Repair & Renew Grant Application Form For households and businesses affected by flooding between 1st April 2013 – 31st March 2014 1. Applicant Information Name of Applicant: Business Name: (if applicable) Address Postcode: Contact Telephone Number: Mobile Telephone Number: Website: E-mail: VAT Registration Number (Businesses only if VAT registered) Any approved payments will be made by BACS payment, please provide bank details of payee: Bank Name: Account Name: Account Number: Sort Code: 2. Address of property affected (if different from above), including postcode Is the building residential or commercial? Is the building listed or in a conservation area? Please provide details Are you the property owner or tenant? Property Flooded Property Owner/Tenant/Lessee Please note a tenant/lessee can only apply when they have received and submitted written approval from the property owner agreeing to the changes/grant aided works Date property was initially flooded 3. Do you know the cause of the flooding Tidal surge Other (please specify) 4. Please briefly describe the primary damage that was caused by the flooding – how has your property been affected by the flooding – please provide any supporting evidence such as photographs 5. Please outline your insurance position Not Insured If the property wasn’t insured has any work been done to remediate since? Provide details of any work undertaken. Insured If yes provide details below Type of Cover Has a claim been made What is the current status of the claim If the claim has been settled please provide evidence of how much and what was claimed for. 6. What is the current status of the premises? Empty Partially Occupied Fully Occupied 7. What Is your grant application for? Resilience/ resistance measures that you will install in the future should your grant be approved? For resilience/ resistance measures that you have already purchased and installed following the flooding (retrospective application). 8. Is your application being submitted as a collaborative application? Yes/No If yes please outline the benefits and provide more information 9. Please indicate which of the available resilience/ resistance measures you intend to or have installed (if a retrospective application), and cost (including VAT). Two like for like quotes should be provided with your application to support the identified cost. Please also supply either technical literature or a technical description of the proposed measures. If you have not selected the cheapest available quote, please briefly explain why. Alternatively, retrospective applications should answer question 11. Please note that the maximum grant that can be applied for is £5,000 (including VAT costs if unrecoverable). Any costs incurred above £5,000 will need to be met from your own funds. When selecting which measures you intend to install, please read the application guidance note and we strongly advise that you consider information available on reference websites such as www.nationalfloodforum.org.uk/property-level-protection-community-tool/. The guidance will help you select the appropriate resilience/ resistance measures for the nature of flooding in your area – not all of the identified measures may be appropriate, and may make limited difference to protecting or minimising the damage to your premises. Should you choose to seek professional advice such as from a surveyor, builder or engineer accredited by a professional organisation such as RICS, the Institute of Civil Engineers or the Chartered Institute of Builders, prior to making an application, you can retrospectively claim up to £500 of the cost as part of your application. Please note that should your application be successful, Redcar & Cleveland Borough Council and or Defra do not have any liability in terms of the effectiveness of the grant aided measures. An indicative list of flood resilience measures is provided at appendix 1. If you identify a measure that is not on the standard list, you should provide full details in the table below. 9. (cont) Please indicate which of the available resilience/ resistance measures you intend to or have installed (if a retrospective application), and cost (including VAT). Details of goods / services being claimed Date of invoice Copy of invoice attached (tick & state invoice no) Value of Claim (excluding recoverable VAT) 10. Two like for like quotes for the purchase and installation of the identified measures should be included with your application together with either technical literature or a technical description of the proposed measure. If you have not selected the cheapest available quote, please briefly explain why. 11. FOR RETROSPECTIVE APPLICATIONS ONLY – If you are applying for works that have already been undertaken, please briefly describe how you ensured value for money i.e. utilised insurance company contractor, or sought quotes from a range of providers. Evidence of quotes and invoices should please be included with your application. 12. Have you received any alternative funding (such as previous grant funding or insurance claim payment) for any of the equipment you are applying for grant funding for? If yes, please specify and state why also seeking Repair and Renew Grant support. Yes/ No 13. FOR APPLICATIONS BUSINESS PREMISES ONLY – Have you received any other public grant funding during the last three years? If so please specify awarding body, detail of assistance received, date of assistance and amount. 10. Sign off Your claim may be subject to audit at a later date. If, following payment, it is found that information contained within the claim is incorrect or the protection measures have been removed from the property; Redcar & Cleveland Borough Council may seek to recover the grant. Please note that as this investment will involve expenditure of public resources, there is naturally public interest in how funds are spent. Details of your claim may be published alongside others supported through the flood funding. Details disclosed will include the name of business/organisation, the amount of funding received and the locality (usually at Parish level). Declaration and Undertaking I confirm that, to the best of my knowledge and belief, all the information in this application is true and correct. I understand that the details in this application may be shared between agencies involved in issuing of flood funding; and that it is subject to publicity and procurement requirements should the application be successful. I agree to any disclosure or exchange of information about this application (including the content of any declaration or undertaking) which the department considers appropriate for the administration, evaluation, monitoring and publicising of the flood funding programme. Signed Print name Position Date 11. Submission checklist Before submitting this application, please complete the following checklist to ensure that you have completed all of the data required. Yes No N/A Does your business meet the SME criteria? Are all questions answered fully? Have you completed the required state aid declaration and De Minimis Disclosure form? Have you completed the Bank Account Details payment form? Have you checked that the goods / services claimed for are not recoverable by other assistance i.e. insurance, VAT recovery etc.? Have you included invoices for all items being claimed for? Appendix 1 Indicative list of possible measures1 (Repair and Renew Grant) Property level-measures Indicative cost range £s2 Airbrick Cover Sewerage Bung Toilet Pan Seal Self-closing airbrick 20-40 30-50 60-80 50-90 Non-return valves 12mm overflow pipe Silicone gel around openings for cables Repair mortar Non-return valves 40mm utility waste pipe Re-pointing external walls with water resistant mortar Waterproof external walls Sump Pump Non-return valves 110mm soil waste pipe Demountable Door Guards Demountable Window Guards Replace sand-cement screeds on solid concrete slabs (with dense screed) Replace ovens with raised, built-under type Replace mineral insulation within walls with closed cell insulation Move electrics well above likely flood level Replace chipboard flooring with treated timber floorboards Mount boilers on wall Automatic Door Guards Move service meters above likely flood level Garage/Driveway Barrier Replace floor including joists with treated timber to make it water resilient Replace gypsum plaster with water resistant material, such as lime Replace chipboard kitchen/bathroom units with plastic units Install chemical damp-proof course below joist level Replace timber floor with solid concrete 70-110 80-120 80-120 80-120 150-250 200-400 400-600 550-650 500-900 500-900 670-740 700-780 720-800 760-840 920-1020 1080-1200 1000-2000 1620-1800 2000-3000 3490-3850 4280-4740 5000-5520 6250-6910 8210-9070 Supplied by HM Government: Flood Support Schemes, Guidance Note: Updated 24th February 2014 1