BP Claims Process Summary

The two fastest ways to submit a claim are by phone and online. BP uses a simple claim form, with specific forms for commercial fishermen, commercial crab fishermen, commercial oyster fishermen, and commercial shrimp fishermen. These forms detail what documentation is needed and are attached to this memo. Claimants should generally file only one claim; if the nature or size of the claim changes in the future, a new claim is not needed. The original claim should just be updated. If you visit a claim center without first obtaining a claim number your claim will be delayed. You will probably be asked to come back to the claims office a few days later after you have obtained a claim number online or via telephone. These are the general categories of claims that can be filed with BP:

Removal and cleanup costs, including assessment, mitigation, and cleanup of spilled oil; Damage to personal and business real estate and other property caused by the oil; Commercial losses, including lost income, profits, and earning capacity, loss of rental

income/cancellations, lost wages, and subsistence income loss; Damage to natural resources; Personal injury caused by the oil spill (the OPA does not require BP to pay bodily injury

claims, but BP says it will evaluate each personal injury claim on a case-by case basis). Under the OPA, the following general principles guide the claims process:

The oil spill must be the legal cause of the claimed loss; The claimed loss cannot be remote or speculative; You must show proof/documentation of the claim; You must take reasonable efforts to minimize the damage suffered; When BP pays a claim, they will only pay for your net loss; You will only be paid once for any given loss – there is no double recovery.

Telephone & Online Filing Step 1: To file a claim via telephone, call BP at 1-800-440-0858. Once you call in, you will be prompted to press “1” to report a new claim. If you do not press “1,” you will be given another number to call for questions about existing claims. Once you press “1,” you will be connected to a BP representative. Interpreters are available. BP will ask you for the following information when you call:

Your Name & Address Primary phone number to contact you Location of your loss – if known Your Social Security number Your Date of Birth Your occupation

After you provide the above information, BP will then ask you what type of damage you are reporting. All damages that you report are recorded as factors of your loss. For example, damage to your boat is one factor; the resulting loss of income is another. You may have one claim with multiple factors. The following types of information will be sought about the nature of each kind of damage that you report:

For property damage, information will be sought about the type of property and how it was damaged, and the extent of that damage. As mentioned above, all damages are listed as factors. Thus, you may have one property damage claim, but multiple factors within that claim.

For loss of income, information is sought about the nature of the income stream, proof that your loss was linked to the oil spill, and proof of historical income.

For personal injury claims, BP will gather information about the nature of your injury or illness, as well as the name and address of any doctor or treatment facility that may have treated your injuries. Again, factors are used, and all symptoms are considered factors. So under your one injury claim, a broken leg would be one factor, and a broken wrist another; they would not be two separate claims.

A claims form can also be completed online through the BP Website, www.bp.com/claim. Specific forms are available for commercial fishermen, crab fishermen, oyster fishermen, and shrimp fishermen You provide the same information via the online form as you would over the phone. Once complete, you submit the form and a confirmation screen appears. Claims submitted online are checked against BP’s claims database to make sure there is no duplication.

After your initial phone call or online submission all of the information you provide is entered into BP’s claim system. A First Notice of Loss is created, reviewed by a claims manager and assigned to the appropriate claim center. Step 2: Within a few days, you will receive a follow-up phone call (or email if you filed your claim online). At that time, a claim number will be assigned to you. It is critical that you keep this

number and use it for all your future correspondence with BP.

Step 3: Three to four days after you receive this call, you will get a second phone call, this time from a claim adjuster assigned to your case. The adjuster will work with you on your claim. During the initial phone call, the adjuster will discuss your claim and answer your questions, and inform you of the documentation that he or she needs to properly process and evaluate your claim. You will be able to fax the documentation to 1-888-873-6217, or bring it with you to meet an adjuster at your local claim center. Step 4: Once the documentation is received, the adjuster will review it and evaluate your claim. If the documentation supports your claim, you will be contacted and advised that your claim has been approved. Or, if the adjuster feels like more evaluation is needed, he or she will refer your claim to the BP Claims Authorization team, who will review or deny accordingly. Step 5: If your claim is approved, and you demonstrate financial hardship, an advance payment will be issued to you. BP will evaluate each claim on a case-by-case basis to determine whether advance payments are needed. These payments may continue as long as the hardship continues, but may also be stopped at any time. Arrangements are then made to deliver payment to you. ***Throughout this process, if you have any questions or concerns about your claim, you can call 1-800-573-8249, which is a help number established specifically to answer questions about your claim. Additionally, at some point in the process, you will be required to present photo identification before you receive any payment on your claim.***

Large and Complex Claims The size and complexity of a claim determine where it will be processed and how long it will take. Claims over $5,000, those based on complex accounting principles, and claims that are indirect or speculative in nature are handled by a special office in Delaware, and will take longer to resolve than simple claims that are handled locally.

