Safety Equipment Reimbursement Application

Safety Equipment Reimbursement Grant Application

APPLICANT INFORMATION

* Indicates required field

Name of Vessel Owner/Grant Recipient *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Vessel Name *

Vessel Home Port *

Email *

Vessel Length *

APPROVED REIMBURSABLE SAFETY EQUIPMENT PURCHASES
For each approved item listed below that you purchase, enter the receipt ($) amount in the item form field.

1. The following purchased item is approved for reimbursement up to an annual limit of two thousand dollars ($2,000):

One New Life Raft *

2. The following purchased item is approved for reimbursement up to an annual limit of one thousand five hundred dollars ($1,500):

One Annual Life Raft Re-pack/Hydrostatic Release *

3. The following purchased items in aggregate are approved for reimbursement up to an annual limit of two thousand hundred dollars ($2,000):

One New EPIRB *

One EPIRB Battery Replacement/Maintenance *

One EPIRB Hydrostatic Release *

One VHF Marine Radio *

One VHF Marine Radio Antennae *

One Satellite Communication Phone *

One FCC Vessel Radio License *

One Bilge Pump *

One Bilge Alarm *

One Watch Alarm *

One Smoke Alarm *

One Carbon Monoxide Alarm *

One Man Overboard Alarm *

One New RADAR/Multifunction Display *

One RADAR Repair *

One Automatic Identification System (AIS) *

One Onboard Drill Conductor Training Coarse *

One GPS/Multifunction Display *

Fire Suppression Equipment *

Flares & Smoke & Signal Devises *

Survival Suits & Associated Appurtenances *

Life Rings & Associated Appurtenances *

Navigation Lights *

Personal Flotation Devises & Associated Appurtenances *

Upload Commercial Fishing License *

Max file size: 20MB

Upload Commercial Boat Registration *

Max file size: 20MB

Upload Landing Receipts *

Max file size: 20MB

Upload Receipts for Approved Purchases *

Max file size: 20MB

Submit Application