeI V - m„r, . <br />: i�,t ..hc foa.]ow.�nf; ia!'ur:r.,i1Acm: <br />i <br />narne of insured <br />came of irisuranee carrier <br />name of insurance nrency <br />policy no. C 7 % � ( effective dAt.e of coverage <br />Rmcunt of eovernge; Public lie:.il' , pr ,rson, Fer occ:urence S <br />' ubl'c l:.'ibil.ity, .e2 .urence - <br />lU Secltrity acid rolicfng o:' tie joirtl;; sec dock erd ;.rorert�� is ; ; ,vided by <br />(check enpliceble items): <br />fencing. >\ security lig":tine. _ property oFmer's presence. <br />cOntract securit' ,ervice. Ot_ne2' (specify; <br />DOCK II' K-41ATION <br />11. List .3ock Use Area Spec if`.crltiL'ns: <br />ilidt.n of s7arel'.ne; ft,- Le-nath of ma-'., dock fmi,1 :bore; i ft. <br />Dock setl'aces from side pr)pert-y lilies aL shore: ft. and <br />12. Deck Construction (check applicable :+ems): <br />a. <br />_ seasonal mock (.vioceted cr rep -aced each year). <br />____ rennPnent Riling with see.;cne-. e.,ck. � pemane::t pilir4 and decking;. <br />`<__ wooden decking. met.el 1i,ackir.;; <br />13 Lis' Dock Accessor4t:,: <br />Number of fire extinguishers svc1leb,e at the doc''w v r <br />Number of life preservers available Pt the dock A' 7 s <br />14• Llst number of sl:; in each cetel;ory ("slips" includes boat lifts): <br />TranRient (day ure only) slips Transient(day use) off -shore buoys <br />f'ermnent moorage s. i;'e <br />Dry storeRe ; rack) s 1 i rs <br />Permanent morree vff-Rhore buoys <br />Maximum r.urber of boats at the dock <br />15• l.fst number of off-street j4ming spaces available fcr users of the joint use <br />dock. I,Prking, If provided must not be separated from the dock by any public <br />mod. - spaces. <br />3 of <br />