Appendix 14 - Damage Claim Sign Procedures Form and Statistics.pdf

STATE OF ILLINOIS

SCOPE OF SERVICES APPENDICES

APPENDIX 14 – DAMAGE CLAIM SIGN, PROCEDURES, FORM, AND STATISTICS

Damage Claim Sign, Procedures, Form, and Statistics

Damage Claim Sign and Procedure Damage Claim Form

Damage Claim Information on Website Historical Damage Claim Statistics

State of Illinois IFB Appendix 14

Damage Claim Procedure If you believe that your vehicle was damaged by an inspector during or as a result of an emissions test at an emissions testing facility, you may complete and submit a damage claim form. You may submit the completed damage claim form to the inspection station where the damage allegedly occurred or online at www.IllinoisAirTeam.com (accessible using the QR code below) within 30 days after the date of the emissions test that relates to the alleged damage. Within 30 days after submitting your completed damage claim, you must submit any relevant information relating to your damage claim. Within 60 days after submitting your completed damage claim form, the Contractor shall notify you of its proposed resolution of your damage claim.

If you are not satisfied with the proposed resolution of your damage claim, within 30 days after receiving the Contractor's proposed resolution, you may petition the Illinois Environmental Protection Agency (Agency) for a review of the adequacy and completeness of the Contractor's proposed resolution. The petition shall be in a form prescribed by the Agency. You may obtain the petition form by calling 847-294-4000, emailing EPA.VETP@Illinois.gov or writing the Agency at:

Illinois Environmental Protection Agency Vehicle Emissions Test Program 9511 Harrison Street Des Plaines, IL 60016

The Agency will notify you in writing of the results of its adequacy and completeness review. The Agency's review is not binding and does not affect your rights under the law. If, after the Agency's review, you are still not satisfied with all or a portion of the Contractor's proposed resolution, you may pursue the damage claim through binding arbitration or in circuit court.

The damage claim requirements are in accordance with 625 ILCS 5/13C-40(b). The damage claim procedures and form may be found using the following link: http://www.IllinoisAirTeam.com

If you have any questions, please contact [Contractor Name] claims department at:

Toll Free: (844) 258-9071 E-Mail: DamageClaims@IllinoisAirTeam.net Fax:

(312)-327-7640

Or Mail to:

[Contractor Name] [Address]

Damage Claim Form

Description of Damage:

If you need additional space, please continue your description on a separate page and attach hereto.

If you have any questions, please call the Illinois Air Team at: 844.258.9071.

The undersigned hereby certifies that the statements contained herein are true and correct. By affixing his/her signature hereto, the undersigned further certifies that he/she is authorized to execute this form.

The Illinois EPA is authorized to require this form pursuant to 625 ILCS 5/13C. Failure to submit this form and/or comply with 625 ILCS 5/13C may result in the denial of your claim. Any person who knowingly makes a false, fictitious or fraudulent material statement, orally or in writing, to the Illinois EPA commits a Class 4 felony. A second or subsequent offense after conviction is a Class 3 felony (415 ILCS 5/44(h)).

Signature Date

To expedite processing of your claim, file your claim online at www.IllinoisAirTeam.com using the QR code on this form.

Vehicle Information

Illinois License Plate Number Vehicle Identification Number (VIN) Model Year Vehicle Make

Vehicle Owner Information Registered Owner 1 Registered Owner 2

Street Address Street Address

City State Zip Code City State Zip Code

Daytime Telephone Number

Daytime Telephone Number

Email Address Email Address

Preferred Method of Contact: Phone Email U.S. Mail (Please select only one method.)

Damage Information

IL 532-3025

Testing Station Location Date Time

VIM 169 Rev. 07/2019

Damage Claim Procedure

If you believe that your vehicle was damaged by an inspector during or as a result of an emissions test at an emissions testing station, you may complete and submit a damage claim form. You must submit the completed damage claim form within 30 days after the date of the emissions test that relates to the alleged damage. You also must submit any relevant information relating to your claim of vehicle damage within 30 days after submitting a damage claim.

[Contractor Name] is responsible for handling and responding to damage claims. It is our goal to resolve each claim as quickly as possible, while allowing time to conduct a thorough investigation. Within 60 days after receiving your damage claim form, [Contractor Name] shall notify you of the proposed resolution. In most cases, a response will be provided within 10 business days of your claim submission.

