Application Form Flood funding support For businesses affected by flooding between 1st December 2013 – 31st March 2014 1. Contact Details Business Name Business Trading Address & Postcode: Business Support Grant Which grant scheme are you applying for? Complete sections 1, 2, 3 & 5 Repair and Renew Complete sections 1, 2, 4 & 5 Main Contact (name) for this application: Position in organisation: Address: (if different from above) Post Code: Contact Telephone Number: Mobile Telephone Number: Website: E-mail: 2. Business Details Type of Organisation (tick below): Sole Trader Please attach a bank statement or annual accounts in the name of the business applying. Partnership Registered Charity Companies House Registration No. Company Limited by Guarantee To be checked by RCBC Company Limited by Shares Is the organisation registered for VAT? Y/N VAT No. Other legal status - please detail When was the organisation established? DD/MM/YYYY Number of Employees: Full Time Please describe what your business does Please give details of how your business was affected by flooding any further evidence to verify and support your claim should be attached to your application i.e. photographs or surveyor report A site visit by RCBC may be required to verify claims Insurance Company name and policy number Please attach a copy of your insurance policy covering the date of the flood(s) and a letter from your insurance assessor to state your claim is being processed or has been settled. Number of Employees: Part Time / Casual 3. Making a claim – Business Support Grant Businesses may claim for costs incurred as a result of the floods which are ineligible to be claimed through a standard business insurance policy. Flood funding support is not available for costs which have been or will be claimed through your business insurance policy, or for VAT where you can recover this through your VAT return. Please enclose a copy of all invoices detailing relevant expenditure and also confirmation of items already claimed for / will be claimed for through business insurance cover and of any policy exclusions. Eligible expenditure may include (but is not limited to): Non recoverable insurance excesses for repair or replacement of buildings Equipment and stock Removal of debris Additional business accommodation or extra staff costs Structural surveys Security measures Exceptional costs to improve access to / for suppliers and customers Immediate clean-up costs Exceptional business costs (i.e. hire of drying equipment) and temporary accommodation to enable the business to continue trading Continuity planning and marketing costs What is not covered: Repayment of existing loans or debt incurred prior to flooding Any costs recoverable under business insurance cover Recoverable VAT Standard staff costs Costs incurred prior to flooding Date (s) affected by flooding Details of goods / services being claimed Date of invoice Copy of invoice attached (tick & state invoice no) Value of Claim (excluding recoverable VAT) 4. Making a claim – Repair and Renew Businesses may claim for costs incurred in relation to goods and services incurred as a result of the floods which are ineligible to claim through insurance. You must not claim for costs which have been or will be claimed through your insurance, or for VAT where you can recover this through your VAT return. Please enclose a copy of all invoices detailing relevant expenditure and also confirmation of items already claimed for / will be claimed for through business insurance cover and of any policy exclusions. An indicative list of flood resilience measures is provided at appendix 1. For eligible properties, any measure recommended by the Property-Protection Adviser report or included in appendix 1 will automatically qualify for Repair and Renew grant funding. Date (s) affected by flooding Details of goods / services being claimed Date of invoice Copy of invoice attached (tick & state invoice no) Value of Claim (excluding recoverable VAT) 5. Sign off This form should be signed by an appropriate responsible person or member of your business or organisation. This is normally the owner, partner, director, chairperson or secretary or treasurer. 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; Redcar & Cleveland Borough Council may seek to recover the grant from your business. 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 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 Council or Funding body considers appropriate for the administration, evaluation, monitoring and publicising of the flood funding programme. Signed Print name Position Date 6. 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? Have you attached evidence to support you claim (please tick)? Photographs Surveyors reports Copy of insurance Details of any insurance claim related to the flooding 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