Kentucky Ferryboat Annual Report - Home | KYTC



Instructions: See the online KYTC Forms Library for a PDF instructions document to guide users in filling out this form. SECTION 1: FERRY INFORMATIONFERRY NAMEREPORT YEARFERRY TYPE FORMTEXT ????? FORMTEXT ????? FORMDROPDOWN RIVER CROSSEDRIVER MILEPOINTCROSSING LENGTHAVERAGE DETOUR LENGTHMilesMinutesMilesMinutes FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????FERRY CAPACITYVehicle Capacity(# of Standard Passenger Cars)Capabilities of Ferry (Mark all that apply.) FORMCHECKBOX Passenger Cars FORMCHECKBOX 3 Axle Trucks FORMCHECKBOX 6+ Axle Trucks FORMCHECKBOX Farm/Construction Equipment FORMCHECKBOX Pickups, SUVs, Vans FORMCHECKBOX 4 Axle Trucks FORMCHECKBOX 1 Axle Trailers FORMCHECKBOX Motorcycles FORMTEXT ????? FORMCHECKBOX 2 Axle Trucks FORMCHECKBOX 5 Axle Trucks FORMCHECKBOX 2 Axle Trailers FORMCHECKBOX Bicycles FORMCHECKBOX Buses FORMCHECKBOX Foot PassengersSECTION 2: FERRY AUTHORITY INFORMATIONAUTHORITY NAMEMAILING ADDRESS (street) FORMTEXT ????? FORMTEXT ?????CITYSTATEZIPPHONE FORMTEXT ????? FORMTEXT ??? FORMTEXT ????? FORMTEXT ?????CONTACT NAMEPOSITION TITLE FORMTEXT ????? FORMTEXT ?????EMAIL ADDRESSPHONE FORMTEXT ????? FORMTEXT ?????LIST WEBSITES & SOCIAL MEDIA ACCOUNTS: FORMTEXT ?????SECTION 3: FERRY OPERATOR INFORMATION FORMCHECKBOX Check box and skip Section 3 if owner and operator are the same.OPERATOR NAME FORMTEXT ?????CONTACT NAMEPOSITION TITLE FORMTEXT ????? FORMTEXT ?????EMAIL ADDRESSPHONE FORMTEXT ????? FORMTEXT ?????SECTION 4: LANDING INFORMATIONLANDING #1LANDING #2Landing Name FORMTEXT ????? FORMTEXT ?????Road FORMTEXT ????? FORMTEXT ?????Road Milepoint FORMTEXT ????? FORMTEXT ?????City FORMTEXT ????? FORMTEXT ?????County FORMTEXT ????? FORMTEXT ?????State FORMTEXT ????? FORMTEXT ?????Highway District FORMTEXT ????? FORMTEXT ?????Parking Available FORMTEXT ????? FORMTEXT ?????Landing Ownership FORMDROPDOWN FORMDROPDOWN SECTION 5: TOWING VESSEL INFORMATIONVESSEL #1 (Primary)VESSEL #2 (Backup 1)VESSEL #3 (Backup 2)Name FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????USCG Official # FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Year Built FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Vessel Length FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Vessel Breadth FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????COD Issue Date FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????COD Expiration Date FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????COI Issue Date FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????COI Expiration Date FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Vessel Service Status FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Date Engine Last Replaced/Overhauled FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Vessel Ownership FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN SECTION 6: PASSENGER BARGE INFORMATIONVESSEL #1 (Primary)VESSEL #2 (Backup 1)VESSEL #3 (Backup 2)Name FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????USCG Official # FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Year Built FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Vessel Length FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Vessel Breadth FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????COD Issue Date FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????COD Expiration Date FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Vessel Service Status FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????COI Issue Date FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????COI Expiration Date FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????# Passengers Allowed FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Date of Next Dry Dock FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Barge Ownership FORMDROPDOWN FORMDROPDOWN FORMDROPDOWN SECTION 7: ATTACHMENT CHECKLIST FORMCHECKBOX Schedule of Hours FORMCHECKBOX Current Fares Schedule (if applicable) FORMCHECKBOX Proof of current liability insurance (certificate of insurance or ACORD certificate of liability insurance) FORMCHECKBOX Copy of current Certificate of Documentation (CG-1270) for each towing vessel FORMCHECKBOX Copy of current Certificate of Inspection (CG-841) for each towing vessel (if applicable) FORMCHECKBOX Copy of current Certificate of Documentation (CG-1270) for each passenger barge FORMCHECKBOX Copy of current Certificate of Inspection (CG-841) for each passenger bargeSECTION 8: CERTIFICATIONI hereby certify, subject to the provisions of KRS 523.100, Unsworn falsification to authorities, that the above information and all attached information is true and correct to the best of my knowledge.PRINTED NAMETITLE FORMTEXT ????? FORMTEXT ?????SIGNATUREDATE FORMTEXT ????? ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download