The County is requesting that 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, documentation and receipts for the necessary work should be submitted (photographs, invoices, statements, cancelled check, etc.).
Withholding Form. This form is to be completed and submitted by property owners who have received debris related insurance money, incurred 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, and documentation and receipts for the necessary work should be submitted (photographs, invoices, statements, cancelled check, etc.).I
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. (NOTE: The Withholding Form is to be used when the property owner does not intend to make payment to the County at any time, and as a result of further necessary debris-related work on their property. 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/FEMA.
The County has prepared sample language (see Insured Statement) for some (but not all) of the different scenarios where a property owner would or would not pay their debris related insurance money. All property owners may use their own phrasing rather than the samples provided.
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 (see question #2) 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.