Documentation is essential. The bigger and more complicated the claim, the more documentation is required. Documentation will consist of things like receipts, appraisals, estimates, income tax returns, wage statements, profit & loss statements, tax receipts, and other economic records that are typical to a claimant’s industry.

Denied Claims If your claim is denied you may be able to receive funds from the National Pollution Funds Center, http://www.uscg.mil/npfc/Claims. To be eligible for National Pollution Funds you must first have filed a claim with BP and that claim must either have been denied OR not settled within 90 days. You will still have to submit documentation to prove your claim. Claimants that are not satisfied with their resolution are urged to call the National Pollution Funds Center (NPFC) at 1-800-280-7118.

Additional Resources

The two sites below are listed on the ASBDC Oil Spill Recovery website, http://www.asbdc.org/oil_spill_disaster_assistance.html.

Deep Water Horizon Response www.deepwaterhorizonresponse.com The Official Site of the Deepwater Horizon Unified Command, it contains contact information for wildlife, oil on land/boom issues, health concerns, damage claims, volunteering, and submitting suggestions for stopping the leak. Alabama Gulf Response www.alabamagulfresponse.com This site was created by BP to serve as a community resource and meeting space for the residents of Alabama with resources specific to the state.

The sites below are not listed on the ASBDC Oil Spill Recovery website, but may be helpful.

Deepwater Disaster Assistance www.disasterassistance.gov/disasterinformation/deepwater.html#resources This site contains information on filing a claim with BP, as well as additional disaster resources on employment, unemployment insurance, food, housing, living assistance, and business loans. USDA Deepwater Disaster Response www.fns.usda.gov/disasters/response/deepwater.htm USDA nutrition assistance programs can help to mitigate the food insecurity likely to be faced by families affected by the Gulf oil spillage. Each of these programs offers particular sources of food assistance to children and their families experiencing adverse economic conditions.

Supplemental Nutrition Assistance Program (SNAP) helps low-income people and families buy the food they need for good health. Benefits are authorized by a State or

local agency and provided on an electronic benefits transfer card that can be used at most grocery stores. Designed to respond to economic conditions, the program has proven over the years to respond quickly to deteriorations in individual and regional circumstances. In general, benefits are available to citizens and immigrants legally admitted for permanent residence. While persons who hold temporary work visa are not eligible, family members may be eligible. For example, an ineligible parent may apply on behalf of their citizen children.

Child Nutrition Programs allow low-income children to receive free meals through schools, child care centers, family day care homes, after school programs and summer programs that participate in the FNS Child Nutrition Programs. Also low-income infants, children up to the age of five and pregnant, breastfeeding and postpartum women can participate in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) and receive a supplemental food package to help meet their nutritional needs. Eligibility extends to immigrants and temporary workers as well as citizens.

The Emergency Food Assistance Program (TEFAP) provides USDA foods through food banks and food pantries for families that need assistance. Eligibility extends to immigrants and temporary workers as well as citizens.

Goeplatform.gov/gulfresponse www.geoplatform.gov/gulfresponse This site integrates the latest data the federal responders have about the oil spill’s trajectory with fishery area closures, wildlife data, and place-based Gulf Coast resources (such as pinpointed locations of oiled shoreline and current positions of deployed research ships) into a customizable interactive map. Contracting Opportunities www.alabamagulfresponse.com/go/doc/3051/549099 Provides information on contracting with BP to provide products and services, as well as an online submission form.

