Flood Recovery Assistance for your Home or Business. Be prepared What you need to know

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1 Flood Recovery Assistance for your Home or Business Be prepared What you need to know

2 Flood Recovery Assistance for your Home or Business Table of Contents New Brunswick Emergency Measures Organization (NB EMO)... 1 Flood Recovery Everything you need to know... 1 Your Property... 1 About your House A Homeowner s Checklist... 1 How to chlorinate your well water... 4 Disaster Financial Assistance / Recovery Program... 7 Recovery Program... 7 Process For Applying For Disaster Financial Assistance (When Announced)... 8 Claimant s Role in Assisting the Adjuster...10 Important information you should read before filling out any forms...11 Do you qualify for disaster financial assistance?...12 FORM A - Declaration of claimant...13 FORM B - Confirmation of Insurance...17 FORM C - Application for an advance payment...21 FORM D1 - Disaster recovery information for personal claim (Homeowners/ Renters)...29 FORM D2 - Disaster recovery information for small businesses (Commercial, Agriculture, Fisheries & Rental)...33 Items & Damages not covered under the DFA Program...37 FORM E - Schedule of Loss...39 FORM F - Application for a Waiver of Individual Deductible...43 FORM G - Application for Direct Deposit Service...51 Claimant s Checklist...55 Mitigation Projects...57 FORM H - Mitigation proposal...59 Service New Brunswick CNB

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4 Flood Recovery Assistance for your Home or Business New Brunswick Emergency Measures Organization (NB EMO) NB EMO s Role and Process for Disaster Financial Assistance Protecting People, Property and the Environment The New Brunswick Emergency Measures Organization (NB EMO) co-ordinates preparedness for emergencies. At the federal, provincial and municipal levels, planning is the key to emergency preparedness. A well established and tested emergency plan helps to ensure a prompt and co-ordinated response by responsible agencies in a time of crisis. NB EMO also co-ordinates provincial response operations during emergencies and administers the disaster financial assistance program. Your Property Flood Recovery Everything you need to know As the owner of the affected property it is your responsibility to ensure that it is a safe and healthy environment for you and those who occupy it. You must therefore take appropriate steps to ensure that clean up and recovery begins as soon as possible and not to wait for Government Assistance. About your House A Homeowner s Checklist After a flood, it is important to restore your home to good order as soon as possible to protect your health and prevent further damage to property and belongings. Whether you do the work yourself or hire a contractor, this handy checklist will help you organize the clean up. Immediate action is important. Your house and furnishings are less likely to grow mould if contents are dried within 48 hours. Before you begin Put your own safety first. Avoid electrical shock. If you are experiencing flooding and need to be disconnected or reconnected, call NB Power at Record details of damage, with photos or video if possible. Contact your insurance agent immediately. Register your flood damages with Service New Brunswick at or on line at Set up a step-by-step action plan to remove all water, mud and other debris; dispose of contaminated household goods and rinse away contamination inside the home. Detailed information is available online from the NB Department of Health Be prepared to make difficult decisions about what to keep and what to throw out. Make sure the building is structurally safe. Look for buckled walls or floors. Watch for holes in the floor, broken glass and other potentially dangerous debris. If in doubt, contact a professional. 1

5 Be prepared Protect Yourself When Cleaning Your Home For personal protection during clean-up, wear rubber gloves and other protective clothing. Avoid direct skin contact with contaminated material. Practice good personal hygiene (i.e. wash hands before eating or smoking) and change outer clothing before entering a clean residence. Heating Do not heat your home to more than four degrees Celsius (about 40 degrees Fahrenheit) until all water is removed. If you use pumps or heaters powered by gasoline, kerosene or propane, buy and install a carbon monoxide sensor. Combustion devices can produce large amounts of lethal carbon monoxide when they are not tuned-up or are improperly ventilated. Mould and Mildew To avoid the health hazards of mildew and mould, water soaked walls and insulation should be removed, and the space and studding allowed to dry thoroughly. Walls constructed of gyproc, plaster or wood will dry out in time but insulation in these walls is no longer effective. As insulation becomes water soaked the weight causes it to settle and compact at the bottom, leaving a large portion of the wall no longer insulated. Caution: Obtain approval from assessors, insurance agents and other relevant agencies before discarding or destroying any furniture or equipment. Food Affected by Flooding To avoid the health hazards of food contamination, all perishable goods, vacuum-packed foods and any other foods affected by flooding should be thrown out. Undamaged, commercially canned foods can be saved if you remove the can labels, thoroughly wash the cans, and then disinfect them with a solution consisting of 15 ml bleach in 4.5 litres of water. Re-label your cans, including expiration date, with a marker. Commercially-canned food which shows no leaks, swelling or rusting at joints or edges should be thoroughly washed and dried. Vacuum-packed foods pose a special hazard due to dried waste material inside crevices and covers. They should be discarded. Home preserves, meats, fish or dairy products should be discarded as unsafe if they have been affected by flood water. Frozen foods left in a freezer will stay frozen for a few days without electricity if the door is kept shut. These products can be refrozen if ice crystals are still present and the food has not been exposed to flood waters. All perishable food left in a refrigerator more than 24 hours without electricity should be discarded. Cooking and eating utensils should be cleaned of all deposits, washed with household detergent or soap and rinsed for at least two full minutes in a mixture containing 15 millilitres (one table spoon) of liquid bleach in 4.5 litres (one gallon) of water. Utensils used for infant feeding should be boiled before use. 2