Following a final decision regarding your claim, you may also petition the Illinois Environmental Protection Agency (IEPA) for a review of the adequacy and completeness of the decision. To petition, you must complete and submit a Damage Claim Review Petition to the IEPA within 30 days after notification of the decision being reviewed. You may obtain a Damage Claim Review Petition by calling: 847.758.3547, or by writing to the Illinois Environmental Protection Agency at: PO Box 767, Elk Grove Village, IL 60009-0767, or emailing them at: EPA.VETP@Illinois.gov.

Required Documentation

The following documentation must be submitted when submitting a damage claim:

A completed Damage Claim Form typed or legibly printed. Note: when submitting the form electronically via the website, there is no additional paper form to complete and submit.

Any relevant documentation related to your claim of vehicle damage; please include the license plate number and your telephone number on all documentation.

Submitting a Damage Claim

Damage claims may be submitted:

Online at www.IllinoisAirTeam.com; or Using one of the methods provided below:

Fax: 312.327.7640;

Mail: [Contractor Name] [Address]; or Email: DamageClaims@IllinoisAirTeam.net.

Damage Claims (website)

If you believe that your vehicle was damaged by an inspector during or as a result of an emissions test at an emissions testing station, you may complete and submit a damage claim form. You must submit the completed damage claim form within 30 days after the date of the emissions test that relates to the alleged damage. You also must submit any relevant information relating to your claim of vehicle damage within 30 days after submitting a damage claim.

[Contractor Name] is responsible for handling and responding to damage claims. It is our goal to resolve each claim as quickly as possible, while allowing time to conduct a thorough investigation. Within 60 days after receiving your damage claim form, [Contractor Name] will notify you of the proposed resolution. In most cases, a response will be provided within 10 business days of your claim submission.

Following a final decision regarding your claim, you may also petition the Illinois Environmental Protection Agency

(IEPA) for a review of the adequacy and completeness of the decision. To petition, you must complete and submit a

Damage Claim Review Petition to the IEPA within 30 days after notification of the decision being reviewed. You may obtain a Damage Claim Review Petition by calling: 847.758.3547, or by writing to the Illinois Environmental Protection

Agency at: P.O. Box 767, Elk Grove, IL 60009-0767, or emailing them at: EPA.VETP@Illinois.gov.

Required Documentation

The following documentation must be submitted when submitting a damage claim:

A completed Damage Claim Form typed or legibly printed. Note: when submitting the form electronically via the website, there is no additional paper form to complete and submit.

Important Note About Entering Your “VIN”: Most Vehicle Identification Numbers (VINs) have 17 digits.

Please be sure to include all 17 digits when you complete an application or submit correspondence. Failure to do so could result in delays in processing your request.

Please note: The VIN provided on your Test Notice postcard IS NOT the complete 17-digit VIN; the first 14 digits are accurate; however, the last three (3) digits were replaced with asterisks for privacy reasons. When providing your VIN, it must include ALL 17 characters, including the three (3) that were replaced with asterisks.

Your vehicle’s VIN can be found on the driver's side dashboard in the corner near the windshield, or on the label on the inside of the driver's side door (where the door latches when it is closed). VINs are also displayed on vehicle sales documents, insurance cards and policies, and vehicle title and registration documents.

Any relevant documentation related to your claim of vehicle damage.

Relevant Timeframes

When submitting a damage claim, it is important to keep the following timeframes in mind:

You must submit the completed damage claim form within 30 days after the date of the emissions test that relates to the alleged damage.

You must submit any relevant information relating to your claim of vehicle damage within 30 days after submitting a damage claim.

[Contractor Name] will notify you of the proposed resolution of your damage claim within 60 days of receiving the claim.

Within 30 days after [Contractor Name] notifies you of their decision, you may petition the IEPA for review of the adequacy and completeness of the [Contractor Name] decision.

Submitting a Damage Claim

Damage claims may be submitted:

Electronically by clicking here;

Manually, using one (1) of the methods provided below, after printing and completing the application:

o Email: DamageClaims@IllinoisAirTeam.net o Fax: 312.327.7640 o Mail: [Contractor Name] [Address]

DAMAGE CLAIM TOTALS

Year Total

2017 48

2018 50

2019 39

2020 25

2021 16

*2022 17

*Total through 11/12/2022