<p> STATE OF WISCONSIN Local Government Property Insurance Fund F Property In the Open</p><p>Policyholder Name Policy Number</p><p>Site Name Site Number Building Name Building Number Address City Zip Code</p><p>*QTY *Linear Ft, Unit Value Total Description Height, Sq Ft Value $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Prepared by Date Telephone</p><p>*Refer to back for Qty, Linear ft, etc.</p><p>OCI 41-096 (R 10/2004) PROPERTY IN THE OPEN – SAMPLE LISTING Property Type Unit of Measure -Indicate on Front Side BLEACHERS & FENCING Bleacher, Wood…………………………………….….Photo Required # of Seats and/or Length & # of rows Bleacher, Aluminum………………………………….. Photo Required # of Seats and/or Length & # of rows Fencing, Chain Link, Under 6 Feet in Height ………….….………... Linear Feet & Height Fencing, Chain Link, 6 Feet and Over in Height……….….………... " Fencing, Wood, Under 6 Feet in Height………………….….……..… " Fencing, Wood, 6 Feet and Over in Height……………….….…….… " DOCKS Fixed Dock …………………………………………... .Photo Required Square Footage Floating Dock …………………………………..…… .Photo Required Square Footage PARKS Barbecue, Steel ………………………………………………….…….. Quantity Bench, Park, Aluminum ……………………………………….………. “ Bench, Park, Wood …………………………………………….…….… " Dumpster, Steel ……………………………………………….……….. “ Picnic Table …………………………………………………….………. " Picnic Pavilion ………………………………………………….………. Square Footage, Construction Rain Shelter ……………………………………………………….……. Square Footage, Construction PLAYGROUND EQUIPMENT Bouncer, Animal …………………………………………………………. Quantity Bouncer, Animal 4-Way………………………………………………..… “ Jungle Gym (Bar Climber) ………………………………………………. " Ladder, Horizontal ……………………………………………………….. " Playstructure, Indicate - Small, Medium or Large.….Photo Required " Seesaw …………………………………………………………………... " Slide, Metal ……………………………………………………………….. " Swing, Belt ……………………………………………………………….. # of Seats Swing, Animal ……………………………………………………………. " Whirl ………………………………………………………………………. Quantity SPORTS Basketball Backstop …………………………………….…………….… Quantity Basketball Court …..…….………………………………….………….… Square Footage, Construction Baseball Dugout …………………………………………………………. Square Footage, Constructon Goal, Basketball, Single …………………………………...………….… Quantity Goal, Basketball, Double …….……………………………..…………... “ Goal, Football ……………..….………………………………………….. " Goal, Soccer ……………………………………………………………… " Running Track ……………………………………………………..……. Quantity, # of Lanes, Type Tennis Court, Indicate - Single Court, Two Court or Four Court …… Quantity Scoreboard, Indicate - Small, Medium, or Large… .Photo Required Quantity, Length, and Height Swimming Pool ……………………………………………………..…… Square Foot - Surface Area MISCELLANEOUS Bus Shelter …………………………….…………….. .Photo Required Square Footage, Construction Fire Hydrant ………………………………………………………..….…. Quantity Foot Bridge……………………………………..………Photo Required Linear Feet Lift Station, Package ……………………………………………..……… # & Capacity of Pumps, depth and interior volume, HP of Motors Lighting, Outdoor ……………………………………………………..…. Quantity, Height, # of lamps per pole Lighting, Street ………………………………………………………..…. Quantity, Height, # of lamps per pole Parking Meters ………………………………………………………...… Quantity Retaining Wall ……………………………………………………………. Construction, Linear Feet, Height, Tank, Fuel Oil, Above Ground ……………………………………….... Gallon Capacity Tank, Fuel Oil, Below Ground ………………………………..………... " Tank, Water, Below Ground, Steel ………………………..….……….. " Tank, Water, Below Ground, Concrete …………………..…….…….. " Tank, Water, On Ground, Steel …………………………..……..…….. " Tank, Water, Elevated, Aquasphere …………………..………..…….. " Tank, Water, Elevated, Waterspheroid ……………..…………..…….. " Tank, Water, Elevated, Double Ellipsoidal ……………………….…... " Telephone-Power Poles ……………………………………………..…. Quantity & Height Tower, Communications …………………………………………….….. Height Tower, Fire ………………………………………………….…………..... " Tower, Observation ………………………………………….……...…… " Tower, Transmission Tower ………………………………………….…. " Traffic Signal, Semi Actuated ……………………………………..…..… Quantity Traffic Signal, Fully Actuated …………………………………….…..…. " Traffic Signal, Semi Actuated with Pedestrian Pushbutton …………. " Traffic Signal, Fully Actuated with Pedestrian Pushbutton …….….…. " Transformer, not portable ………………………………………………… Quantity, Type, KVA</p><p>Aguasphere Waterspheroid Double Ellipsoidal</p><p>OCI 41-096 (R 10/2004)</p>