The county is requesting that at least one of three forms be submitted by every property owner. The following information should assist you in determining which form is appropriate for your circumstance.

Reimbursement form

This form is to be completed and submitted by property owners requesting reimbursement for all or a portion of the debris-related insurance money that was paid to the county. In addition to the reimbursement form, any statement from your insurance company verifying the amount of debris related insurance money paid to you, authorization that the expenses are eligible under the category of insurance, and documentation and receipts for the qualifying work should be submitted (photographs, invoices, statements, cancelled check, etc.). You should also submit an insured statement explaining in detail the circumstances of the necessity of the additional debris removal.

Withholding form

This form is to be completed and submitted by property owners who have received debris-related insurance money, incurred eligible offsetting expenses, and are not turning over to the county the full amount of the debris related insurance money. In addition to the withholding form, any statement from your insurance company verifying the amount of debris-related insurance money paid to you, authorization that the expenses are eligible under the category of insurance, and documentation and receipts for the qualifying work should be submitted (photographs, invoices, statements, cancelled check, etc.).  You should also submit an insured statement explaining in detail the circumstances of the necessity of the additional debris removal.

Insured statement

This statement is to be submitted by all other property owners who are turning over debris-related insurance money to the county and not submitting a reimbursement form or a withholding form. Property owners who are turning their entire debris-related insurance money to the county should submit an insured statement with their payment. Property owners who are retaining their debris-related insurance money until a later date should submit an insured statement indicating the amount of debris insurance payments and the reason for retaining the funds. (NOTE: The withholding form is to be used when the property owner does not intend to make payment to the county at any time. The property owner who is deferring payment to the county to a later date should use the insured statement, and include language that he/she will contact the county at a later date to reconcile any possible debris-related insurance money that could be due to CalOES.

The withholding form, request for reimbursement form and the insured statement all contain language that the property owner has not received a duplication of benefits and that the statements contained in the document are true and correct and the property owner understands the county is relying on the truth and accuracy of the statement. In addition, the withholding and reimbursement forms state that the activity for which the funds are requested/withheld is an allowable expense under the category of insurance that paid the debris removal funds.