      

NAME OF CLAIMANT

ADDRESS

TELEPHONE NUMBER

SOCIAL SECURITY NUMBER

STATE COMMERCIAL FISHERMAN LICENSE NUMBER(S): TX, LA, MS, AL, FL

IS THIS CLAIM FOR LOSS OF INCOME? □ YES □ NO IS THIS CLAIM FOR DAMAGE TO A VESSEL(S) OR EQUIPMENT? □ YES □ NO IF YES, WHAT IS THE NAME OF THE VESSEL(S)? _____________________________________________________________________________________ WHAT IS THE STATE VESSEL LICENSE NUMBER(S)? _____________________________________________________________________________________ DESCRIBE IN DETAIL THE NATURE OF DAMAGES CLAIMED. DESCRIBE THE DAMAGE TO THE VESSEL(S) OR EQUIPMENT. AND/OR DESCRIBE HOW YOUR INCOME HAS BEEN AFFECTED: _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ DEFINE THE AREA WITHIN WHICH YOU FISH THAT HAS BEEN AFFECTED BY THE OIL SPILL. _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

1

Commercial Fisherman Claims Form

      STATE THE AMOUNT OF CATCH AND/OR SALES OF FISH COLLECTED FROM THIS FOR THE PRIOR THREE YEARS. ALSO, PROVIDE THE DATE(S) OF CATCH SALE. _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ DO YOU HAVE RECORDS AND OR SALES RECEIPTS OF THE CATCH(ES)? □ YES □ NO IF YES, ARE THESE RECORDS/RECEIPTS AVAILABLE FOR OUR INSPECTION? □ YES □ NO WHAT WAS THE AMOUNT OF INCOME YOU DECLARED ON YOUR TAX RETURNS FROM THE SALES OF FISH FOR THE PAST THREE YEARS? 2007 ________________________2008 _______________________2009 ________________________ ARE THESE TAX RECORDS AVAILABLE FOR OUR INSPECTION? □ YES □ NO ARE YOU CURRENTLY EMPLOYED AS A FULL-TIME COMMERCIAL FISHERMAN? □ YES □ NO IF NO: WHAT IS YOUR OTHER EMPLOYMENT AND/OR OCCUPATION? _________________________________ WHAT PERCENTAGE OF YOUR INCOME IS DERIVED FROM THIS OTHER EMPLOYMENT? ______________ SINCE APRIL 21, 2010, HAVE YOU ATTEMPTED TO FISH OUTSIDE OF THE AREA IDENTIFIED IN THIS CLAIM? □ YES □ NO IF YES: PROVIDE LOCATIONS, AMOUNT OF FISH COLLECTED AND/OR SOLD FROM EACH LOCATION, AND INCOME DERIVED FROM THOSE SALES. _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ WHAT IS THE FULL AMOUNT YOU ARE REQUESTING FOR THIS CLAIM? ____________________________

2

      

3

HOW DID YOU ARRIVE AT THIS FIGURE? __________________________________________________________________________________________________________________________________________________________________________ IS THIS CLAIM FOR ECONOMIC DAMAGES ONLY OR ALSO FOR PHYSICAL DAMAGES TO YOUR VESSEL(S)? □ YES □ NO HAVE YOU ALREADY SUBMITTED THIS CLAIM TO ANOTHER INSURANCE COMPANY OR GOVERNMENT AGENCY? □ YES □ NO __________________________________________________________________________________________________________________________________________________________________________ IF YES, PROVIDE THE NAME AND ADDRESS OF THE COMPANY OR AGENCY: __________________________________________________________________________________________________________________________________________________________________________ DO YOU PLAN TO SUBMIT THIS CLAIM TO ANOTHER INSURANCE COMPANY OR GOVERNMENT AGENCY? □ YES □ NO IF YES, PROVIDE THE NAME AND ADDRESS OF COMPANY OR AGENCY: __________________________________________________________________________________________________________________________________________________________________________ ARE YOU REPRESENTED BY AN ATTORNEY? □ YES □ NO IF YES, PROVIDE NAME AND ADDRESS OF YOUR ATTORNEY: __________________________________________________________________________________________________________________________________________________________________________

 

