2. DRAINAGE ASSISTANCE PROGRAM

   Please submit one form per project.

4. What type of project is this?*

   1. Neighborhood Project
   2. Individual Project
6. Project Address*
8. Description of Proposed Improvements*
10. Property Owner's Name*
12. Property Owner's Phone Number*
13. Property Owner's Email*
15. Property Owner's Address of Reimbursement*
17. Project Contact Name*
18. Project Contact Phone Number*

20. Submit copies of all bids along with designs for the proposed improvements with the application.  If you are doing the work yourself, submit a written estimate of the materials and costs.  Bids are required if a contractor will perform the work.  Once the application is approved you will receive a copy of the approval through email or hand delivery.

22. File Upload Bids and/or Estimate*
23. File Upload Plans or Sketches *
25. I agree to allow employees of the City of Rock Island to observe this improvement during construction and to allow employees to enter my property to do so. I understand that the City's participation will be forthcoming only after the City determines the completed work to be acceptable.*

    1. Yes
    2. No
27. I further agree that the City of Rock Island, its officers, and employees are not and will not be responsible or liable for damage, failure of the improvements or consequential damage resulting from this activity.*

    1. Yes
    2. No
29. I also accept all maintenance and upkeep of the design for a minimum of five (5) years and understand that all refurbishing of the improvements will be the responsibility of me, as the property owner, and not that of the City of Rock Island.*

    1. Yes
    2. No
31. I hereby request participation in the Rock Island Drainage Assistance Program. I understand that if this project is accepted into the program, I am responsible to pay at least 25% of the project cost and the City of Rock Island will reimburse me up to 75% of my project cost (up to $3,000 maximum), after all the construction has been completed and accepted by the City. I have enclosed copies of the bids and sketches for the proposed work.*

    1. Yes
    2. No
33. This application must be approved and signed by an authorized representative of the City of Rock Island prior to any work being done or the project will not be eligible for the Rock Island Drainage Assistance Program (RIDAP).
Leave This Blank:


35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit Submit and Print

* indicates a required field