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19/20 Kangaroo Island Bushfire - On-farm Emergency Water Infrastructure Rebate SchemeApplication – May 2021Please note the Scheme will close when funding is exhausted or 5pm, 31 October 2021, whichever occurs first

The South Australian Government in partnership with the Australian Government is providing a rebate of up to 50 per cent (to a maximum of $50,000 - GST exclusive) to support Kangaroo Island (KI) bushfire impacted primary producers increase water security. The support is via provision of a rebate for the costs associated with the purchase, installation, and repairs to on-farm water infrastructure for livestock and permanent horticulture that:

Increases water security for animal welfare purposes now and for future adverse events.

Assists primary producers to be more resilient to future adverse events to protect high value livestock and horticulture assets.

Through joint Commonwealth/State Disaster Recovery Funding Arrangements, a rebate of up to 50% and up to $50,000 is available.

Before preparing and applying, all Applicants should read the information contained within the Scheme Guidelines.

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1. Application eligibility and checklist You need to answer “Yes” or N/a to the following to obtain a prompt decision.

Are you a property owner, share-farmer or lessee in the livestock grazing industry or horticulture industry that is located in, and directly impacted by the 2019/20 KI Fire? (refer Attachment 1 of Scheme Guidelines)

☐ Yes ☐ No

You are a property owner, share-farmer or lessee in the livestock grazing industry or horticulture industry before 20 December 2019;

☐ Yes ☐ No

Will the rebate be used to reimburse costs incurred by you that are consistent with the eligible activities listed in the Scheme Guidelines?

☐Yes ☐No

Do you derive more than 50% of your individual income from the Primary Production business?Or

If your Primary Production business commenced between 1 July 2015 and 30 June 2021 will you derive at least 50% of your gross income from the Primary Production business within three years?

☐ Yes ☐No

Does your Primary Production business enterprise have an ABN?Note: an Application cannot proceed unless this condition is met.

☐Yes ☐No

Is your Primary Production business registered for GST and registered with the ATO as a primary producer?

☐ Yes ☐No

Is the water infrastructure installed for livestock permanently residing on your property or for permanent horticultural plantings established on your property?

☐ Yes ☐No

For activities that are complete or have commenced you undertook repairs or upgrades to eligible existing water infrastructure for livestock or existing permanent horticultural plantings on or after 1 July 2019

☐ Yes ☐No☐N/a

For activities that are yet to commence we/I confirm that no financial commitment will be made prior to receiving funding approval from the program.

☐ Yes ☐No☐N/a

For activities that are yet to commence we/I confirm all project activities will be completed within 6 months of receiving funding approval,

☐ Yes ☐No☐N/a

You have not received funding from another South Australian / Australian Government program in respect of the same activities (this includes the Primary Producer “Clean Up” Grants)?

☐ Yes ☐No

Funding for the activities applied for in this application are either not covered by, or are in excess of, the amount covered by any insurance claim associated with the 2019/20 Kangaroo Island bushfire?

☐ Yes ☐No

Has this Application been completed and signed by the Applicant(s)? ☐ Yes ☐No

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Attachments Have you attached a copy of your latest council rates notice or other

evidence of land ownership?OR

If the property is leased or share-farmed, have you attached a copy of the current lease or share-farming agreement?

☐ Yes ☐No

For activities complete or commenced: Have you provided copies of tax invoices or receipts evidencing expenditure incurred for eligible activities and photos of completed infrastructure installed?

☐Yes ☐No☐N/a

For activities yet to commenceHave you provided copies of written quotes outlining costs for eligible activities?

☐Yes ☐No☐N/a

Do you have all required approvals to undertake the project? (this includes dam and graded catchment approvals - for further information go to KI Landscape Board)

☐ Yes ☐ No

2. Applicant Details

Trading Name of Primary Production Business

Legal Name of proprietor of Primary Producer (if different from trading name)

ABN of Primary Producer:

Contact person:

Address:

Suburb/Town Postcode:

Phone: Mobile:

Email:

Previous AssistanceHave you previously applied for funding from the On-farm Emergency Water Infrastructure Rebate Scheme?

☐ Yes ☐ No

If yes, please provide your reference number if known

Reference No _ _ _ _ _

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Please briefly describe your Primary Production business, including providing details of your livestock or horticulture enterprise and how the proposed activities will improve resilience and viability in future dry conditions.

3. Owners and ShareholdersPlease provide details of all the owners, partners or shareholders in the primary production business.Name Date of Birth Name Date of Birth

4. Farm / Property locationPlease briefly describe the location where the water infrastructure is required, including Section Number(s), Hundred and/or Certificate of Title or Crown Lease reference(s).