6 Flood Recovery Assistance for your Home or Business Refrigerators, Freezers, Stoves and Other Appliances Appliances (that have not been partially and entirely immersed in flood water) and food contact surfaces should be cleaned as follows: Ensure electrical power is turned off. Clean the unit thoroughly with a detergent solution, rinse with clean water that has been previously boiled, and then wash with a solution containing one-half cup of bleach in nine litres (two gallons) of water. Allow to dry with door kept open. Note: Any appliance that has been partially or wholly immersed in water is no longer insulated. It cannot be dried without removal. A qualified service technician should be contacted before the appliance is put into service or thrown out. Hazardous Products Household hazardous products, such as pesticides, can also cause problems. Contaminated items and surfaces should also be cleaned. Although small amounts of household hazardous products or agricultural products can be placed in plastic bags and discarded with domestic garbage, significant quantities should be handled differently, under the advice of the Department of Environment. Basements and Rooms It is important to use a good soap or detergent, elbow grease, and lots of hot water when cleaning. Walls, solid floors, and ceilings should be thoroughly scrubbed with a good detergent or soap and water. Avoid household bleach. Organic content and ph in flood waters as well as contact time required for bleach to kill microorganisms may render bleach ineffective. For significant flood or water damage, you may consult with an air quality specialist or professional cleaner. Water and wastes can be removed by pumping, pails, shovels, etc. Wastes should be buried at least 15 metres (50 feet) away from the source of any water supply. Lime may be used to cover wastes before covering with soil. This advice applies to all waste disposals in the following section. Oil or petroleum products are usually removed with Varsol or similar products. After cleaning, open doors and windows to air thoroughly and help the drying process. Oil Clean-up An oil spill which occurs in a house could create a contamination problem that can be difficult to correct. Peat moss can be used to remove floating oil. If only finished basement walls have been affected, the odour can be eliminated by removing and discarding the wall covering, studding, insulation and any other permeable material. Caution should be taken in using electrical equipment during cleaning since the fumes could ignite and cause an explosion. Dispersants should be avoided in cases where oil tanks have been ruptured. 3

7 Be prepared Household Furnishings Solid wood or metal furniture can be cleaned with a household detergent solution, wiping clean and then wiping dry. Furniture should be left to dry outside before furniture polish may be applied where needed. Upholstered furniture and mattresses affected by flooding should not be used. Reminder: Anything that stays wet long enough will grow mould; mould can make people sick. Dry everything quickly to avoid future health problems. Water Contamination Private water supplies affected by flooding should not be used until they have been disinfected and tested. Until tests indicate a safe water supply, water for drinking and personal use should be brought to a rolling boil for at least 1 minute and then stored in clean covered containers. Communicate with your local Health Protection Branch office for information on how to proceed to have your water tested. For more information and useful links, visit the River Watch website: How to chlorinate your well water If you rely on a well for your water, you may have to chlorinate it from time to time. Chlorination refers to the process of flushing your well and water system with a chlorine solution. This process is usually applied in order to accomplish one of the following: Disinfecting to neutralize coliform bacteria Disinfecting after making repairs to your well or following extended period of non-use Temporary elimination of hydrogen sulphide (or rotten egg ) odours Temporary removal of iron and manganese build-up Removal of bacteria that create slime Read all of the instructions before proceeding! 1. Before you begin the chlorination process, store enough water to meet your household needs for a minimum of 24 hours. 2. Next, remove any filter, water conditioners, or any type of water treatment system, or find a way to by-pass them during chlorination. 3. Use the following chart to determine the amount of chlorine solution that is recommended for your water system. For dug wells use approximately 1 litre of chlorine solution for every 100 litres of water. 4 Note: The chlorine solution is simply common unscented household bleach, containing 3-5% sodium hypochlorite.

8 Flood Recovery Assistance for your Home or Business Volume of Chlorine Solution Chart Vol. of Chlorine Solution (litres) per diameter of Well Well Depth (ft) 4 inch 5 inch 6 inch less than Pour the chlorine solution into your well. If your well head is buried, excavation is probably required. An alternative is to apply the chlorine solution through an air line, if there is one leading from the well to your home. There are two methods for using the air line: you can either insert the air line into the container of chlorine solution and pump your well until all the solution is consumed, or simply pour the solution into the air line (If you use either of these methods, flush the air line out with clean water after chlorinating your well). 5. Attach a garden hose to an outside faucet and place the other end into the well. Turn on the outside faucet and allow the water to circulate for approximately 1 hour. Note: If your well head is buried and you choose not to excavate, or the garden hose cannot be connected to the air line, disregard this step. 6. Open each faucet in your water distribution system, (including inside and outside faucets, cold and hot water faucets, dishwashers, toilets, baths and showers), one at a time, until the smell of chlorine is apparent, then quickly shut them off. This will thoroughly chlorinate your water distribution system. Note: During this procedure, chlorinated water that is permitted to enter your sewage system should be kept to a minimum, as an excess amount of chlorine may affect the biological activity of a septic tank system. 7. Do not operate your water system for a minimum of 8 hours (overnight, for example) or longer if possible. A 24 hour period is recommended, but may not always be practical. 8. Place the end of your garden hose in an outside location where the chlorinated water will not run into a natural waterway (such as a stream, brook, lake, etc.) or damage any desired 5