FISHERIES LOSS

COMMERCIAL FISHERMAN File Checklist for Documentation

A. DAILY SALES JOURNALS ____DAILY SALES JOURNALS JANUARY 1, 2010-APRIL 21, 2010 ____DAILY SALES JOURNALS JANUARY 2009-DECEMBER 2009 ____DAILY SALES JOURNAL JANUARY 2008–DECEMBER 2008 B. SALES RECEIPTS ____VENDOR SALES RECEIPTS-JANUARY 2010–MARCH 2010 ____VENDOR SALES RECEIPTS-JANUARY 2009-DECEMBER 2009 ____VENDOR SALES RECEIPTS-JANUARY 2008–DECEMBER 2008 C. INCOME TAX STATEMENTS ____ 2010 FEDERAL INCOME TAX RETURN (profit/loss business) ____ 2009 FEDERAL INCOME TAX RETURN (profit/loss business) D. LICENSE NUMBER(S) _____COPY OF COMMERCIAL FISHERMAN’S LICENSE LICENSE #_________________ _____COPY OF COMMERCIAL GEAR LICENSE LICENSE #_________________

_____COPY OF COMMERCIAL VESSEL LICENSE LICENSE #_________________ ABOVE DOCUMENTATION IS A MINIMUM REQUIREMENT. IN SOME CASES, ADDITIONAL DOCUMENTATION MAY BE REQUIRED. IF YOU ARE UNABLE TO PRODUCE REQUIRED DOCUMENTATION, A WRITTEN EXPLANATION IS REQUIRED.

4

 

NAME OF CLAIMANT

ADDRESS

TELEPHONE NUMBER

SOCIAL SECURITY NUMBER

STATE COMMERCIAL CRABBER LICENSE NUMBER: TX, LA, MS, AL, FL

STATE VESSEL LICENSE NUMBER: TX, LA, MS, AL, FL

STATE COMMERCIAL GEAR LICENSE NUMBER: TX, LA, MS, AL, FL

IS THIS CLAIM RELATED TO DAMAGE TO PROPERTY? □ YES □ NO IF YES, PLEASE COMPLETE PART A. IS THIS CLAIM RELATED TO DAMAGE TO EQUIPMENT? □ YES □ NO IF YES, PLEASE COMPLETE PART A. IS THIS CLAIM FOR LOSS OF PROFITS AND/OR EARNINGS? □ YES □ NO IF YES, PLEASE COMPLETE PART B. PART A: DESCRIBE IN DETAIL THE DAMAGES TO PROPERTY OR EQUIPMENT: _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ HAVE REPAIRS BEEN MADE? □ YES □ NO

2

Crabber Claims Form

 

PART B: DESCRIBE IN DETAIL THE LOSS OF PROFITS AND/OR EARNINGS: _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ DESCRIBE THE NUMBER AND TYPES OF TRAPS YOU USE TO HARVEST CRABS: _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ IDENTIFY AS CLOSELY AS POSSIBLE WHERE YOUR CRAB TRAPS WERE PLACED (OR ATTACH A MAP): _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ HOW MANY CRAB TRAPS ARE INCLUDED IN THIS CLAIM? -______________________________________ HOW MANY CRAB TRAPS HAVE NOT BEEN RECOVERED? _______________________________________ DID YOU SEE OIL IN THE WATER IN THE AREA OF YOUR CRAB TRAPS? □ YES □ NO IF YES, ON WHAT DATE(S)? ______________________________________________________________ DID ANYONE ELSE SEE OIL IN THE WATER ON THESE DATE(S)? □ YES □ NO IF YES, PROVIDE NAMES, ADDRESSES, AND TELEPHONE NUMBERS OF THOSE WHO SAW OIL IN THE WATER ON THESE DATES: _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ WHAT WAS THE AMOUNT OF HARVEST AND/OR SALES OF CRABS HARVESTED FROM THE AREA IDENTIFIED IN THIS CLAIM FOR THREE YEARS PRIOR TO THIS DATE?

