Eligibility Application - Inspection Program (RCM-111)

IMPORTANT: An eligibility application must be complete and compliant in order to be processed. If the application is incomplete, you will be notified and will have five (5) business days to provide the required information. If the City does not receive a response within this timeframe, the file will be closed. The City may require additional documents or information to establish the occurrence of the eligible disaster.

A) Applicant Identification

1. Applicant’s name

2. Mailing address

3. Telephone

4. Email

Owner

Co-owner

Authorized representative

If you are an authorized representative, please attach the authorization/mandate.

Notice: The total size of all documents submitted must not exceed 50 MB in order to ensure successful transmission of the form by email. Applicants are advised to submit lightweight files and short video recordings only.

Drop files here or click to upload them.

B) Building Concerned

1. Property address

2. Lot number / roll number (if known)

Residential dwelling

Commercial

No

Yes

If this is a co-ownership, please attach a power of attorney signed by all co-owners.

Notice: The total size of all documents submitted must not exceed 50 MB in order to ensure successful transmission of the form by email. Applicants are advised to submit lightweight files and short video recordings only.

Drop files here or click to upload them.

C) Eligible Disaster

Water damage caused by flooding or sewer backup, resulting exclusively from the torrential rainfalls of August 9, 2024, or July 13, 2025.

August 9, 2024

July 13, 2025

Flooding

Sewer backup

3. Brief description of damages

4. Affected areas

D) Supporting Documents (check and attach)

You must attach documents demonstrating the occurrence of the eligible disaster.

D1 - Select AT LEAST ONE of the following options:

Proof of notification of damages sent to the City + proof of damages

Proof of a claim submitted to the City + proof of damages

Proof of a claim submitted to an insurance company + proof of damages

Any other proof of damages demonstrating the occurrence of the eligible disaster beyond any reasonable doubt.

Attachments

Notice: The total size of all documents submitted must not exceed 50 MB in order to ensure successful transmission of the form by email. Applicants are advised to submit lightweight files and short video recordings only.

Drop files here or click to upload them.

D2 — Proof of damages (to attach):

Photos

Videos

Professional report

Invoices

Attachments

Notice: The total size of all documents submitted must not exceed 50 MB in order to ensure successful transmission of the form by email. Applicants are advised to submit lightweight files and short video recordings only.

Drop files here or click to upload them.

D3 — Work already completed (attach, if applicable):

Photos

Videos

Professional report

Invoices

Attachments

Notice: The total size of all documents submitted must not exceed 50 MB in order to ensure successful transmission of the form by email. Applicants are advised to submit lightweight files and short video recordings only.

Drop files here or click to upload them.

Details of work completed

E) Declarations, Authorizations and Commitments (required)

E1 — Applicant Declarations

By signing, I declare that:

Only one application is being submitted for this building.

The information provided is accurate and complete.

Note: An applicant who provides information that renders the application false, inaccurate, or incomplete may lose eligibility for the Program and may have to reimburse the value of the services provided.

E2 — Consents / Authorizations (check each box)

I consent to sharing with the City all information, evidence, and documents collected or produced as part of the Program.

I authorize the City to use this information, evidence, and documents for municipal purposes.

I authorize the City and its authorized agent to access the property (interior/exterior) for the purposes of applying the by-law (inspection/diagnosis).

In the event of a sale of the property, I agree to provide the purchaser with all information, evidence, and documents collected or produced as part of the Program.

E3 — Availability and Cooperation

I understand that the City may invalidate an application if the owner or representative does not cooperate (e.g., unreachable or unavailable despite three (3) contact attempts).

I understand that the City may invalidate an application if the required information is not submitted within the deadlines established and confirmed in writing.

I understand that fees of $100 plus taxes will be charged if the authorized agent travels to the property and the owner or their representative is not present; no further appointment will be scheduled until the invoice is paid in full.

E4 — Acknowledgment (incomplete file)

I understand that my application will be considered complete only when all required documents have been received and deemed sufficient to establish eligibility.

F) Signature

Signature

By submitting this application, I expressly acknowledge that the City of Dorval, its employees, and its representatives shall not be held liable in any way for the content of the documents that will be provided, nor for the recommendations that may be issued by the authorized agent retained by the City within the context of the Inspection and Subsidy Programs. I further assume full responsibility for any work that I choose to have carried out by the contractor of my choice. I also acknowledge having read and understood the eligibility requirements of the Programs and agree to accept any sanctions that may be imposed in connection with any potential non-compliance. Finally, I acknowledge that the purpose of the proposed work is to improve the resilience of the building identified above and that, notwithstanding the implementation of such measures, a new disaster may nevertheless occur.

Date

If the applicant is a representative:

Name

Title / relationship to owner

Yes

No

Important Notice: Only one application per person is permitted. Multiple applications submitted by the same individual may not be processed.

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Eligibility Application - Inspection Program (RCM-111)

A) Applicant Identification

B) Building Concerned

C) Eligible Disaster

D) Supporting Documents (check and attach)

D1 - Select AT LEAST ONE of the following options:

D2 — Proof of damages (to attach):

D3 — Work already completed (attach, if applicable):

E) Declarations, Authorizations and Commitments (required)

E1 — Applicant Declarations

E2 — Consents / Authorizations (check each box)

E3 — Availability and Cooperation

E4 — Acknowledgment (incomplete file)

F) Signature

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to share ?