Event date: ^Date or approximate ranges when the event occurred^ AGRN: ^Australian Government Reference Number^ Name of EPA ^Name of the asset i.e.^ Is the estimated total Yes ^If the estimated cost is $1 million there is no need to seek cost of the project over Commonwealth agreement^ $1 million? Proposed project start ^dd/mm/yyyy^ date Proposed project finish ^dd/mm/yyyy^ date Scope of project description of the scope of the restoration or replacement works to be completed^ Name of eligible ^Name of the entity who owns the asset^ undertaking Previous EPA Form Yes attached Have there have been No ^If there have been changes i.e. eligible undertaking, any change in infrastructure type, role of asset in state’s infrastructure etc. you will circumstances that may need to fill out a new EPA Approval Form^ affect the asset’s classification as an EPA? State/territory contact Name: ^Full name of the contact officer^ officer details Title: ^Job title of contact officer^ address: ^Email address of the contact officer^ Phone number: ^Contact phone no. incl area code, of the contact officer^ Commonwealth Name: ^Full name of Commonwealth officer^ notification (to be Title: ^Job title of Commonwealth officer^ completed by AGD) Email address: ^email address of the Commonwealth^ Phone number: ^contact phone no. including area code of the contact officer^ Approved/Not approved (please circle) Signature: Date: / / [Please note that 1. Only those costs associated with restoring or repairing the essential public asset in the activated local government area for this disaster event are eligible to be claimed for reimbursement under the Natural Disaster Relief and Recovery Arrangements (NDRRA) Determination 2012 (Version 2 .Commonwealth agreement does not deem all associated project costs as being eligible for reimbursement under the NDRRA; just that the asset/s identified satisfy the requirements of clause 5.3.2 of the NDRRA. In addition, this agreement does not preclude the Commonwealth from identifying ineligible costs upon completion and acquittal of the project.]
Event date: ^Date or approximate ranges when the event occurred^ AGRN: ^Australian Government Reference Number^ Name of EPA ^Name of the asset i.e.^ Is the estimated total cost of the project over $1 million? Yes ^If the estimated cost is $1 million there is no need to seek Commonwealth agreement^ Proposed project start date ^dd/mm/yyyy^ Proposed project finish date ^dd/mm/yyyy^ Scope of project description of the scope of the restoration or replacement works to be completed^ Name of eligible undertaking ^Name of the entity who owns the asset^ Previous EPA Form attached Yes Have there have been any change in circumstances that may affect the asset’s classification as an EPA? No ^If there have been changes i.e. eligible undertaking, infrastructure type, role of asset in state’s infrastructure etc. you will need to fill out a new EPA Approval Form^ State/territory contact officer details Name: ^Full name of the contact officer^ Title: ^Job title of contact officer^ address: ^Email address of the contact officer^ Phone number: ^Contact phone no. incl area code, of the contact officer^ Commonwealth notification (to be completed by AGD) Name: ^Full name of Commonwealth officer^ Title: ^Job title of Commonwealth officer^ Email address: ^email address of the Commonwealth^ Phone number: ^contact phone no. including area code of the contact officer^ Approved/Not approved (please circle) Signature: Date: / / [Please note that 1. Only those costs associated with restoring or repairing the essential public asset in the activated local government area for this disaster event are eligible to be claimed for reimbursement under the Natural Disaster Relief and Recovery Arrangements (NDRRA) Determination 2012 (Version 2 .Commonwealth agreement does not deem all associated project costs as being eligible for reimbursement under the NDRRA; just that the asset/s identified satisfy the requirements of clause 5.3.2 of the NDRRA. In addition, this agreement does not preclude the Commonwealth from identifying ineligible costs upon completion and acquittal of the project.]
NDRRA-Determination-Attachment-C-Essential-Public-Assets-Approval-Form.docx