3

 

AMOUNT(s) _____________________________DATE(s) _______________________________________ DO YOU HAVE RECORDS OR RECEIPTS? □ YES □ NO IF YES, PLEASE ATTACH. WHAT WAS THE AMOUNT OF INCOME YOU DECLARED ON YOUR TAX RETURNS FROM THE SALES OF CRABS FOR THE PAST THREE YEARS? 2007 ________________________2008 _______________________2009 ________________________ DO YOU HAVE RECORDS THAT SHOW YOUR EXPENSES RELATED TO YOUR CRABBING OPERATIONS? □ YES □ NO HAVE YOU EVER RECEIVED ANY TYPE OF DAMAGES SETTLEMENT OR OTHER PAYMENT REGARDING THE CRAB FISHERIES NAMED IN THIS CLAIM? □ YES □ NO IF YES: WHAT WAS THE AMOUNT OF THE SETTLEMENT OR OTHER PAYMENT? __________________________ WHO PAID THE SETTLEMENT OR OTHER PAYMENT? _________________________________________ ARE YOU CURRENTLY EMPLOYED AS A FULL-TIME COMMERCIAL CRABBER? □ YES □ NO IF NO: WHAT IS YOUR OTHER EMPLOYMENT AND/OR OCCUPATION? _________________________________ WHAT PERCENTAGE OF YOUR INCOME IS DERIVED FROM THIS OTHER EMPLOYMENT? ______________ SINCE APRIL 21, 2010, HAVE YOU ATTEMPTED TO CRAB OUTSIDE OF THE AREA IDENTIFIED IN THIS CLAIM? □ YES □ NO IF YES: PROVIDE LOCATIONS, NUMBER OF CRAB TRAPS USED AT EACH LOCATION, AMOUNT OF CRABS HARVESTED AND/OR SOLD FROM EACH LOCATION, AND INCOME DERIVED FROM THOSE SALES. _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

4

 

5

__________________________________________________________________________________________________________________________________________________________________________ WHAT IS THE FULL AMOUNT YOU ARE REQUESTING FOR THIS CLAIM? ____________________________ HOW DID YOU ARRIVE AT THIS FIGURE? __________________________________________________________________________________________________________________________________________________________________________ HAVE YOU ALREADY SUBMITTED THIS CLAIM TO ANOTHER INSURANCE COMPANY OR GOVERNMENT AGENCY? □ YES □ NO __________________________________________________________________________________________________________________________________________________________________________ IF YES, PROVIDE THE NAME AND ADDRESS OF THE COMPANY OR AGENCY: __________________________________________________________________________________________________________________________________________________________________________ DO YOU PLAN TO SUBMIT THIS CLAIM TO ANOTHER INSURANCE COMPANY OR GOVERNMENT AGENCY? □ YES □ NO IF YES, PROVIDE THE NAME AND ADDRESS OF COMPANY OR AGENCY: __________________________________________________________________________________________________________________________________________________________________________ ARE YOU REPRESENTED BY AN ATTORNEY? □ YES □ NO IF YES, PROVIDE NAME AND ADDRESS OF YOUR ATTORNEY: __________________________________________________________________________________________________________________________________________________________________________

 

FISHERIES LOSS

COMMERCIAL CRAB FISHERMAN File Checklist for Documentation

A. DAILY SALES JOURNALS ____DAILY SALES JOURNALS JANUARY 1, 2010-APRIL 21, 2010 ____DAILY SALES JOURNALS JANUARY 2009-DECEMBER 2009 ____DAILY SALES JOURNAL JANUARY 2008–DECEMBER 2008 B. SALES RECEIPTS ____VENDOR SALES RECEIPTS-JANUARY 2010–MARCH 2010 ____VENDOR SALES RECEIPTS-JANUARY 2009-DECEMBER 2009 ____VENDOR SALES RECEIPTS-JANUARY 2008–DECEMBER 2008 C. INCOME TAX STATEMENTS ____ 2010 FEDERAL INCOME TAX RETURN (profit/loss business) ____ 2009 FEDERAL INCOME TAX RETURN (profit/loss business) D. LICENSE NUMBER(S) _____COPY OF COMMERCIAL FISHERMAN’S LICENSE LICENSE #_________________ _____COPY OF COMMERCIAL GEAR LICENSE LICENSE #_________________

_____COPY OF COMMERCIAL VESSEL LICENSE LICENSE #_________________ _____COPY OF COMMERCIAL TRAP LICENSE FOR 2010 LICENSE #_________________

ABOVE DOCUMENTATION IS A MINIMUM REQUIREMENT. IN SOME CASES, ADDITIONAL DOCUMENTATION MAY BE REQUIRED. IF YOU ARE UNABLE TO PRODUCE REQUIRED DOCUMENTATION, A WRITTEN EXPLANATION IS REQUIRED.

