Compliance
 

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

 
Eligibility
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

 
Reimbursement  

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

 
Grants
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 doc 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