Reimbursement Application - Subsidy Program (RCM-112)

IMPORTANT: The reimbursement application must be completed and submitted to the City of Dorval within six (6) months of the confirmation of eligibility of the work within the context of the Subsidy Program. The fees related to the work carried out by the City’s authorized agent within the context of the Inspection Program are deducted from the eligible reimbursable amount.

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. RCM 111 File Number

3. Date of eligibility (RCM-112)

C) Documents to Attach (check and attach)

Summary table of invoices (Excel format) – one line per invoice

Legible and detailed copies of all invoices (compliant invoices)

Copies of required permits and certificates (if applicable)

Proof that an insurance claim was led, proof of the amount paid by the insurer, or proof that the insurance policy did not cover this type of claim.

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.

D) Declarations (required)

By signing, I declare that:

I declare that the work covered by this application corresponds to the work approved and recommended in the corrective work plan.

I declare that the attached invoices are complete, legible, and detailed.

I understand that certain expenses may be ineligible (e.g., tools, improvements, double funding, costs covered by insurance).

I consent to the City and its authorized agent verifying the compliance of the work (visit/inspection).

I declare that the information provided is accurate and complete.

F) Signature

Signature

En soumettant cette demande, je reconnais expressément que la Cité de Dorval, ses employés et ses représentants, ne peuvent être tenus aucunement responsable du contenu des documents qui seront fournis, ni des recommandations qui seront formulées par le mandataire retenu par la Cité, dans le cadre des Programmes d’inspection et de subvention. J’assume également l’entière responsabilité des travaux que je choisirai d’exécuter par l’entrepreneur de mon choix. De plus, je reconnais avoir pris connaissance des conditions d’admissibilité des Programmes et j’accepte les sanctions qui peuvent m’être imposées en lien avec tout manquement possible. Enfin, je reconnais que la réalisation des travaux qui seront proposés vise à améliorer la résilience du bâtiment identifié ci-dessus et qu’un nouveau sinistre pourrait néanmoins survenir malgré l’implantation de ces mesures.

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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