HomeMy WebLinkAboutGeothermal Asset Fund Claims Form2014COUNTY OF HAWAI`I
PLANNING COMMISSION
GEOTHERMAL ASSET FUND CLAIMS FORM
CLAIMANT: __________________________________________________________________
CLAIMANT’S SIGNATURE: ___________________________ DATE: __________________
ADDRESS: _________________________________________________________________
_________________________________________________________________
_________________________________________________________________
TELEPHONE NO. (BUSINESS) ___________________ (RESIDENCE) ________________
TAX MAP KEY (if applicable):____________________________________________________
NATURE OF CLAIM:
THIS PETITION MUST BE NOTARIZED AND ACCOMPANIED BY:
1. List of documents supporting the claim, showing evidence of adverse impact.
2. Additional information regarding the nature of the claim, including the way in which the claimant
has been adversely impacted and the compensation sought.
3. When the claimant is an organization, the claimant shall submit a list of officers, a membership
list, and a copy of the organization’s by-laws.
4. Original and twenty (20) copies of this claim form and all supporting documents.
Subscribed and sworn to, before me
this ________ day of __________
____________________________
Notary Public, State of Hawai`i
My commission expires:
COUNTY OF HAWAI`I PLANNING COMMISSION
ELIGIBILITY OF GEOTHERMAL ASSET FUND CLAIMS
Claims for compensation from the Geothermal Asset Fund (GAF) may be filed by any person or
organization who is adversely impacted under the activity of geothermal development authorized
under Geothermal Resource Permit (GRP) No. 2 issued to Puna Geothermal Venture. Persons or
organizations that have already been compensated for damage claims due to a specific event
through means other than this GAF, shall not be eligible for file claims for compensation for the
same event against this fund. Claims filed with the County of Hawai`i Planning Department
prior to the adoption of County of Hawai`i Planning Commission Rule No. 12 (Geothermal
Asset Fund) may be reaffirmed through the filing of the attached Geothermal Asset Fund Claims
Form. The claims form and supporting documents shall be filed with the County of Hawai`i
Planning Department, 101 Pauahi Street, Suite 3, Hilo, Hawai`i 96720.
1. Claims for community approved mitigation projects shall address the alleviation or
attenuation of direct detrimental effects of geothermal operations carried out pursuant to
GRP No. 2.
2. Claims for temporary relocation shall indicate the dates and duration.
3. Adverse impacts shall include physical injury, medical and health conditions, business or
economic loss, nuisance, or any other claim of adverse impact which is able to be
substantiated by evidence.
4. Adverse impact claims may be supported by documents such as doctor’s affidavits,
photographs, bills, invoices, other expert opinions or testimony, etc. Documents shall be
provided upon request.
5. Claims will be acted upon with initial filing date setting the first come, first served basis.
Any claim received before the adoption of Rule No. 12 shall be resubmitted in
accordance with the criteria and guidelines set forth in the rule.
6. An action on the merits of a claim by the professional claims adjuster to recommend
approval or denial of a claim and subsequent Planning Commission action to confirm or
reject the claims adjuster’s recommendation shall, after exhaustion of the Planning
Commission appeal process, become final and shall bar any subsequent claim before the
Planning Commission by the same claimant based upon the same facts.