Res 1998-049 - Laserfiche WebLink

Home Browse Search

SECTION IV. TOTAL REIMBURSEMENT REQUEST (continued) 2. The lNRCC has a required owner/operator contribution or "deductible" that must be met before costs can be reimbursed. The required deductible is based: 8 bow many single petroleum storage tanks the applicant owns or operates in Texas; 8 if specific corrective action milestones are met; and 8 the number of occurrellCes when the application is detennined to be administratively complete at the lNRCC. An initial deductible is required for each Occurrence (LPST ID Number - the deductible may increase based upon the failure to meet specific corrective action milestones). The deductible, or "owner/operator contribution" will be as follows: II NUMBER OF REQUIRED FAILURE TO FAILURE TO FAILURE TO SINGLE DEDUCTIBLE SUBMIT A SUBMIT MEET PETROLEUM ($) SITE AND RECEIVE THE GOAI3 IN STORAGE TANKS ASSESSMENT APPROVAL THE APPROVED APPLICANT OWNS PRIOR TO FOR CORRECTIVE OR 12123196 CORRECTIVE ACflONPLAN OPERA TES IN AcrION PLAN BY TEXAS PRIOR TO 11123198 12J23IfTf less than 13 tanks; $ 1,000 $ 2,000 $ 4,000 $ 8,000 13 to 99 tanks, inclusive; $ 2,500 $ 5,000 $10,000 $20,000 100 to 999 tanks, inclusive; or $ 5,000 $10,000 $20,000 $40,000 1,000 or more tanks. $10,000 $20,000 $40,000 $80,000 If a site has received a closure letter and has a subsequent release on or after 9/1/95, the deductible will be $50,000. a. Number of single petroleum storage tanks owned or operated in Texas: Three l3) l Ah:porO b. Enter required deductible: ............................................................................. 3. Provide the following information in order to calculate the total reimbursement request for this application: a. From the Reimbursement Claim Summary (Section V), provide the total cost for corrective action """""""""""""""""""""""""""""""""""""'" b. Enter the required deductible amount: {Same as line (1.b.)}: .....................................................,..... c. For the corrective action expenses requested to be reimbursed in this application, provide the amount of reimbursement that has already been received for these expenses or for whicb a claim was filed ............................................................................. Insurer name: Policy number: As of / / (date), insurance reimbursement has been (check one): 0 received 0 claimed TOTAL REIMBURSEMENT REQUEST (3.a.). (3.b.). (3.e): .................... SECTION V. REIMBURSEMENT CLAIM SUMMARY 1NRCC APPUCATION FOR REIMBURSEMENT E-Z FORM 12 1NRCC.()23()..EZ (Revised 09-01-95)