9 Be prepared vegetation (like your vegetable garden). Allow the water to flow until a strong chlorine odour is no longer apparent (generally 2 to 3 hours). If you have a low yield well, be careful not to pump the well dry. Note: During this procedure, the water may have the colour of tea, but the colour will improve after a short period of time. Aeration screens in faucets and the cold water inlet of washing machines may become plugged with sediment. For water systems equipped with jet pumps, there is also a possibility that the jet may become clogged with sediment. It is important to keep this in mind, especially if the jet is located in the well column, which may require excavation of the well head. 9. Turn on each faucet in the house (one at a time), and run the water until the odour of chlorine is no longer present. It is recommended that you do not drink the water during this flushing period. 10. Once the flushing process is complete you may resume normal use of your water, keeping in mind that it may be two to three days before the chlorine odour and taste is completely gone. Note: If you chlorinated your well to address a coliform bacteria problem, you should have your well water tested at an accredited lab before using it again. To do this, you will need to collect a water sample about one week after you have chlorinated your system and have it analyzed immediately after collecting it (within 24 hours). 11. If the chlorination process results in a noticeable improvement in your water quality, but the problem redevelops after two to three weeks, repeat steps 1 to 9, using two to three times the amount of chlorine solution recommended for your water system. In addition, you should increase the period of time in which you do not operate your water system (step 7) to a minimum of 24 hours. A Final Note Depending on the characteristics of your well water quality, it may be necessary to chlorinate your well system more than once a year. Chlorination may or may not improve your water quality, and in some cases, provide only a temporary or short-term solution. There are many household water treatment systems available that are approved by the National Sanitation Foundation (NSF). Look for a listing of retailers who carry these systems, in the yellow pages of the telephone book. Questions? Need more Information? If you have any questions or require additional information, please contact any office of the New Brunswick Department of Environment. You can also contact the Department of Environment by calling our general number (506) or by visiting our website at the following address: You can contact any office of the New Brunswick Department of Health or visit their website at this address: 6

10 Flood Recovery Assistance for your Home or Business Disaster Financial Assistance / Recovery Program What is Disaster Financial Assistance (DFA)? Disaster Financial Assistance is a program managed by New Brunswick Emergency Measures Organization within the Department of Public Safety. There are two important steps to this program. First Step: After any disaster, NB EMO assesses the damages that have occurred. Second Step: Based on the information received and the Disaster Financial Assistance Policy, NB EMO makes a recommendation to government. Government then decides if a financial assistance program is needed. No assistance can be given until government approves a Disaster Financial Assistance Program. If you need assistance call Service New Brunswick at the following toll-free number It is important to note that we all have a duty to safeguard ourselves, and property from damage. Therefore, the Disaster Financial Assistance program does not pay for any damage or loss that is, or could be, covered by an insurance policy. Assistance, when provided, is only available after all other forms of disaster aid have been received and only covers uninsurable loss. You should contact your insurance company immediately to find out if the damage you suffered is covered by your policy and have Form B completed. Record details of damage, with photos or video if possible. If Government approves a disaster financial assistance program, is there a deductible amount I have to pay? Yes, a deductible will be applied and is identified when the program is announced. The deductible is automatically waived for clients of Social Development. It may also be waived in cases of low income (Form F). Recovery Program The recovery program will allow residents to receive information and register their flood-related damage with a single telephone call, and will put health and safety inspection teams in contact with residents in the flood-affected areas to allow them to return to their homes more quickly. Registering with SNB at is the first step in the recovery process, which includes three elements: Complementary assistance, including water and electrical testing to ensure safety. Health and safety inspections, to assess damage and determine what repairs are required for residents to safely return to their homes. 7