6

 

NAME OF CLAIMANT

ADDRESS

TELEPHONE NUMBER

SOCIAL SECURITY NUMBER

OYSTER LEASE NUMBER(S): TX, LA, MS, AL, FL

PARISH/COUNTY OF RECORDATION AND DATE OF RECORDATION OF OYSTER LEASE(S): TX, LA, MS, AL, FL

HOW LONG HAVE YOU HELD THIS/THESE OYSTER LEASE(S)? ____________________________________ DESCRIBE IN DETAIL THE NATURE OF DAMAGES CLAIMED: _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ DID YOU SEE OIL IN THE WATER WITHIN THE BOUNDARIES OF YOUR OYSTER LEASE(S)? □ YES □ NO IF YES, FOR EACH LEASE PROVIDE THE FOLLOWING: LEASE NUMBER, DATE(S) YOU SAW OIL IN THE WATER: __________________________________________________________________________________________________________________________________________________________________________

29

Oyster Lease Owner Claims Form

 

DID ANYONE ELSE SEE OIL IN THE WATER ON THESE DATE(S)? □ YES □ NO IF YES, PROVIDE NAMES, ADDRESSES, AND TELEPHONE NUMBERS OF THOSE WHO SAW OIL IN THE WATER ON THESE DATES: _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ LIST EACH LEASE AND THE CROP/OYSTER POPULATION OF MARKET-SIZED OYSTERS FOR EACH PRIOR TO APRIL 21, 2010: _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ HAVE YOU EVER HAD AN ASSESSMENT OF YOUR STANDING CROP/OYSTER POPULATION OF YOUR LEASE(S)? □ YES □ NO IF YES, PROVIDE THE NAME OF THE PERSON(S) PERFORMING THE ASSESSMENT(S) AND THE DATE(S) OF THE ASSESSMENT(S). ATTACH COPIES. _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ HAVE YOU HAD AN ASSESSMENT OF YOUR OYSTER LEASE(S) SINCE APRIL 21, 2010. □ YES □ NO IF YES, PROVIDE THE NAME OF THE PERSON(S) PERFORMING THE ASSESSMENT(S) AND THE DATE(S) OF THE ASSESSMENT(S). ATTACH COPIES. _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ DO YOU HAVE RECORDS AND OR SALES RECEIPTS OF THE HARVEST(S) FROM YOUR OYSTER LEASE(S)? □ YES □ NO IF YES, ARE THESE RECORDS/RECEIPTS AVAILABLE FOR OUR INSPECTION? □ YES □ NO

30

 

WHAT WAS THE AMOUNT OF INCOME YOU DECLARED ON YOUR TAX RETURNS FROM THE SALES OF OYSTERS FOR THE PAST THREE YEARS? 2007 ________________________2008 _______________________2009 ________________________ ARE THESE TAX RECORDS AVAILABLE FOR OUR INSPECTION? □ YES □ NO IDENTIFY ALL BUYERS OF OYSTERS FOR THE OYSTER LEASE(S) NAMED IN THIS CLAIM: _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ TO YOUR KNOWLEDGE, HAS A CLAIM EVER BEEN MADE PRIOR TO APRIL 21, 2010 FOR DAMAGES TO OR OYSTER MORTALITY REGARDING THE OYSTER LEASE(S) NAMED IN THIS CLAIM? □ YES □ NO IF YES: WHAT WAS THE NATURE OF EACH CLAIM FOR EACH OYSTER LEASE? INCLUDE TYPE OF DAMAGE, DATE THE CLAIM WAS FILED, NAME(S) OF PERSON(S) FILING THE CLAIM(S), AND PARTY AGAINST WHOM THE CLAIM(S) WERE FILED: _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ HAVE YOU EVER RECEIVED ANY TYPE OF DAMAGE STATEMENT, RIGHT-OF-WAY SETTLEMENT, OR OTHER PAYMENT FOR ANY OYSTER LEASE(S) THAT IS/ARE PART OF THIS CLAIM? □ YES □ NO IF YES, PROVIDE THE LEASE NUMBER(S), DATE OF THE SETTLEMENT, AMOUNT OF THE SETTLEMENT, AND FROM WHOM THE SETTLEMENT AND/OR PAYMENTS WERE RECEIVED: _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ WHAT IS THE FULL AMOUNT YOU ARE REQUESTING FOR THIS CLAIM? ____________________________

