ࡱ                >  	               $          .          #    5@	                  bjbj22                  	 5  X  X  T                                                                     &      &  &      &      v      v      v                   n      n      n  8          ,                                               J             l     n      n      n      n      n      n  $     R    d                        v                              "                                   &      &                       q       $      $      $        (   &  8         v            l              $                                                            l      $     $      $  :     ,   ^     v                                                                               Vs\i        n             
           @  ,     0           
   g        ^   g                               &      &      &      &                      g              v        (     >   ]  ,   $        $     A                                                                          n                               n                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         MARINE COMMERCIAL LIABILITYSUPPLEMENTARY INFORMATION FOR STEVEDORESApplicants Name:Mailing address and phone number:3.   Number of years in business:		Number of years under current management:Location(s):Please advise the following for each type of cargo separately:Tonnage handled	Tonnage estimated	Method ofType of Cargo		Last 12 months	next 12 months	handling General Break-bulk Cargoes	______________	______________	____________Refrigerated/chilled Cargoes	______________	______________	____________Bulk Grain			______________	______________	____________Coal/Bulk Ores			______________	______________	____________Liquid Chemicals		______________	______________	____________Bulk Oils			______________	______________	____________Scrap Metals			______________	______________	____________Heavy Lift Cargoes		______________	______________	____________Containerized			______________	______________	____________Automobiles			______________	______________	____________Explosive, Flammable orToxic Cargoes			______________	______________	____________Machinery			______________	______________	____________	Total Annual Gross Receipts last 5 years:19__ _________19__ _________19__ __________19__ __________19__ ___________For liquid cargoes in bulk, are you responsible for hook-up of pipes(a) Aboard Ship?  Yes   No	(b) At shoreside connection/tank farms?  Yes    No8.   Are you responsible for properly and safely stowing as well as loading or unloading      	cargoes?  Yes    No9.   Do you perform lighterage operations?  Yes   No   If yes,  (a) How far offshore are 	the lightered ships?   ___miles  (b) What kind of cargoes are involved?10. Do you own or lease the terminal you service?11. Do you operate using your own cargo handling equipment?12. If Ships handling equipment is used, what percentage of the time does this happen?13. Whose employees operate the equipment? Yours or the Ships?14. If Ships crew operate the equipment, do they do so under your direction?  Yes   No15. Is there a municipal or volunteer fire department?16. What is the distance from the nearest fire fighting facility?17. Number if fire hydrants at your facility?18. Number of fire extinguishers at your facility?19. Who is your current insurance carrier?20. How long insured by them?21. Has your insurance ever been cancelled?         If yes, why and by whom?22. Limit of liability requested $_______________	Deductible $______________23. If our quotation is accepted, what is date of attachment?24. Current premiums? (i.e. Minimum & Deposit and adjustment rate):25. Are revenues generated from other than the marine operations described above? ____      If so, provide details:26. Does applicant use employee leasing services and/or temporary workers? _________      If so, are there hold harmless/indemnity agreements in place in the applicants favor?                        _______ Waiver of subrogation? _______ Are certificates of insurance obtained?       ________ What limits? _________________________________________________27. List all losses during the last 5 years (amounts should include deductible)Date of Loss	Amount Paid	Amount Outstanding		Description of Loss28. Contact and phone number to arrange an inspection:29. Producer remarks:Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance containing any false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime. (Applicable to New York State Only.)Signing this application does not bind the Applicant to purchase the insurance or the Company to accept the risk, but it is agreed that this application shall be the basis of the contract should a policy be issued.__________________________________	__________________________________	____________________________	Applicant Signature			Company Title				Date__________________________________	__________________________________	____________________________Producer Signature			Company Title				Date	Ed. 7/99	Page  PAGE 3 of 3 EMBED Word.Picture.8                                                                                                                                                                                                                                                                                                                                                                                        K  M  	  u  9  :  [  \  T  b  c  i  j  k  l  q  s  t  u              ź                                                                                                                                                                              jv5C
h UVh  j    h UhH  h h mH nH u j    hGx Uh  	hGx h 
hGx CJ  	hGx 5
hGx CJ  	hGx >*h3  hGx  j    h UmH nH u           !  "  K  L  M  _  `                    !	  "	  N	  	  	                                                                                                                                                                                                                                                                                                                          `   @^@  
& F      
& F      $a$   gd     T  t                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            	  	  
  L
  
  
  
  6  u        <  s  u  v  w  x  y  z          6                                                                                                                                                                                                                                                                                                                                           h^h  
& F       dh 	 ! dh              
  b      1  s          j      9  :            u                                                                                                                                                                                                                                                                                                                                                             d  !       i                                   [  \  3  4        (                                                                                                                                                                                                                                                                                                                	  00]0^0  	 ! dh    dh    d `   d  (  T  r  s  t                                                                                                                                                                                                                                                                                                                                                                                                                                                         gd       	  00]0^0  / =!"#$%  `!  H.H+o`:              p# @ q   x[}l^/ۄLb{&N:lg'1$N䫀p@4Q"	j@I"Um"J$RB
i%$RUJ+"}{>?<{37cv
 ՝_7ee#j/eRuJj>5F߇cȮݙ-+`gow?1lבUU~v!~T{gvܜy~`0Z~BdI51uP8³ W\Yxo}Zl'/W׊udkxm-L$.\
>9GÛ< 8m}pċw<~7?μ|gң['wtsᗙڽ`킽;=8x =z^xIxpb:x"'NSNcxp?྾+9s8#F8}4z8ă_O̅p]:+;}?o?$?~<c{ñ|9<yẀÇñcٳp_^9|yo!R)~hiiXWWL<σZO᭷ނ?VX0w\سgxxCߗ0|H{]u6Mxȑ#}E80Cu!!lOݷ|-_Db"C;L744-eĘ>)c7hD|1q"pe4"iSCqi;cf+Gq.rx5(&09˥Jk]|vE;Fv>1!]쬡1>8'amxhxǚkxَؖ18fvHSEJk#ˋqr(ƚk;D}Ӻv$[N&A߆q(i,q)NFШqjzu҉Dk0];