11 Be prepared Disaster financial assistance, which may be available to assist in covering eligible costs of repairs. Once registered, residents will be provided with an information package and any required paperwork to initiate an assistance claim. Health-and-safety inspection teams will assess whether a home or place of business is safe enough for residents or owners to return. Each team is comprised of members specialized in electrical; gas and fire prevention; structural housing; and public health. The specialization of these teams will allow them to effectively determine if repairs are needed before residents return home. Process For Applying For Disaster Financial Assistance (When Announced) When you receive this guide, read the instructions carefully and then complete the application forms, sign them and have them witnessed. Return you re application to NB EMO before the deadline for applications expires. If you have any questions, call the Disaster Financial Assistance Office at the following toll-free number for assistance between 8:15am 4:30pm When the program is approved by government, local radio and newspapers will carry information on the program and deadlines for application. Advance Payment After you receive a health and safety inspection you may apply for an advance payment to help start repairs based on this inspection. Advance payments assist home and business owners by giving them funds immediately to pay for urgent work that will enable them to re-occupy their property as quickly as possible. Advance payments may be authorized by the New Brunswick Emergency Measures Organization against the total value of an eligible claim under a Disaster Financial Assistance Program. Advance payments will normally be for claims in excess of $10,000, may not exceed the total payable value of the claim and may not exceed $4,000. Eligibility criteria are as follows: The claimant must have registered for the Disaster Financial Assistance Program, through Service New Brunswick (SNB), by calling or online at For repairs, health or safety measures, the claimant must be the registered owner of the property (Proof of ownership must be substantiated by a copy of your property tax bill (not receipt of payment). For replacement of personal property, the claimant must be the registered owner or a tenant (proof of residency may be substantiated by a telephone, power bill or rental/lease agreement). 8

12 Flood Recovery Assistance for your Home or Business If flooding has been forecasted for your area you must be able to demonstrate that you took precautions to protect your property from rising water: for example, that you moved possessions from the basement to a higher area in the home. If you cannot demonstrate this, your possessions may not be eligible for assistance. If damages exceed $10,000, you may be eligible for an advance up to $4000. The claimant must sign an undertaking to use the advance specifically for the purpose authorized. Disaster Financial Assistance Process 1. First, NB EMO reviews your application to see if you are eligible for the approved program. If you are, your claim is sent to an insurance adjuster from the Canadian Independent Adjusters Association. The adjuster then makes contact with you and arranges for a site visit, and appraises the damage to your property and belongings. The adjusters will not be able to advise on the amount of assistance you may receive. 2. The adjuster will then submit a report to the Chief Adjuster who will review and check all calculations. Following the review your claim is sent to the Manager of the Disaster Financial Assistance Program. 3. Your claim is then reviewed by an auditor to ensure that only eligible damages have been allowed prior to the writing of your assistance cheque. The cheque is then issued to you. 4. If at any time in the process it is determined that you will not receive assistance, you will be informed in writing by the program manager. Independent Adjusters The role of the Canadian Independent Adjusters Association (CIAA): To represent the collective interest of independent adjusters to government, industry and the public on a provincial, regional and national level. To develop and maintain the highest standards of professionalism through a defined code of ethics and fair practice policies. The Department of Public Safety contracts the services of the Independent Adjusters Association. The association appraises all individual claims in a fair and unbiased way, according to industry standards, to determine eligibility under the guidelines established by the Disaster Financial Assistance Program. Payments are based on the insurance adjuster s determination of damages and not on estimates and/or payments to private contractors. The Adjusters are all members of the Canadian Independent Adjusters Association, and as such, are professional individuals who have extensive background in the field of personal and business property loss. 9

13 Be prepared Claimant s Role in Assisting the Adjuster: 1. You should have all invoices, receipts, photos and estimates readily available when the adjuster completes the site visit. It is not the adjuster s role to obtain estimates. 2. Complete your schedule of loss (Form E) in advance of a site visit, to assist the adjuster in determining what your losses were. 3. Keep accurate records of hours spent on clean up and any repairs completed by you or a contractor. Note: It is the claimant s responsibility to attempt to reduce damage by taking necessary steps to save their property where possible. Maintaining accurate records of all damages will help expedite your claim. Failure to follow the noted steps could affect the outcome of a claim and/or cause delays in payment of eligible losses. Fraud To knowingly misrepresent, exaggerate or falsify the damages on your claim may be considered to be fraud and you could be charged under the Criminal Code of Canada. This program reserves the right to investigate any claim to verify that information contained in the claim is accurate and correctly reflects the actual losses of the claimant. Hiring a Contractor It is the responsibility of the property owner to make the necessary arrangements for cleanup and repairs. While the use of contractors to perform clean up or repairs is the property owner s decision, it is strongly recommended that care be taken in choosing a contractor. Government s role is only to provide financial assistance in accordance with the Disaster Financial Assistance (DFA) Guidelines and the property owner should be mindful that DFA does not necessarily cover all items, the full cost of clean up or repairs that a contractor may charge. For more information on hiring a contractor check the Canada Mortgage and Housing Corporation website at or the Canadian Home Builders Association website at HiringaRenovator/index.php 10

