Appendix 1 - Application for Certificate of Compliance for Dispensing Facilities (with BASA)


WORD doc format of Appendix1.doc

Appendix 1R - Renewal Application for Certificate of Compliance for Dispensing Facilities


WORD doc format of Appendix1R.doc

Appendix 2 - Application for Eligibility

WORD doc format of Appendix2.doc

Application for Eligibility Checklist 

WORD doc format of Appchecklist.doc

Owner Authorization for Eligibility Form 

WORD doc format of Eligibility_Owner_Authorization.doc


Appendix 4 - Application for Reimbursement


WORD doc format of Appendix4.doc

- Submission Guidelines


WORD doc format of Claims_Reimbursement_app.DOC

Insurance Questionnaire 

WORD doc format of InsuranceQuestionaire.doc

Appendix 4A - Listing of Costs, Expenses and Obligations EXCEL xls format of Appendix_4A.xls
Appendix 4A - Guidance WORD doc format of Appendix_4A_guidance.doc
Appendix 4A - Example Form EXCEL xls format of Appendix_4A_example.xls
Appendix 5 - Competitive Bidding 

WORD doc format of Appendix5.doc

Appendix 6 - Third Party Claims Arising from a Civil Court Action 

WORD doc format of Appendix6.doc

Owner Authorization for Claims Form 

WORD doc format of Claims_Owner_Authorization.doc

Policy for Insurance and Subrogation Contributions 

WORD doc format of Subrogation.doc

Application for Economic Hardship Status

Request for Reconsideration Form


WORD doc format of Application_Economic_Hardship_Status.doc

WORD doc format of Request for Reconsideration

City and Towns Grants Application 

WORD doc format of USTGrant.doc

Appendix A - Cost Breakdown Worksheet 

EXCEL xls format of Appendix_A_CostBreakdownWorksheet.xls

Eligible and Ineligible Costs 

WORD doc format of Eligible_IneligibleCosts.doc

Commonwealth Standard Contract Form 

PDF pdf format of Standard_Contract_Form.pdf

Fee Collection  
Notice Regarding Special Fuels 

PDF pdf format of Notice_to_Distributors.pdf

Form 500 - Monthly Delivery Fee Reporting Form 

WORD docx format of FR500.DOC

Form 501 - Monthly Delivery Fee Report - Schedules 1-3 

WORD doc format of Fr501.DOC

Form 502 - Application for Delivery Fee Abatement 

WORD doc format of Fr502.DOC

Example of a completed Monthly Delivery Fee Report
 PDF pdf format of Example of Completed Monthly Delivery Free File Report

Miscellaneous Forms
Notification of Assignment Policy and Form 

PDF pdf format of Notice_Assign_Policy.pdf

IRS Form W-9 (Massachusetts Substitute)


PDF pdf format of newMass_W9.pdf