8.ؑPw4c8p,/1i̤-	3$#,Ŗ-5c_tcluanVhIq8qNyfk%lF{&LÖy5%ÈQ@f`2Br8t#mLb~O k hjCvqp-+|Pm$jt=VͲGs#V^꽫VM܌TboԱ43ep͒{t]xVE+ă'oF߲Qi!NvnDzIqw 6&t+ &A|MC:TkD㫻&<퓥%r5d=}G7m_YŴPo)!43o,a,?2XTO8:EYʫC4T-?'tδі4ovHi*ƴHG8s|ӲxVYdq2P0K_	M-bqa6Jc"&-(Ű\>]zǘmF"VؕYpu>XF.t7%Rn4$RR6_ D-cq$4M4·.ޤi2)3F'.(	p!vT<xDtQG{|H t /홮c{d9b[x<3\OGC-p<f<x³6k8 CĔ3G^1~box'16rI!p=QY &^QOA`QH&&*|`y.GQ= T|l%8A4AoBWSTf>Q8jphHE<w'](w*'_* %xu88@N$xVx@ˠs8E=GK)`zcU*⾇s^I pC|}L45)q)qO#13T \
]rYލ㸅BJ.Z%ĉnԩiebu>sX*$p-LβyXh:	MGlC0⛬B8julFt&2(x6.9݅ez|ٵ.)؀9˶ȇfÕkG'8F>"8aM񀫴P[^Ԓ*|[6 !RVG[@:uD#AIC#%B*AƄ^7p`r1k-Lb#@60VKJ=T\*|h
rpzH#,V`BPc/ad}cH#}!F\*fQ$>JAu(\p^ۛcj#mѷRNhmU881}5}z̓§^<PUp߁/`D(8۬b۶:2=,W6I3hrqRܰFAۈ|=b8#rxGV1r5 {ZXR,"G<,0w7(G6cҬ+7#ca.":zVrReDGRqsi0x5#
ad51ƻ+~ fRЙ Yڿ")g1&Bsו|vM1&C7]2/[%d8,zep5B:ٔ<ጕ>ph>UuGCS?0^p\_`r||ef4- ƍ3Ǭҝ*è-h&]zRs{[ySm/}}%8ѫbTBB8ꎎ\Ι^J"3ܙ(>Ʊ&53-8TΜcdMi@8dq$[;v$ʹwRxq(/2;nU	/iǝU J+LTY¿9)DGY|Ee%φl$>[e NM:M_N7Y[Yz'qX̉Y{tS?ΉeD1;H,o}}5IWˍid[gsuZz%@ !I{f钙W5f8Itm
d)<zaס?i-F-Z8ʟPZG_\rōi.#f
cwZͫyJ;av}MjZK(oR__W$^YD#M_<&d	Mjj3+ػUU.~YjN                                                         D d       
             P                                 b   
      
  c $      A   ?        ?  3 "     `   ?           2   H.H+o      D     _`!  H.H+o`:              p# @ q   x[}l^/ۄLb{&N:lg'1$N䫀p@4Q"	j@I"Um"J$RB
i%$RUJ+"}{>?<{37cv
 ՝_7ee#j/eRuJj>5F߇cȮݙ-+`gow?1lבUU~v!~T{gvܜy~`0Z~BdI51uP8³ W\Yxo}Zl'/W׊udkxm-L$.\
>9GÛ< 8m}pċw<~7?μ|gң['wtsᗙڽ`킽;=8x =z^xIxpb:x"'NSNcxp?྾+9s8#F8}4z8ă_O̅p]:+;}?o?$?~<c{ñ|9<yẀÇñcٳp_^9|yo!R)~hiiXWWL<σZO᭷ނ?VX0w\سgxxCߗ0|H{]u6Mxȑ#}E80Cu!!lOݷ|-_Db"C;L744-eĘ>)c7hD|1q"pe4"iSCqi;cf+Gq.rx5(&09˥Jk]|vE;Fv>1!]쬡1>8'amxhxǚkxَؖ18fvHSEJk#ˋqr(ƚk;D}Ӻv$[N&A߆q(i,q)NFШqjzu҉Dk0];
8.ؑPw4c8p,/1i̤-	3$#,Ŗ-5c_tcluanVhIq8qNyfk%lF{&LÖy5%ÈQ@f`2Br8t#mLb~O k hjCvqp-+|Pm$jt=VͲGs#V^꽫VM܌TboԱ43ep͒{t]xVE+ă'oF߲Qi!NvnDzIqw 6&t+ &A|MC:TkD㫻&<퓥%r5d=}G7m_YŴPo)!43o,a,?2XTO8:EYʫC4T-?'tδі4ovHi*ƴHG8s|ӲxVYdq2P0K_	M-bqa6Jc"&-(Ű\>]zǘmF"VؕYpu>XF.t7%Rn4$RR6_ D-cq$4M4·.ޤi2)3F'.(	p!vT<xDtQG{|H t /홮c{d9b[x<3\OGC-p<f<x³6k8 CĔ3G^1~box'16rI!p=QY &^QOA`QH&&*|`y.GQ= T|l%8A4AoBWSTf>Q8jphHE<w'](w*'_* %xu88@N$xVx@ˠs8E=GK)`zcU*⾇s^I pC|}L45)q)qO#13T \
]rYލ㸅BJ.Z%ĉnԩiebu>sX*$p-LβyXh:	MGlC0⛬B8julFt&2(x6.9݅ez|ٵ.)؀9˶ȇfÕkG'8F>"8aM񀫴P[^Ԓ*|[6 !RVG[@:uD#AIC#%B*AƄ^7p`r1k-Lb#@60VKJ=T\*|h
rpzH#,V`BPc/ad}cH#}!F\*fQ$>JAu(\p^ۛcj#mѷRNhmU881}5}z̓§^<PUp߁/`D(8۬b۶:2=,W6I3hrqRܰFAۈ|=b8#rxGV1r5 {ZXR,"G<,0w7(G6cҬ+7#ca.":zVrReDGRqsi0x5#
ad51ƻ+~ fRЙ Yڿ")g1&Bsו|vM1&C7]2/[%d8,zep5B:ٔ<ጕ>ph>UuGCS?0^p\_`r||ef4- ƍ3Ǭҝ*è-h&]zRs{[ySm/}}%8ѫbTBB8ꎎ\Ι^J"3ܙ(>Ʊ&53-8TΜcdMi@8dq$[;v$ʹwRxq(/2;nU	/iǝU J+LTY¿9)DGY|Ee%φl$>[e NM:M_N7Y[Yz'qX̉Y{tS?ΉeD1;H,o}}5IWˍid[gsuZz%@ !I{f钙W5f8Itm
d)<zaס?i-F-Z8ʟPZG_\rōi.#f
cwZͫyJ;av}MjZK(oR__W$^YD#M_<&d	Mjj3+ػUU.~YjN                                                                                                                                                                                                                                                                                                                                                                                                                   	   
                                                                   !   "   %   0   '   (   )   *   +   ,   -   R   Q   2   3   4   5   6   7   8   9   :   ;   <   =   >   ?   @   B   C   D   E   F   G   H   J   K   L   M   N   O   P   b   T   U   V   W   X   Y   Z   [   \   ]   ^   _   `   a   R o o t   E n t r y                                                 	           F            \i/   @      D a t a                                                         
                                               W o r d D o c u m e n t                                                                                     5      O b j e c t P o o l                                                                        Vs\i\i            _ 1 1 2 7 5 7 7 3 1 1                                               	           F    Vs\iVs\i            1 T a b l e                                                                                          &           C o m p O b j                                                                                                h        O b j I n f o                                                                                                               8  @ 8           N o r m a l       _HmH	sH	tH	                  D A  D          D e f a u l t   P a r a g r a p h   F o n t     V i@ V          T a b l e   N o r m a l     :V   4   4 