14 Flood Recovery Assistance for your Home or Business Important information you should read before filling out any forms All forms pertaining to your claim must be filled out, signed and witnessed. Any missing information will result in the hold up of your claim and you receiving your assistance. Reminder: You must include a copy of your property tax bill (not receipt of payment). FORM A DECLARATION OF CLAIMANT: Legal request from claimant to receive assistance. Must be completed and signed by claimant and a witness. No file will be opened without this Declaration. Must include a copy of your property tax bill as proof of principal residence and if, a renter, a copy of your rental agreement. FORM B CONFIRMATION OF INSURANCE. This form must be completed by your insurance provider before you can receive assistance through the Disaster Financial Assistance Program. FORM C APPLICATION FOR AN ADVANCE PAYMENT. Advance payments may be authorized by the New Brunswick Emergency Measures Organization against the total value of an eligible claim under a Disaster Financial Assistance Program. FORM D1 DISASTER RECOVERY INFORMATION FOR PERSONAL CLAIM: This form must be completed in detail in order for a personal claim to be processed (or D2). FORM D2 DISASTER RECOVERY INFORMATION FOR SMALL BUSINESS CLAIM: Small Business owners, Rental Properties owners and the owners of Farms or Fishers must complete this form. FORM E SCHEDULE OF LOSS: Complete this form and give it to the independent adjuster when they visit. The adjuster will fill in the last column. If you are not sure about some items, reference the list of damages and items for personal and business claims which is not inclusive. FORM F - APPLICATION FOR A WAIVER OF INDIVIDUAL DEDUCTIBLE: If you are a home owner or renter, complete this form to apply for the deductible to be waived. FORM G - APPLICATION FOR DIRECT DEPOSIT SERVICE: By signing up for Direct Deposit payments you reduce delays in receiving payments and establish a more secure method of payment. FORM H MITIGATION PROPOSAL: To apply for assistance to help mitigate or improve your home to reduce future flooding damages. Please return all completed forms and attachments to: New Brunswick Emergency Measures Organization Disaster Financial Assistance Office P.O. Box 6000 Fredericton, New Brunswick E3B 5H1 Telephone: Note: Each claim must include Form A, B, D1 or D2 and E. Assistance to make a claim will be provided upon request. Application for Adjustment of Tax where Real Property is Damaged or Destroyed: only to be completed by claimant and mailed to the address shown on the form if you wish to receive a tax adjustment If additional information is required you will be contacted. Those personal claimants with low income or in difficult financial circumstances may apply for a waiver of the deductible. For additional information contact NB EMO, Disaster Financial Assistance Office at

15 Be prepared Do you qualify for disaster financial assistance? If you were flooded: 1. How did the flood waters enter your Home/Business? (Please check the appropriate box): Column A Wall cracks Floor cracks Windows Doorways Column B Toilets Floor drains Sump Other pipes If water entered your home/business under Column B, then your insurance policy may provide coverage. 2. If you own the affected property (homeowner) Do you live here for most of the year? Yes If you answered No, then you do not qualify for assistance. No 3. If you are a Small Business a. Are you the day to day operator of the business? Yes No b. Are you the majority shareholder? Yes No If you answered No to any of the above questions, then you do not qualify for assistance. 4. If you are the owner of a rental property Are you the Principal owner of the rental property? Yes No Do you derive 50% plus, of your income from the renting? Yes If you answered No to any of the above questions, then you do not qualify for assistance. 5. If you are a renter, assistance for personal contents only may be available. Contact Service New Brunswick if you have any questions about these qualifications for assistance ( ). No 12

16 Flood Recovery Assistance for your Home or Business FORM A - DECLARATION OF CLAIMANT I / We of (Community and Postal Address) in the County of and Province of New Brunswick DO SOLEMNLY DECLARE: 1. That I / We are the owner(s) (tenants) of the lands and premises and chattels located at the above address. 2. That I / We suffered damage to my/our lands and premises and chattels located at the above address by reason of a which occurred within the Province of New Brunswick commencing. 3. That I / We wish to obtain assistance for the damages caused to my/our lands and premises and chattels at the above address by such disaster. 4. That the property damaged or destroyed was not insured for loss except. 5. I / We UNDERTAKE that the monies paid to me/us shall be used in restoring my/our lands and premises and chattels located at the above address to their condition previous to the said disaster. 6. I / We undertake to indemnify and save harmless the Province of New Brunswick from all claims and demands of any other person for payment of assistance made hereunder as a result of misrepresentations on my / our part. DATED this day of A.D., 20. Signature of Declarant Signature of Declarant Signature of Witness Signature of Witness Note: The Province of New Brunswick is not responsible for the interests of lien claimants, mortgagees, or other creditors of the claimants and all payments made hereunder are made on the understanding that the claimant is the person legally entitled to assistance. This confidential information will be used only for the purpose for which it has been collected. It may only be conveyed to other government departments and agencies for the purpose of disaster financial assistance. Please print in bold letters using ink only, except for signatures. Please delete I or We / My or Our with a pen stroke as appropriate. White copy EMO Yellow copy Claimant 13

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18 Flood Recovery Assistance for your Home or Business FORM A - DECLARATION OF CLAIMANT I / We of (Community and Postal Address) in the County of and Province of New Brunswick DO SOLEMNLY DECLARE: 1. That I / We are the owner(s) (tenants) of the lands and premises and chattels located at the above address. 2. That I / We suffered damage to my/our lands and premises and chattels located at the above address by reason of a which occurred within the Province of New Brunswick commencing. 3. That I / We wish to obtain assistance for the damages caused to my/our lands and premises and chattels at the above address by such disaster. 4. That the property damaged or destroyed was not insured for loss except. COPY 5. I / We UNDERTAKE that the monies paid to me/us shall be used in restoring my/our lands and premises and chattels located at the above address to their condition previous to the said disaster. 6. I / We undertake to indemnify and save harmless the Province of New Brunswick from all claims and demands of any other person for payment of assistance made hereunder as a result of misrepresentations on my / our part. DATED this day of A.D., 20. Signature of Declarant Signature of Declarant Signature of Witness Signature of Witness Note: The Province of New Brunswick is not responsible for the interests of lien claimants, mortgagees, or other creditors of the claimants and all payments made hereunder are made on the understanding that the claimant is the person legally entitled to assistance. This confidential information will be used only for the purpose for which it has been collected. It may only be conveyed to other government departments and agencies for the purpose of disaster financial assistance. Please print in bold letters using ink only, except for signatures. Please delete I or We / My or Our with a pen stroke as appropriate. White copy EMO Yellow copy Claimant 15