31

 

32

HOW DID YOU ARRIVE AT THIS FIGURE? __________________________________________________________________________________________________________________________________________________________________________ HAVE YOU ALREADY SUBMITTED THIS CLAIM TO ANOTHER INSURANCE COMPANY OR GOVERNMENT AGENCY? □ YES □ NO __________________________________________________________________________________________________________________________________________________________________________ IF YES, PROVIDE THE NAME AND ADDRESS OF THE COMPANY OR AGENCY: __________________________________________________________________________________________________________________________________________________________________________ DO YOU PLAN TO SUBMIT THIS CLAIM TO ANOTHER INSURANCE COMPANY OR GOVERNMENT AGENCY? □ YES □ NO IF YES, PROVIDE THE NAME AND ADDRESS OF COMPANY OR AGENCY: __________________________________________________________________________________________________________________________________________________________________________ ARE YOU REPRESENTED BY AN ATTORNEY? □ YES □ NO IF YES, PROVIDE NAME AND ADDRESS OF YOUR ATTORNEY: __________________________________________________________________________________________________________________________________________________________________________

 

FISHERIES LOSS

COMMERCIAL OYSTER FISHERMAN File Checklist for Documentation

A. DAILY SALES JOURNALS ____DAILY SALES JOURNALS JANUARY 1, 2010-APRIL 21, 2010 ____DAILY SALES JOURNALS JANUARY 2009-DECEMBER 2009 ____DAILY SALES JOURNAL JANUARY 2008–DECEMBER 2008 B. SALES RECEIPTS ____VENDOR SALES RECEIPTS-JANUARY 2010–MARCH 2010 ____VENDOR SALES RECEIPTS-JANUARY 2009-DECEMBER 2009 ____VENDOR SALES RECEIPTS-JANUARY 2008–DECEMBER 2008 C. INCOME TAX STATEMENTS ____ 2010 FEDERAL INCOME TAX RETURN (profit/loss business) ____ 2009 FEDERAL INCOME TAX RETURN (profit/loss business) D. LICENSE NUMBER(S) _____COPY OF COMMERCIAL FISHERMAN’S LICENSE LICENSE #_________________ _____COPY OF COMMERCIAL GEAR LICENSE LICENSE #_________________

_____COPY OF COMMERCIAL VESSEL LICENSE LICENSE #_________________ ABOVE DOCUMENTATION IS A MINIMUM REQUIREMENT. IN SOME CASES, ADDITIONAL DOCUMENTATION MAY BE REQUIRED. IF YOU ARE UNABLE TO PRODUCE REQUIRED DOCUMENTATION, A WRITTEN EXPLANATION IS REQUIRED.

33

 

NAME OF CLAIMANT

ADDRESS

TELEPHONE NUMBER

SOCIAL SECURITY NUMBER

STATE COMMERCIAL SHRIMPER LICENSE NUMBER(S): TX, LA, MS, AL, FL

IS THIS CLAIM FOR LOSS OF INCOME? □ YES □ NO IS THIS CLAIM FOR DAMAGE TO A VESSEL(S) OR EQUIPMENT? □ YES □ NO IF YES, WHAT IS THE NAME OF THE VESSEL(S)? _____________________________________________________________________________________ WHAT IS THE STATE VESSEL LICENSE NUMBER(S)? _____________________________________________________________________________________ DESCRIBE IN DETAIL THE NATURE OF DAMAGES CLAIMED. DESCRIBE THE DAMAGE TO THE VESSEL(S) OR EQUIPMENT. AND/OR DESCRIBE HOW YOUR INCOME HAS BEEN AFFECTED: _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ DEFINE THE AREA WITHIN WHICH YOU COLLECT SHRIMP THAT HAS BEEN AFFECTED BY THE OIL SPILL. OR, DEFINE THE LOCATION OF YOUR STATIONARY NETS. _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

1

Commercial Shrimper Claims Form

 