l a      ( k@ (           N o   L i s t                	             @V                         M90                                               l                          ,   b $   SOhͥf z           @                           |    (    	                
          D   
      
      A    "                        B    
        S              	   ?                           P    t                                                         j0           @        r                              @      U n k n o w n                                   G  z                  T i m e s   N e w   R o m a n   5                       S y m b o l   3&  z                  A r i a l   "     h    lz&lz&                                         !                                                                                                                                                                                                                                                                                                                            r4                                                                                   
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  	           F   Microsoft Word Picture 
   MSWordDoc    Word.Picture.8 9q                                                                                                                        Oh +'0                                                  	          
   4     @     L     X     d     l     t     |               s         s    
   Specialty          pec      Stevedores application        Estelle Balestrieri    W o r d D o c u m e n t                                              	                                       1          S u m m a r y I n f o r m a t i o n                           ( 
                                       A           D o c u m e n t S u m m a r y I n f o r m a t i o n           8                                      I          1 T a b l e                                                                                                 S   {       5@	                  bjbj22                  	   X  X                                                                         .      .  .      .      .      .      .             d                                  d                                         )      )      )      y     {      {      {      {      {      {  $     R    x                        .      )                        "   )      )      )                    .      .                      [       Q      Q      Q      )  
   .            .            y              Q                                                      )      y      Q      Q              Q      .      .                                                              Q                 ¯ޑ              3  
   Q              m       0         Q      z      =  
   z      Q              B     V     .      .      .      .                      z              .      Q     )      )      Q      )      )                                      )      )      )                  d      d  $                 G  
   d      d                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  hj0  j    hj0 UmH nH u        P  v:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  N N!#"## $$ $%   nr  SOhͥfPNG

   IHDR      d   t+*   gAMA     PLTE   			!!!%%%)))---333000555777222999===99>66:I>>>>I 3f 3g5f 3i 3n;j7h 3w 3u4r 3{I>I<AAEnBmKu$Kr)Ns,Qv+Wz3Uw4Vy6Y|;\| BdAAAFFFJJJMMMEESMM[QQQVVVYYY^^^JUVUUfWYi]]sA_|Khaaafffiiimmmbbyqqqwwwvvvuuuzzz}}}~~~cv| 34 3 3 3 3 3 36	:F@7Y(O5a>`CG#M*T6\;f3`FfTlYoDw\qVsWwfwk{dwfzwwnuDfFhHkUwQtXxHtc|]y^wkqvw}~uoxsZǙ̙˙ňۆә̚ˉؙՒئʩݭݨټݲҮϭ囫޸ƶ٩κwZ   	pHYs    >T>  
IDATxŚOhP/){KA.zPt!.0REbLQ18Aaq)	dEs@ S?D%4Plģ49L/a3i}r~{|ΰޒ'OauO~ٓw7_+ !scCvz0~qB./.@'cOo/*GmOctܹs{z>_	@kmH9a9rnZqn}|.
