The Summit Owner’s Association Insurance Certification

I declare that the current and any future watercraft moored at my boat slip is/will be insured and that I will maintain the minimum liability insurance, bodily injury in the amount of $100,000/$300,000 and personal property in the amount of $50,000/$100,000, as outlined in my boat slip lease, the Declarations of Covenants, Conditions and Restrictions of the Summit Owner’s Association, and any rules duly instituted by the Association board of Directors.

Name of Insurance Company

Lot Number: _______________________

Boat Slip # Assigned ____________

South Carolina Boat Registration # ____________________________

Signature of Boat Owner __________________________________________________

Boat Owner Name (Print) ________________________________________

Date ______________________

004-09