Highway 89 Road Closure Financial Impact Form - Markleeville Residents & Workforce

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This form is to assess the financial impact to Markleeville residents and Workforce in the Highway 89 Road Closure Impact Area. Please provide as much detail as possible. This form will be utilized by an Inter-Agency Review Committee to provide financial assistance to those impacted by the Highway 89 Road Closure. These forms will not be released to the public and all information contained herein will remain confidential. Due to the limited funds available and the severity of the impact of the Highway 89 Road Closure, the Highway 89 Road Closure fund may not be able to fund your full request.

Please provide any proof if possible in the form of receipts, images and/or reports to assist with the review process. They can be emailed to info@alpinecounty.com. Make sure to provide identifying information with the form of proof.

1. Name, Email, Physical Address, Phone Number

2. Financial Impact Category - what type of financial impact did you incur as a result of the Highway 89 Road Closure?

Property Damage

Loss of Income

Unforeseen Expenses

All of the Above

Other:

3. What is the total financial impact ($) from the estimated damages?

4. Please describe and identify estimated damages. Example (Flooding, Food Loss, Income Loss, Increased Travel Expenses, etc..). For additional travel expenses please utilize the federal mileage rate $.625/mile to calculate additional travel costs.

5. If your commute to your place of employment was impacted, were you provided options to work remotely?

Yes

Clear selection

6. Would you like to be referred to Alpine County Social Services for support?

Yes

Maybe

Clear selection

7. How much financial assistance will be provided by your insurance company, if any?

8. How much will you receive from other disaster assistance? (Example: GoFundMe, Fundraising, Donations)

9. What amount of assistance are you requesting from the Highway 89 Road Closure Fund?

10. Additional comments

Please provide any proof of your financial impact, if possible, in the form of receipts, images and/or reports to assist with the review process. For fuel costs, please They can be emailed to info@alpinecounty.com or mailed to: ACCC, PO Box 265, Markleeville, CA 96120.

Make sure to provide identifying information with the form of proof.

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