{`\y$g<T7`zCS@83GKSL.):8	Ar8(sO)RPj cKp<0v{76IGCl+| wdx'U՛9(XL͑f=MS^F}/N'}&OGn{<"7('1wrTns4sp~@kaL	-~yQ0dc}VR. x{nf5^l62F$+5MBڸ5)ZYFÉRx:tTL1KWn_i[kU$M2Ɨ#Β(2?<FQ`2
\Y~0MيUjc3g(7p16FxԺo<co_7 _O)I۟3涾~cx1]zo5v5K\t.+^K<
mfY	]fcEm2gNSGFGaO,!ƄwXm#XMȴV36<c΋X2%ER.CLĨZ|#F\wmpF[lB6uꘋ HCWteL+0gBܪhsQ,Nq&AOg/XB6 M<x	\"7LFsT]*uT?S:6]\D<6FD2`TXoZp4pw2 0y2͏ާ*8Dǐt4/Cyo^V'caXG!O8r&D:xWo8	C=o}ß󍫹sc{Z\\<,`qd43\c܋b4a":b]"XΔU fQcoY50xL !0  "7{%Ůuhq{ثvJŰC$՛	QlA<
fOfRk\yL
 	`zJ !&*DxgR gO<Vẁ#	ͷ	-t[T;Bs&MtÏmHF%_G5ˈ	%&<I84#mWJ^HG[/XPqYoy1cVdBRvs	>,01e2l<[t%mė3
\L#~IY2.û@eIvN2%W(ghyХRˢ]bD I3,dȂ:&"LX:Jcc1U2a* kDE.-E0BK_ACޡo$#(~Ƚl9\A~2&Oh0QLqOJڨRME7(TT@a%,I
:a!礍<
饦! BS2vՒ@Yi0+	}
DF68($45ix#cq
ƘoaF,w0BKp4z'p+q.lƂؚ(h#)N>E-k#-ͦ2t$$LUT926x>_qhftpJ˾6R[^hGr#'wHbl޺t,?\>y6fsU4*0}Ck'ؕ}g_ǣ}:]1.?HG1(c^T9S;-/*Ee6D2*ѩl,43, 
+1qO佥scpZwl+/sBo<UC@ J}#*jZߪoT-g
1_:uㅯOpHmpH]H>J70COaqy%ǂ3)D5KckңEJN?-_C>7WaҧRuo_zmp,BI ŏ?bi!ߙl&w1W`=e7tu]Vmi%3zE\5/_-6,N~a"ُI1s-L _kcdbkB^Nt6($4\,PZ_Mp}]|͏0rB:#ۭO)e"kQx]c'q7iU"eXxVϟGݴGdL]kw}>:vt6MrhZs91e,.-molX4ػy+-k!ݪk/c857.JsWHֵl>/F.OxOsÁ>nv>{yw]lڞpR/󱡎*0YNt/5r.ic#˾fk#]M6GSҌ^\ќQlSܭ?C?3tsP    IENDB`                                                                                                                                                                                                                                                                                                                                                                                              Oh +'0   l                                               	           
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   0       C o m p O b j                                                                                          j                                                                                                                              2 te      Microsoft Word 10.0 @    F#    @    c@    2\i@    2\i         o                                                ՜. +,0            h      p                                                                          Great American Insurance  s                L     A

                                                  Title                        
  	           F   Microsoft Word Document 
   MSWo               <  @ <           N o r m a l       CJ _HmH	sH	tH	> @  >          	 H e a d i n g   1     $$@& a$ >*                 D A@ D          D e f a u l t   P a r a g r a p h   F o n t     V i@ V          T a b l e   N o r m a l     :V   4   4 
l a      ( k  (           N o   L i s t         4 @  4           H e a d e r      !   4  @ 4           F o o t e r      !   H T@ H          
 B l o c k   T e x t     00]0^0 5CJ                                                                      
  (                    !   "   K   L   M   _   `                              !  "  N          L        6  u        <  s  u  v  w  x  y  z          6                
  b      1  s        	  j	  	  	  9
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    u      i                                   [  \  3  4        (  T  r  s  t            0                       0                       0                       0                       0                        0                       0                        0       "                 0       "                0       "                 0       "                0      "                 0       "                 0       "                 0       "                 0       "                0       "                 0       "                 0       "                 0       "                0      "                 0       "                 0       "                 0       "                 0       "                0       "                 0       "                 0       "                 0       "                 0       "                 0       "                 0       "                 0       "                 0       "                 0       "                 0       "                 0       "                 0       "                 0       "                 0       "                 0       "                 0       "                 0       "                 0       "                0      "                 0       "                 0       "                 0       "                0      "                 0                        