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20 Flood Recovery Assistance for your Home or Business FORM B - CONFIRMATION OF INSURANCE This form must be completed by your insurance provider before you can receive assistance through the Disaster Financial Assistance Program. Please return to NB EMO at 65 Brunswick Street, Fredericton, NB, E3B 1G5 or to your local DFA field office, if there is one available in your community. Name of Applicant: Name of Co-Applicant: (if applicable) Civic Address: Type of Policy Carried: Homeowners Policy Tenants Policy Policy Number: Name of Insurer: During the period of the major flooding event, did the following apply to the insured? 1. Sewer Back Up Endorsement Yes No 2. Water Extension Endorsement Yes No 3. Any form of Flood Coverage Yes No 4. If yes for 1, 2 or 3 has a claim been submitted to you? Yes No 5. If yes, was the claim denied? Yes No (Please use the comments section below to explain why claim was denied) 6. Does the insurance provider offer a policy for flood damage? i.) Homeowner Yes No ii.) Business Yes No iii.) Fishing Enterprise Yes No 7. If yes, what is the maximum coverage provided? 8. Did the homeowner avail of this maximum? 9. Amount of the deductible carried, if any: 10. Was the policy holder paid a settlement for a claim during the period of a major flooding event? Yes No If yes, please provide amount of payout $ 11. Tenants policy in place (content coverage only) Yes No 12. Comments: Signature of Agent/Company Date Please Print Name Phone Number Thank you for providing this information. 17

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22 Flood Recovery Assistance for your Home or Business FORM B - CONFIRMATION OF INSURANCE This form must be completed by your insurance provider before you can receive assistance through the Disaster Financial Assistance Program. Please return to NB EMO at 65 Brunswick Street, Fredericton, NB, E3B 1G5 or to your local DFA field office, if there is one available in your community. Name of Applicant: Name of Co-Applicant: (if applicable) Civic Address: Type of Policy Carried: Homeowners Policy Tenants Policy Policy Number: Name of Insurer: During the period of the major flooding event, did the following apply to the insured? 1. Sewer Back Up Endorsement Yes No 2. Water Extension Endorsement Yes No 3. Any form of Flood Coverage Yes No COPY 4. If yes for 1, 2 or 3 has a claim been submitted to you? Yes No 5. If yes, was the claim denied? Yes No (Please use the comments section below to explain why claim was denied) 6. Does the insurance provider offer a policy for flood damage? i.) Homeowner Yes No ii.) Business Yes No iii.) Fishing Enterprise Yes No 7. If yes, what is the maximum coverage provided? 8. Did the homeowner avail of this maximum? 9. Amount of the deductible carried, if any: 10. Was the policy holder paid a settlement for a claim during the period of a major flooding event? Yes No If yes, please provide amount of payout $ 11. Tenants policy in place (content coverage only) Yes No 12. Comments: Signature of Agent/Company Date Please Print Name Phone Number Thank you for providing this information. 19

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24 Flood Recovery Assistance for your Home or Business Page 1 of 2 FORM C - APPLICATION FOR AN ADVANCE PAYMENT Name of Applicant: Applicant s Medicare No.: Name of Co-Applicant: Co-Applicant s Medicare No.: (if applicable) (if applicable) Mailing Address: Home Phone: Work Phone: Other number where you can be reached: address: Civic Address of Property damaged or destroyed (with postal code): DECLARATION OF APPLICANT(S) 1. I / We apply for an advance of $ (maximum of $4 000) against any disaster assistance for property damaged or destroyed located at the address described above that may be granted under the Disaster Financial Assistance Program. 2. I / We apply for such advance assistance described above as the: [Please check applicable box(es)] Homeowner Co Homeowner 3. I / We make this application on behalf of: All members of the homeowner s household (i.e. spouse, children, parents, etc) A non-profit organization A small business (corporation, sole proprietorship, partnerships, etc) A farm operation or farming business 4. I / We have suffered uninsurable* loss or damage to the land, premises and chattels described above, which to the best of my / our knowledge and belief exceeds $4,000. (*the Disaster Financial Assistance Program does not pay for any damage or loss that is covered by an insurance policy) 5. I / We agree to provide all information and documentation required by the New Brunswick Emergency Measures Organization (NB EMO) to assess my / our eligibility for advance assistance and to allow any authorized representative of NB EMO access to the above described building(s) / dwelling(s). 6. I / We authorize any person, agency or organization, including federal, provincial or municipal government departments, to release to NB EMO, or any of its representatives, information required for the purpose of determining or verifying eligibility for the advance assistance that I / we have applied for herein. I / We hereby acknowledge that a photocopy of this authorization shall be sufficient to allow for the release of the specific information requested. 7. I / We acknowledge and agree that I / we will be required to also submit an application for the Disaster Financial Assistance Program for the purposes of assessing my / our total claim for assistance. 8. I / We acknowledge and agree that the advance assistance that I / we receive shall be subject to the following: 21

