Reimbursement applications

Reimbursement applications. (1) Timing of applications. An eligible applicant shall submit an application within the dates required by s. 292.65 (8) (a) , Stats. (2) Contents of applications. An owner or operator who seeks reimbursement of response action costs shall complete and submit to the department all the following: (a) An application form containing all the following: 1. The owner or operator’s name and address and a statement indicating how the applicant qualifies as an owner or operator under s. NR 169.07 . 2. If an agent of the owner or operator is directing the response action, the name, address and phone number of the agent and a dated copy of the agency agreement. 3. A statement indicating whether the owner or operator has applied or will apply to another department program or another government agency for reimbursement of response action costs incurred for the same facility. 4. Information regarding multiple owner or operators including: a. Names, addresses and phone numbers of all co–owners and all co–operators. b. A certification that the owner or operator has made a reasonable effort to notify other owners or operators. 5. Dry cleaner facility information including information on whether the facility is still operating or operable, pollution prevention measures implemented and information on the construction of the facility. 6. Discharge information associated with the facility. 7. Consultant information, including the contact name and business name. 8. Insurance information, including a statement indicating whether any portion of the response action costs for which the owner or operator seeks reimbursement may be covered by insurance, or a statement from the owner’s or operator’s insurance company stating that the insurance company has denied the owner’s or operator’s claim for reimbursement of the response action costs 9. Other relevant information requested by the department. (b) A reimbursement cost summary form containing all the following: 1. The total eligible response action costs for which the owner or operator seeks reimbursement from the department and a breakdown of those costs into the categories listed in par. (e) . 2. Other relevant information requested by the department. (c) A map showing the town, range, section and quarter–quarter section location of the facility. (d) An accurate legal description of the land parcel where the facility is located which corresponds to the most recent accurate parcel description filed with the register of deeds in the county where the land parcel is located. (e) A cost detail worksheet form which lists and identifies each eligible response action cost for which the applicant seeks reimbursement from the department, indicates whether the response action cost was for an immediate action, interim remedial action, site investigation or remedial action, and allocates cost to one of the following categories: 1. Soil investigation. 2. Soil remediation. 3. Groundwater investigation. 4. Groundwater remediation. 5. Air/vapor investigation. 6. Air/vapor remediation. 7. Laboratory and other analysis. 8. Miscellaneous. (f) Invoices or other information documenting and cross referencing each of the costs listed under par. (e) and identifying the nature of the materials or services provided, the amount charged for the materials or services, the identity of the provider, and the dates on which the materials or services were provided (g) Canceled checks or other information documenting that the applicant has paid all of the costs under par. (e) , and cross referenced to the statement provided under par. (e) . (h) For each cost listed under par. (e) , a copy of the accepted bid proposal as well as a cumulative listing of all change orders to the original bid proposal approved to date. (i) A spreadsheet that identifies and cross references each cost in par. (e) with the documentation under pars. (f) and (g) supporting that cost. (j) A substitute W–9 tax form completed by the owner or operator applying for reimbursement. (k) Other relevant information required by the department. (L) A statement indicating whether the owner or operator has had past discharges at the facility for which a closure has been granted by the department. (m) A record of investigation results and data interpretation. (n) Contracts for eligible costs incurred because of the discharge and records of the contract negotiations. (3) Costs included in applications. (a) Each reimbursement application shall include all eligible response action costs paid after the date an applicant’s last application was submitted and before or on the date the current application is submitted. (b) An owner or operator may not apply for reimbursement of eligible response action costs paid before the date of a prior reimbursement application to the department, unless those costs were not eligible for reimbursement under this chapter at the time of the prior application. (4) Application frequency. (a) An owner or operator shall submit applications for immediate and interim actions as specified in s. NR 169.11 . (b) An owner or operator may submit an application for reimbursement of site investigation costs when a complete ch. NR 716 site investigation report is submitted to and approved by the department. (c) An owner or operator who incurs costs for a ch. NR 716 site investigation may submit a request for reimbursement prior to completing the site investigation report. The minimum reimbursement request shall be $15,000 and only one reimbursement request may be submitted within any fiscal year. No more than 3 reimbursement requests, each accompanied by a summary of work completed through the date of the last invoice may be submitted prior to submittal of the site investigation report. A final reimbursement request may be submitted upon department approval of the site investigation report. (d) Not including the final application submitted after closure has been granted, an owner or operator may not submit more than 2 applications for remedial action reimbursement for each facility in a fiscal year. (5) Fraudulent applications. (a) No person may make, or conspire with another person to make, any false, deceptive or misleading representation in connection with any reimbursement application under this chapter. (b) Any person who makes or conspires with another person to make any false, deceptive or misleading representation in connection with a reimbursement application under this chapter is ineligible for any reimbursement for that response action or any other response action taken or ordered at any dry cleaning facility within 5 years after the date of that application. (c) Any person who has reason to believe that that person has received any reimbursement for which that person is ineligible under this section shall immediately notify the department and shall refund with the notification the full amount of any reimbursement for which that person is ineligible.