STATE THE AMOUNT OF CATCH AND/OR SALES OF SHRIMP COLLECTED FROM THIS FOR THE PRIOR THREE YEARS. ALSO, PROVIDE THE DATE(S) OF CATCH SALE. _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ DO YOU HAVE RECORDS AND OR SALES RECEIPTS OF THE CATCH(ES)? □ YES □ NO IF YES, ARE THESE RECORDS/RECEIPTS AVAILABLE FOR OUR INSPECTION? □ YES □ NO WHAT WAS THE AMOUNT OF INCOME YOU DECLARED ON YOUR TAX RETURNS FROM THE SALES OF SHRIMP FOR THE PAST THREE YEARS? 2007 ________________________2008 _______________________2009 ________________________ ARE THESE TAX RECORDS AVAILABLE FOR OUR INSPECTION? □ YES □ NO ARE YOU CURRENTLY EMPLOYED AS A FULL-TIME COMMERCIAL SHRIMPER? □ YES □ NO IF NO: WHAT IS YOUR OTHER EMPLOYMENT AND/OR OCCUPATION? _________________________________ WHAT PERCENTAGE OF YOUR INCOME IS DERIVED FROM THIS OTHER EMPLOYMENT? ______________ SINCE APRIL 21, 2010, HAVE YOU ATTEMPTED TO COLLECT SHRIMP OUTSIDE OF THE AREA IDENTIFIED IN THIS CLAIM? □ YES □ NO IF YES: PROVIDE LOCATIONS, AMOUNT OF SHRIMP COLLECTED AND/OR SOLD FROM EACH LOCATION, AND INCOME DERIVED FROM THOSE SALES. _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ WHAT IS THE FULL AMOUNT YOU ARE REQUESTING FOR THIS CLAIM? ____________________________

2

 

3

HOW DID YOU ARRIVE AT THIS FIGURE? __________________________________________________________________________________________________________________________________________________________________________ HAVE YOU ALREADY SUBMITTED THIS CLAIM TO ANOTHER INSURANCE COMPANY OR GOVERNMENT AGENCY? □ YES □ NO __________________________________________________________________________________________________________________________________________________________________________ IF YES, PROVIDE THE NAME AND ADDRESS OF THE COMPANY OR AGENCY: __________________________________________________________________________________________________________________________________________________________________________ DO YOU PLAN TO SUBMIT THIS CLAIM TO ANOTHER INSURANCE COMPANY OR GOVERNMENT AGENCY? □ YES □ NO IF YES, PROVIDE THE NAME AND ADDRESS OF COMPANY OR AGENCY: __________________________________________________________________________________________________________________________________________________________________________ ARE YOU REPRESENTED BY AN ATTORNEY? □ YES □ NO IF YES, PROVIDE NAME AND ADDRESS OF YOUR ATTORNEY: __________________________________________________________________________________________________________________________________________________________________________

FISHERIES LOSS

COMMERCIAL SHRIMP FISHERMAN File Checklist for Documentation

A. DAILY SALES JOURNALS ____DAILY SALES JOURNALS JANUARY 1, 2010-APRIL 21, 2010 ____DAILY SALES JOURNALS JANUARY 2009-DECEMBER 2009 ____DAILY SALES JOURNAL JANUARY 2008–DECEMBER 2008 B. SALES RECEIPTS ____VENDOR SALES RECEIPTS-JANUARY 2010–MARCH 2010 ____VENDOR SALES RECEIPTS-JANUARY 2009-DECEMBER 2009 ____VENDOR SALES RECEIPTS-JANUARY 2008–DECEMBER 2008 C. INCOME TAX STATEMENTS ____ 2010 FEDERAL INCOME TAX RETURN (profit/loss business) ____ 2009 FEDERAL INCOME TAX RETURN (profit/loss business) D. LICENSE NUMBER(S) _____COPY OF COMMERCIAL FISHERMAN’S LICENSE LICENSE #_________________ _____COPY OF COMMERCIAL GEAR LICENSE LICENSE #_________________

_____COPY OF COMMERCIAL VESSEL LICENSE LICENSE #_________________ ABOVE DOCUMENTATION IS A MINIMUM REQUIREMENT. IN SOME CASES, ADDITIONAL DOCUMENTATION MAY BE REQUIRED. IF YOU ARE UNABLE TO PRODUCE REQUIRED DOCUMENTATION, A WRITTEN EXPLANATION IS REQUIRED.

-4