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26 Flood Recovery Assistance for your Home or Business Page 1 of 2 FORM C - APPLICATION FOR AN ADVANCE PAYMENT Name of Applicant: Applicant s Medicare No.: Name of Co-Applicant: Co-Applicant s Medicare No.: (if applicable) (if applicable) Mailing Address: Home Phone: Work Phone: Other number where you can be reached: address: Civic Address of Property damaged or destroyed (with postal code): DECLARATION OF APPLICANT(S) 1. I / We apply for an advance of $ (maximum of $4 000) against any disaster assistance for property damaged or destroyed located at the address described above that may be granted under the Disaster Financial Assistance Program. COPY 2. I / We apply for such advance assistance described above as the: [Please check applicable box(es)] Homeowner Co Homeowner 3. I / We make this application on behalf of: All members of the homeowner s household (i.e. spouse, children, parents, etc) A non-profit organization A small business (corporation, sole proprietorship, partnerships, etc) A farm operation or farming business 4. I / We have suffered uninsurable* loss or damage to the land, premises and chattels described above, which to the best of my / our knowledge and belief exceeds $4,000. (*the Disaster Financial Assistance Program does not pay for any damage or loss that is covered by an insurance policy) 5. I / We agree to provide all information and documentation required by the New Brunswick Emergency Measures Organization (NB EMO) to assess my / our eligibility for advance assistance and to allow any authorized representative of NB EMO access to the above described building(s) / dwelling(s). 6. I / We authorize any person, agency or organization, including federal, provincial or municipal government departments, to release to NB EMO, or any of its representatives, information required for the purpose of determining or verifying eligibility for the advance assistance that I / we have applied for herein. I / We hereby acknowledge that a photocopy of this authorization shall be sufficient to allow for the release of the specific information requested. 7. I / We acknowledge and agree that I / we will be required to also submit an application for the Disaster Financial Assistance Program for the purposes of assessing my / our total claim for assistance. 8. I / We acknowledge and agree that the advance assistance that I / we receive shall be subject to the following: 23

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28 Flood Recovery Assistance for your Home or Business a) That such amount is an advance against the total amount of disaster assistance that my be granted to me / us by NB EMO as a result of my / our claim for assistance required under paragraph 7; b) That such advance shall be deducted from the total amount of disaster assistance as may be provided to me / us; and c) That such advance will be used by me / us to make repairs or replacements as required by NB EMO to satisfy its requirements for disbursement of an advance against disaster assistance. Page 2 of 2 9. I / We acknowledge and agree that if NB EMO determines that I / we do not qualify for the Advance against Disaster Financial Assistance Program for property damaged or destroyed in an amount of that was advanced to me/us, or if I / we qualify for an amount less than the amount that I / we received as part of the Advance against Disaster Financial Assistance Program for property damaged or destroyed that I / we agree that the advance assistance provided pursuant to this Application, or the applicable portion thereof, shall be repaid, as a debt due and owing to the Government of New Brunswick, upon its demand. 10. I / We authorize NB EMO to use the Provincial Medicare Number provided in any manner required for the administration of this agreement. 11. I / We declare that the information given in this application is true, correct and complete; that I / we have not withheld any information which may have an effect on this Application; and that no other person has applied for or received advance assistance for the above described building(s) / dwelling(s) or any other building(s) / dwelling(s) which I / we are the registered owner of or have an interest in. Dated at, New Brunswick, this day of, 20. Witness Witness Signature of Applicant Signature of Co-Applicant (if applicable) 25

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30 Flood Recovery Assistance for your Home or Business Page 2 of 2 a) That such amount is an advance against the total amount of disaster assistance that my be granted to me / us by NB EMO as a result of my / our claim for assistance required under paragraph 7; b) That such advance shall be deducted from the total amount of disaster assistance as may be provided to me / us; and c) That such advance will be used by me / us to make repairs or replacements as required by NB EMO to satisfy its requirements for disbursement of an advance against disaster assistance. 9. I / We acknowledge and agree that if NB EMO determines that I / we do not qualify for the Advance against Disaster Financial Assistance Program for property damaged or destroyed in an amount of that was advanced to me/us, or if I / we qualify for an amount less than the amount that I / we received as part of the Advance against Disaster Financial Assistance Program for property damaged or destroyed that I / we agree that the advance assistance provided pursuant to this Application, or the applicable portion thereof, shall be repaid, as a debt due and owing to the Government of New Brunswick, upon its demand. 10. I / We authorize NB EMO to use the Provincial Medicare Number provided in any manner required for the administration of this agreement. 11. I / We declare that the information given in this application is true, correct and complete; that I / we have not withheld any information which may have an effect on this Application; and that no other person has applied for or received advance assistance for the above described building(s) / dwelling(s) or any other building(s) / dwelling(s) which I / we are the registered owner of or have an interest in. COPY Dated at, New Brunswick, this day of, 20. Witness Witness Signature of Applicant Signature of Co-Applicant (if applicable) 27