Please list all relevant Certificate of TitlesCertificate of Title/Crown Lease (e.g. CT 1234/567)

Hundred (e.g. Duncan)Local Government Area

Note: if activities are on more than on property, more than one please attach a list

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5. Water InfrastructurePlease check the relevant box below and complete table manually.

□ Application is for water infrastructure activities that are completed.

□ Application is for water infrastructure activities that are yet to start.

Once you have completed the table please transfer Sub Totals to the Total Rebate Assistance Requested table below to work out your Total Rebate Request.

Note if insufficient space please attach list

Livestock Installation of New & Existing Infrastructure 50% – 1 July 2019 – 30 June 2022 use the Scheme Guidelines Section 3 activities a) to r)

Activity

New

In

fras

truc

ture

Existi

ng

Infr

astr

uctu

reCurrent stock type

(cattle, sheep, other)

Current stock

number watered

Additional stock type

(cattle, sheep, other)

Additional stock number

watered

Quantity to be installed

Total Cost (excl GST)

Please √ tick if New or Existing Infrastructure

☐ Pipe √ x(metres)

☐Tanks

(litres)☐Troughs

(number)☐Pumps

(capacity)☐Water devices and technology

(including telemetry)

(number)☐New dam

(capacity)☐Graded Catchment

(capacity☐ De-silting existing dams

Restored capacity (kL)

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Activity

New

In

fras

truc

ture

Existi

ng

Infr

astr

uctu

re

Current stock type (cattle, sheep, other)

Current stock

number watered

Additional stock type

(cattle, sheep, other)

Additional stock number

watered

Quantity to be installed

Total Cost (excl GST)

☐ Bores (new)

(volume / depth)☐ Associated power supply

(generator) (number)

☐ Desalinisation Plant

volume / depth)☐Other (describe)

☐ Freight to install equipment

☐ Professional installation costs

Repairs and Upgrades of Existing Infrastructure Total Cost (excl GST)

☐ Windmills

(number)☐ Dam linings

Restored capacity (kl)☐ De-silting and sludge removal

(tanks and bores)Tanks – litres

Bores (volume / depth)☐ Leak Detection Units

(number)☐ Water devices and technology

(including telemetry)(number)

☐ Plastic sheeting (dams)

Restored capacity (kl)☐ Dam covers

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Activity

New

In

fras

truc

ture

Existi

ng

Infr

astr

uctu

re

Current stock type (cattle, sheep, other)

Current stock

number watered

Additional stock type

(cattle, sheep, other)

Additional stock number

watered

Quantity to be installed

Total Cost (excl GST)

Restored capacity (kl)

Sub Total - Rebate Assistance Requested Table - LIVESTOCK$

Horticulture Installation of New and Existing Infrastructure 50% – 1 July 2019 to 30 June 2022 use the Scheme Guidelines Section 3 activities s) to bb)

Activity New

In

fras

truc

ture

Ex

isting

In

fras

truc

ture Current crop type

Current cropHa

wateredAdditional crop type

Additional cropHa

watered

Quantity to be installed

Total Cost (excl GST)

Please √ tick if New or Existing Infrastructure

☐ Bores (repairs)√ x

(volume /depth)☐ Associated power supply

(generators)(number)

☐New dam

(capacity)☐ De-silting existing dams

Restored capacity (kl)☐Graded Catchment

(capacity☐Desalination Plant

Volume/depth)☐Other

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☐ Freight to install equipment

☐ Professional installation costs

Sub Totals - Rebate Assistance Requested - HORTICULTURE$

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6. Total Rebate Assistance Requested

Rebate Summary

Total Costs New Infrastructure & Existing Infrastructure

(Enter sub-totals from above tables in the cells below)

Rebate 50%

LIVESTOCKSubtotal $

Sub Total x 50%

$

HORTICULTURESubtotal $

Sub Total x 50%

$

Total Rebate $ $

Please note the rebate is calculated on GST exclusive eligible costs incurred.

Please attach all relevant invoices / receipts to support your Application, (see Scheme Guidelines for more information). Make sure you keep a copy of all documents submitted.

7. Payment DetailsSubject to approval and submission of a tax invoice for the amount of the rebate, the rebate payment inclusive of any applicable GST will be credited directly to your bank account via Electronic Funds Transfer (EFT). Please provide your nominated bank account details:Account Name: BSB: Account No:

8. Authorisation, Declaration and Certification1) I/We authorise the Minister for Primary Industries and Regions (Minister), acting

through the Department of Primary Industries and Regions (PIRSA), to obtain and exchange any information regarding my/our affairs from my/our banker, accountant, or other source. If requested, I/We authorise my/our banker, accountant or any other business contacts to supply any required information to PIRSA.

2) I/We declare that I/We own a Primary Production business located in a KI Fire Scar affected area (as per Attachment 1 of the Scheme Guidelines).

