NGĀ PUNA RAU RANGITĪKEI Freshwater Grant Claim Form

• Type of Claim Form

  Manawatu River Accord

  Regional Freshwater

  Focus Catchment

  Lake Horowhenua Clean-up Fund

• Environmental Management Officer

  Select Lucy Ferguson Anna Regtien Anna Monk Claire Ridler Joe Martin Other

  • Lucy Ferguson
  • Anna Regtien
  • Anna Monk
  • Claire Ridler
  • Joe Martin
  • Other

• Job Number

Claimant Details

• Name of Claimant

• Postal Address
  Address

• Telephone Number

• Cell Phone Number

• Email Address

Completed Works

• Financial Year Works Completed

  2016/17

  2017/18

  2018/19

  2019/20

• Fencing

• Type of Fencing

• Length of Fencing

• Rate/m ($)

• More Fencing

• Type of Fencing

• Length of Fencing

• Rate/m ($)

• Total Fencing Cost (excl. GST)

• Plants

• Number of Plants Planted

• Supplier of plants

• Cost of Plants ($)

• More than one supplier of plants

• Number of plants planted

• Supplier of Plant

• Cost of Plants

• Total Cost for Planting ($)

• Total Plant Costs (excl. GST)

• Other

• Other Costs

  Select Fenceline Prep Earthworks Fish Pass Structures Weed Control Troughs Gate

  • Fenceline Prep
  • Earthworks
  • Fish Pass
  • Structures
  • Weed Control
  • Troughs
  • Gate

• Total Other Costs (excl. GST)

Funding Share of Costs

• Funding share of fencing costs (TMORT/HRC/Landowner) ($)

• Funding share of planting costs (TMORT/HRC/Landowner) ($)

• Funding share of other costs (TMORT/HRC/Landowner) ($)

• Percentage share of fencing costs (TMORT/HRC/Landowner) (%)

• Percentage share of planting costs (TMORT/HRC/Landowner) (%)

• Percentage share of other costs (TMORT/HRC/Landowner) (%)

• Total cost share (TMORT/HRC/Landowner) ($)

• Average percentage (TMORT/HRC/Landowner) (%)

Location of Works

• Location of Works
  Address

• Water Management Zone

  Select Mana_1a Mana_1b Mana_1c Mana_2a Mana_2b Mana_3 Mana_4 Mana_5a Mana_5b Mana_5c Mana_5d Mana_5e Mana_6 Mana_7a Mana_7b Mana_7c Mana_7d Mana_7e Mana_8a Mana_8b Mana_8c Mana_8d Mana_9a Mana_9b Mana_9c Mana_9d Mana_9e Mana_10a Mana_10b Mana_10c Mana_10d Mana_10e Mana_11a Mana_11b Mana_11c Mana_11d Mana_11e Mana_11f Mana_12a Mana_12b Mana_12c Mana_12d Mana_12e Mana_13a Mana_13b Mana_13c Mana_13d Mana_13e Mana_13f Rang_1 Rang_2 Rang_3 Rang_4 Whai_1 Whai_2 Whai_3 Whai_4 Whai_5 Whai_6 Whai_7 Whau_1 Whau_2 Whau_3 Whau_4 Tura_1 Ohau_1 Owha_1 East_1 Akit_1 West_1 West_2 West_3 West_4 West_5 West_6 West_7 West_8 West_9 Hoki_1

  • Mana_1a
  • Mana_1b
  • Mana_1c
  • Mana_2a
  • Mana_2b
  • Mana_3
  • Mana_4
  • Mana_5a
  • Mana_5b
  • Mana_5c
  • Mana_5d
  • Mana_5e
  • Mana_6
  • Mana_7a
  • Mana_7b
  • Mana_7c
  • Mana_7d
  • Mana_7e
  • Mana_8a
  • Mana_8b
  • Mana_8c
  • Mana_8d
  • Mana_9a
  • Mana_9b
  • Mana_9c
  • Mana_9d
  • Mana_9e
  • Mana_10a
  • Mana_10b
  • Mana_10c
  • Mana_10d
  • Mana_10e
  • Mana_11a
  • Mana_11b
  • Mana_11c
  • Mana_11d
  • Mana_11e
  • Mana_11f
  • Mana_12a
  • Mana_12b
  • Mana_12c
  • Mana_12d
  • Mana_12e
  • Mana_13a
  • Mana_13b
  • Mana_13c
  • Mana_13d
  • Mana_13e
  • Mana_13f
  • Rang_1
  • Rang_2
  • Rang_3
  • Rang_4
  • Whai_1
  • Whai_2
  • Whai_3
  • Whai_4
  • Whai_5
  • Whai_6
  • Whai_7
  • Whau_1
  • Whau_2
  • Whau_3
  • Whau_4
  • Tura_1
  • Ohau_1
  • Owha_1
  • East_1
  • Akit_1
  • West_1
  • West_2
  • West_3
  • West_4
  • West_5
  • West_6
  • West_7
  • West_8
  • West_9
  • Hoki_1

• Map of Works

  Media

• Photo of Completed Works

  Media

Risk Management

• Were there any incidences (injury, illness, near miss) when undertaking the work?

  Yes

  No

• What incidences occurred?

• Were any new risks identified or any changes to controls needed for existing risks?

  Yes

  No

  N/A

• What risks/ changes were identified?

• Is there anything new we have learned that will improve safety for future projects?

  Yes

  No

• What have we learned?

Certification

• I hereby certify that the above is a true and complete statement of costs (excluding GST) of work which has been carried out in a workman-like manner, in terms of Horizons Regional Council's approval, on my property, and hereby apply for a grant accordingly. Available for inspection are relevant invoices supporting the above purchases of Goods and Services.

• Signature of Claimant

  Sign

• I hereby certify that I have inspected the work, and the work has been carried out in a satisfactory manner in accordance with the approved proposal and I now recommend payment of the Environmental Initiative Applicable.

• Signature of Environmental Management Officer

  Sign

• Signature of NPRR Project Manager/Executive

  Sign