Eligibility Application - Subsidy Program (RCM-112)

IMPORTANT: An eligibility application must be complete and compliant in order to be processed. All eligibility applications must be received by the City of Dorval no later than December 31, 2027.

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) Reference – Inspection Program (RCM‑111)

Eligibility requirements: The applicant must have participated in the Inspection Program (RCM 111) and obtained the corrective work plan. If the work has already been completed, the completed work must be included in the corrective work plan.

RCM 111 File Number (if known)

D) Documents to Attach (check and attach)

Corrective work plan

Cost estimate: contractor quotes/estimates OR detailed budget estimates (eligible work or equipment purchased by the owner)

Approximate timeline

Proof of insurance company refusal or payment received

Co‑ownership (if applicable): subsidy‑sharing agreement signed by all co‑owners

Completed work (if applicable): documentation enabling evaluation of the work (photos, invoices, reports, etc.)

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.

E) Declarations and Authorizations (required)

By signing, I declare that:

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

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

I understand that any modification to the work must be submitted and approved before being carried out.

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

I declare that the information provided is accurate and complete.

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

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 - Subsidy Program (RCM-112)

A) Applicant Identification

B) Building Concerned

C) Reference – Inspection Program (RCM‑111)

D) Documents to Attach (check and attach)

E) Declarations and Authorizations (required)

F) Signature

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to share ?