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32 Flood Recovery Assistance for your Home or Business General: FORM D1 - DISASTER RECOVERY INFORMATION FOR PERSONAL CLAIM (Homeowners/ Renters) Name of Applicant: Applicant s Medicare No: Name of Co-Applicant: Co-Applicant Medicare No: Home phone: Work phone: Employer: If Native, Band #: Housing: 1. Are you presently living in your home? Yes No If no please answer the following questions. 2. Who are you staying with now? Friends Relatives Other Name: What is your current address and telephone number? 3. How much longer will these arrangements be available to you? 4. When did you leave your home? Dependants other than Spouse: Name of dependant Age Relationship School/Grade Homeowner/ Renters information: Do you own your home? Yes No Amount of Mortgage or / Rent: Do you rent? Yes No Gross Family Income: You must Include a copy of the Property Tax Assessment or / Lease agreement. I certify that the information provided in this application is true and accurate to the best of my knowledge. Signature of Applicant: Date: Signature of Co-Applicant: Date: This confidential information will be used only for the purpose for which it has been collected. It may only be conveyed to other government departments and agencies for the purposes of disaster financial assistance. 29

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34 Flood Recovery Assistance for your Home or Business General: FORM D1 - DISASTER RECOVERY INFORMATION FOR PERSONAL CLAIM (Homeowners/ Renters) Name of Applicant: Applicant s Medicare No: Name of Co-Applicant: Co-Applicant Medicare No: Home phone: Work phone: Employer: If Native, Band #: Housing: 1. Are you presently living in your home? Yes No If no please answer the following questions. 2. Who are you staying with now? Friends Relatives Other Name: What is your current address and telephone number? 3. How much longer will these arrangements be available to you? COPY 4. When did you leave your home? Dependants other than Spouse: Name of dependant Age Relationship School/Grade Homeowner/ Renters information: Do you own your home? Yes No Amount of Mortgage or / Rent: Do you rent? Yes No Gross Family Income: You must Include a copy of the Property Tax Assessment or / Lease agreement. I certify that the information provided in this application is true and accurate to the best of my knowledge. Signature of Applicant: Date: Signature of Co-Applicant: Date: This confidential information will be used only for the purpose for which it has been collected. It may only be conveyed to other government departments and agencies for the purposes of disaster financial assistance. 31

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36 Flood Recovery Assistance for your Home or Business FORM D2 - DISASTER RECOVERY INFORMATION FOR SMALL BUSINESSES (Commercial, Agriculture, Fisheries & Rental) Small business is defined under the Disaster Financial Assistance Program as an owner-operated business where the owner/operator is acting as the day to day manager. Small business is defined as having a yearly gross revenue as reported for income tax purposes of at least $10,000 but not more than $2 million and employing not more than the equivalent of 20 full-time employees. Registered Business Name List all Owners of the Company/Business and extent of participation in the day-to-day management of the small business Percentage of Ownership Owner/ Operator (Name): Business Phone Number: Mailing Address: Civic Address (Location of business affected): The following information must be provided or your claim will not be processed: 1. Copy of share registry/ or a letter from a lawyer or a chartered accountant confirming your percentage of ownership of the business. 2. Proof of business income in the form of a present fiscal year financial statement. 3. Copy of property tax assessment /Lease agreement for the business. I certify that the information provided in this application is true and accurate to the best of my knowledge. Signature of Owner/ Operator: Date: Witness: Date: This confidential information will be used only for the purpose for which it has been collected. 33

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38 Flood Recovery Assistance for your Home or Business FORM D2 - DISASTER RECOVERY INFORMATION FOR SMALL BUSINESSES (Commercial, Agriculture, Fisheries & Rental) Small business is defined under the Disaster Financial Assistance Program as an owner-operated business where the owner/operator is acting as the day to day manager. Small business is defined as having a yearly gross revenue as reported for income tax purposes of at least $10,000 but not more than $2 million and employing not more than the equivalent of 20 full-time employees. Registered Business Name Owner/ Operator (Name): Business Phone Number: List all Owners of the Company/Business and extent of participation in the day-to-day management of the small business COPY Percentage of Ownership Mailing Address: Civic Address (Location of business affected): The following information must be provided or your claim will not be processed: 1. Copy of share registry/ or a letter from a lawyer or a chartered accountant confirming your percentage of ownership of the business. 2. Proof of business income in the form of a present fiscal year financial statement. 3. Copy of property tax assessment /Lease agreement for the business. I certify that the information provided in this application is true and accurate to the best of my knowledge. Signature of Owner/ Operator: Date: Witness: Date: This confidential information will be used only for the purpose for which it has been collected. 35

Flood Recovery for your Home or Business. Be prepared What you need to know

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