3) I/We

a) Declare that I/we contribute more than 50% of our labour and capital to the Primary Production business and derive more than 50% of my/our gross individual income from a Primary Production business.

Or

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b) I/We have commenced our farming operation between 1 July 2015 and 30 June 2021 and 50% of my/our gross income will be derived from the Primary Production business within three years of the date of this Application.

4) I/We declare that the water infrastructure in respect of my/our Application is installed for livestock permanently residing or for permanent horticultural plantings on my/our property.

9. Terms and Conditions1) I/We acknowledge and agree that if I/we receive a rebate pursuant to this Application

that this Application will constitute a legally binding agreement between the Minister and me/us, and I/We accept and undertake to comply with these terms and conditions.

2) I/We acknowledge the rebate is by way of reimbursement for costs outlined in this Application in relation to the purchase and installation of water infrastructure for livestock or horticulture as outlined in the Scheme Guidelines in connection with my/our Primary Production business.

3) I/We agree to provide PIRSA, if necessary, with such information and/or reports as PIRSA may reasonably require to enable PIRSA to monitor my/our performance of my/our obligations under this agreement and ensure that the rebate is used for the reimbursement of costs relating to water infrastructure activities outlined in this Application.

4) I/We agree to a PIRSA representative undertaking an inspection of our property if required to confirm that the water infrastructure activities outlined in this Application have been undertaken.

5) I/We agree that any activity that I/we undertake in connection with my/our use of the rebate complies with the laws from time to time in force in South Australia.

6) I/We agree that if I/we

a) fail to comply with any of these terms and conditions;

b) have, in any dealings with the Minister or with PIRSA or in this Application, provided any false, misleading, incomplete or incorrect information,

I/we will be liable to repay such amount of the rebate as the Minister may demand in writing.

7) I/We enter into the undertaking under clause 6) to repay all, or a portion of, the rebate with the intention of creating a legally binding, valid and enforceable obligation owed by me/us to the Minister.

8) I/We confirm that our primary production business is not insolvent or under external administration or bankruptcy proceedings and that the business owners are not bankrupt or subject to bankruptcy proceedings at the time of making this Application.

9) I/We agree that nothing in this Application nor any payment of the rebate pursuant to this agreement will create a partnership, joint venture or association of any kind between me/us and the Minister or PIRSA, nor will it render the Minister or PIRSA liable for any debt or liability incurred by me/us in connection with this Application or the agreement.

10)I/We agree that neither the Minister nor PIRSA will be liable to reimburse any losses of

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mine/ours that may result from this Application or the payment of the grant pursuant to this Application or the water infrastructure activities outlined in this Application.

11)I/We warrant that the information provided in this Application (including in Section 7 Authorisation, Declaration and Certification) is true and correct in every particular.

12)I/We acknowledge that this Application, including any attachments and supporting documents, once submitted to PIRSA will become subject to the operation of the Freedom of Information Act 1982 (SA), and could, subject to the provisions of that Act, be released pursuant to a request made under that Act.

13)I/We authorise the Minister, acting through PIRSA to disclose any information contained in this Application, and any attachments and supporting documents, to any other agency of the South Australian Government or to any agency of any other State for the purpose of or in connection with the administration of the KI Bushfire On-farm Emergency Water Infrastructure Scheme or any other similar program or scheme.

14)I/We agree to participate in any monitoring and evaluation activities.

EXECUTED as a DEED by the Applicant named below:Name of Signatory Signatory Position

(e.g.Director/Secretary)

Signature Date

Note: Each person who is an owner of the Applicant’s Primary Production business must sign above. If the legal owner of the Primary Production business is a company then:

(a) the company must be named as the legal owner of the Applicant on page 2 of this Application; and

(b) the Application must be signed by either two directors of the company or a director and the company secretary (unless the company has a sole director and company secretary in which case that sole director and company secretary must sign this Application).

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10. Further Information

More Information

For more information & to discuss your Application contact:

Department of Primary Industries and RegionsEmail: pirsa.recovery@sa.gov.au

Alternately, please call 1800 931 314

Lodging Applications

Completed Applications (with all supporting documentation) should be forwarded to:

By Mail

2019/20 KI Bushfire On-Farm Emergency Water Infrastructure Rebate Scheme PIRSA – Rural Solutions SAGPO Box 1671ADELAIDE SA 5001

In Personcompleted Applications can be submitted to PIRSA Business Support staff at the following locations:

Kingscote – 56 Dauncey Street, Kingscote

If submitted at a PIRSA office, staff will undertake a preliminary check to confirm that the Application is completed and that you have provided all relevant supporting documentation.

By Email: Completed Applications can be emailed to: PIRSA.GrantsEnquiries@sa.gov.au

Applications submitted by email should be submitted with a title of “On-Farm Emergency Water Rebate Scheme”.