<p> Wharfingers Supplementary Application</p><p>Insured Location(s): 1. 2. 3. 4. 5. Facilities Description (Dimensions/age/construction/mooring,etc.) for each of the locations above 1. 2. 3. 4. 5. Water depth (per loc): Number of berths (per loc): Maximum draft of vessels calling (per loc): 1. 2. 3. 4. 5.</p><p>Type of vessels handled (indicate number per year):</p><p>Self-Propelled Dry Cargo ______Tankers ______</p><p>Barges Dry Cargo ______Tank ______Other ______</p><p>Annual Number of Dockings last 5 years: (total number of vessel calls)</p><p>20______20 ______20______20______20______</p><p>Annual Number of Vessel Days last 5 years: (total number of days - all vessels)</p><p>20______20 ______20______20______20______</p><p>Average value of vessels: ______</p><p>Are vessels inspected and signed for when picked up and delivered?</p><p>Vessels are moved by: Hand______Power Winch______Other______</p><p>Describe traffic passing to and from off your facility:</p><p>No part of this document may be reproduced, published or posted without the permission of The Hartford. Page 1 of 2 Who is responsible for mooring vessels at your facility?</p><p>Is cargo handling equipment owned or leased? ______If leased, are you responsible for complying with Mfg. recommended maintenance (or is there a maintenance service contract)? ______</p><p>Describe loading and unloading equipment including type, capacity and power: </p><p>Describe your procedures in the event of a breakaway:</p><p>Number of hours watchman is on duty ______Is clock punched ______</p><p>Is facility lighted? Fenced?Describe public access:</p><p>Are fueling services provided? Types of fuel handled:</p><p>Who is responsible for bilge inspection and pumping if needed?</p><p>Municipal or volunteer fire department?______Distance from insured location?______</p><p>Number of fire hydrants at insured location? ______</p><p>Number of fire extinguishers at your facility ______Size______Kind______</p><p>Current Premiums (i.e. Minimum & Deposit and adjustment rate):</p><p>Are revenues generated from other than wharfinger operations ? Yes No If yes, provide details:</p><p>No part of this document may be reproduced, published or posted without the permission of The Hartford.</p>