ROADS END IMPROVEMENT ASSOCIATION

Application for Reimbursement of Street Repairs

I, _______________________________________________________________________________

(applicants full name, please print)

_________________________________________________________________________________

(street address, apt. no.)                             (city or town)                                 (zip code)

am applying for reimbursement of up to one-half (1/2) of the cost of crushed rock and/or grading to be used on a projected street repair involving the following area:

_________________________________________________________________________________

  (describe fully the area to be repaired, including street[s], and the exact scope of the planned work)

_________________________________________________________________________________

I have read the enclosed REIA Street Maintenance Policy (August 8, 2007) and agree, as follows:

1) The responsibility of the Association is limited to the purchase of crushed rock and/or grading only.

2) The amount of reimbursement shall be limited to $1,000.00, per project, or one-half the cost of crushed rock and/or grading, whichever is smaller.

3) This application precedes the ordering of the material.

4) I guarantee payment of the balance of the project cost.

5) Following approval by the Association of the project, I will submit an invoice for the crushed rock and/or grading.

6) The Association assumes no liability for any claims that may result from the improvements made persuant to this project.

 

____________________________________________________    ______________

(applicants signature)                                                                     (date)