0                        0                        0                        0                       0                        0                        0                        0                        0                        0                        0                        0                        0                        0                        0                        0                        0                        0                        0                        0                       0                      0                        0                        0                        0                        0                        0                        0                        0                        0                        0                        0                        0                        0                        0                        0                       0                       0                       0                       0                       0                       0                       0                       0                       0                       0                       0                        0                        0                        0                        0                        0                        0                        0                        0             p      @  0                 My0                                         @   0                       0                   M90                                                                     "              	      (                                    "   !t              :  l                          ,   2 $   H.H+o      (      @                               (    	                    
          Z   
     
  s *   A      ?       ?                       B    
        S              	   ?                  M    t         _ 1 1 1 0 7 0 5 5 4 7  _ 1 1 2 7 5 7 7 3 1 1 	 O L E _ L I N K 2            @  @               B|    M C|    Q D|    E|   ,N  E  E  N                       M  S  S                   =      *urn:schemas-microsoft-com:office:smarttags	PlaceName =      *urn:schemas-microsoft-com:office:smarttags	PlaceType 9      *urn:schemas-microsoft-com:office:smarttagsplace V      *urn:schemas-microsoft-com:office:smarttags
PersonNamehttp://www.microsoft.com                                 X  a  T  s  t              U  W  6  :  m  u          Q	  i	  
  
  {        6  Z  T  s  t     3  3  3  3  3  3  3  3  3  3         M   `         <  z      T  b  l  q  s  t                       T  s  t           	 S p e c i a l t y   	 S p e c i a l t y   	 S p e c i a l t y   	 S p e c i a l t y   	 S p e c i a l t y    S p e c i a l t y   D i v i s i o n   	 S p e c i a l t y    N Y C I R J G    N Y C I R J G    E s t e l l e   B a l e s t r i e r i    y}; 	 :,R 	                         h h^h`o(    .                         h h^h`o(    .    :,R            y};                                             3 Gx  H     z  3  T  s                      @        ul                             @      U n k n o w n                                   U z                  T i m e s   N e w   R o m a n   T a h o m a   5                       S y m b o l   3&  z                  A r i a l   "  q   h    @lF@lF"[    o            o               "                                                                                                                                                                                                                                                                                                                             24              L  L                                                                     3                              H     ( ?    3                 	 S p e c i a l t y  E s t e l l e   B a l e s t r i e r i                                                                                                                                                                                                                                                                                                                                                                                                                                        rdDoc    Word.Document.8 9q                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
