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Contract Sheet

Summary Sheet

CONTRACT SHEET TIPS:

This sheet is very straight forward. Again, be complete in the "description of activity"cell. Describe in detail what type of work was completed.

SUMMARY SHEET TIPS:

This sheet is designed to summarize ALL your damage sites. This information willassist the FEMA team in coordinating the proper personnel to assist with your claim.

1) List all sites by category.

Categories: A = DebrisB = Emergency measuresC = Roads and bridgesD = Water control facilitiesE = Buildings and equipmentF = UtilitiesG = Other facilities, including parks

2) Assign site numbers to each site or project.

3) Give a brief description of the damages.

4) Record your damage estimate in dollars.

5) Identify any special considerations.

6) Add any comments about the projects.

7) Answer the two questions on the bottom of the sheet about other sites or projectsnot included on this sheet.

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How do I determine the benefit rate for employees?

Use the Benefit sheet tab found in this program, detailed instructions can be found on the HELP sheet.

Why do I have to detail straight and overtime labor hours if straight time is not eligible for temporary work?

Because equipment use is eligible for all work, temporary and permanent.

Who is eligible to receive the volunteer labor credit?

The eligible applicant who benefited from the labor.

How is volunteer labor valued?

Generally, the applicants applicable pay rates should be used for inkind job descriptions, i.e.: volunteers performinglaborer duties would be valued at the highway departments laborer scale, volunteers performing heavy equipment dutiesshould be valued at the highway departments HEO rate, etc.

How is the volunteer labor credit applied in "real dollars"?

The applicants' category A and B damage survey reports are reviewed, and totaled collectively. The volunteer labor creditis applied to the non-federal share. Therefore, the volunteer labor credit damage survey report may have a total of $10,000for example, but if the non-federal share when totaled only equals $5,000 then the applicant will only receive $5,000

FREQUENTLY ASKED QUESTIONS

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DATE

FIPS NUMBER/(applicant identification number)

APPLICANTS REPRESENTATIVE TITLE

TELEPHONE NUMBER

19XXFEMA DECLARATION NUMBER

CATEGORY

LOCATION

SCOPE OF WORK

APPLICANTS REPRESENTATIVE

DATA ENTRY SHEET

APPLICANT NAME

COUNTY

PROJECT NUMBER

DAMAGED FACILITY

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2. FIPS NUMBER

04. PROJECT NUMBER FEMA

19XX

1. Does the damaged facility or item of work have insurance and/or is it an insurable risk? (e.g., buildings, equipment, vehicles, etc.)

Yes No Unsure

2. Is the damaged facility located within a floodplain or coastal high hazard area, or does it have an impact on a floodplain or wetland?

Yes No Unsure

3, Is the damaged facility or item of work located within or adjacent to a Coastal Barrier Resource System Unit or an Otherwise Protected Area?

Yes No Unsure

4. Will the proposed facility repairs/reconstruction change the pre-disaster condition? (e.g., footprint, material, location, capacity, use or function)

Yes No Unsure

5. Does the applicant have a hazard mitigation proposal or would the applicant like technical assistance for a hazard mitigation proposal?

Yes No Unsure

6. Is the damaged facility on the National Register of Historic Places or the state historic listing? Is it older than 50 years? Are there more, similar build

Yes No Unsure

7. Are there any pristine or undisturbed areas on, or near, the project site? Are there large tracts of forestland?

Yes No Unsure

8. Are there any hazardous materials at or adjacent to the damaged facility and/or item of work?

Yes No Unsure

9. Are there any other environmentally or controversial issues associated with the damaged facility and/or item of work?

Yes No Unsure

1/0/1900

COMMENTS:

COMMENTS:

COMMENTS:

5. LOCATION

0

COMMENTS:

0

COMMENTS:

Form must be filled outfor each project.

FEDERAL EMERGENCY MANAGEMENT AGENCY

SPECIAL CONSIDERATIONS QUESTIONS1, APPLICANT'S NAME 3. DATE

0

COMMENTS:

COMMENTS:

COMMENTS:

COMMENTS:

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FOR (applica

LOCATION OF WORK: CATEGORY 0 19XX

SCOPE OF WORK: PROJECT NO. 0

VENDOR DESCRIPTION OF ACTIVITY CONTRACT PERIOD OF CONTRACTNUMBER CONTRACT COST

TOTAL -$

I CERTIFY THAT THE DATA PROVIDED HERE WAS TRANSCRIBED FROM DOCUMENTS AND RECORDS AVAILABLE FOR AUDIT.

CERTIFIED BY TITLE 1/0/1900

0

NUMBER

DATE0

CHECK

0

FORCE ACCOUNT CONTRACTS 0

FEMA0

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TOTAL PAYROLL IN DOLLARS

DOLLARS & HOURS

Holidays / 2080 =

Vacation Leave / 2080 =

Sick Leave / 2080 =

* Social Security *

* Medicare *

* Umemployment / total payroll = *

* Worker's Comp / total payroll = *

** Retirement / total payroll = **

Health Benefits / total payroll =

Life Insurance Benefits / total payroll =

Total (in % of annual salary)

I CERTIFY THAT THE INFORMATION ABOVE WAS TRANSCRIBED FROM PAYROLLRECORDS OR OTHER DOCUMENTS WHICH ARE AVAILABLE FOR AUDIT.

CERTIFIED:

TITLE:

DATE:

* Only categories for overtime fringe benefits. ** Only when supported by employee contract

0.00%

0.00%

0.00%

6.20%

1.45% 1.45%

REGULAR TIME % OVERTIME %

19XX

0

0

0

0

(FIGURES IN YELLOW AUTOMATICLY "GO" TO THE FORCE ACCOUNT LABOR SHEETS)

P.A. ID:PROJECT NUMBER:

6.20%

1/0/1900

7.65% 7.65%

FEDERAL EMERGENCY MANAGEMENT AGENCY

APPLICANT'S BENEFITS CALCULATION WORKSHEET

APPLICANT:DISASTER NUMBER:

0

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FOR

LOCATION OF WORK:

SCOPE OF WORK:

TYPE OF EQUIPMENT FEMA DATE AND HOURS WORKED

CAPACITY & HP AS APPROPRIATE CODE

TOTAL HOURS

I CERTIFY THAT THE DATA PROVIDED HERE WAS TRANSCRIBED FROM DOCUMENTS AND RECORDS AVAILABLE FOR AUDIT.

CERTIFIED BY TITLE

0

FORCE ACCOUNT EQUIPMENT 0

0

0

0

CATEGORY

PROJECT NO.

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FOR

LOCATION OF WORK:

SCOPE OF WORK:

TYPE OF EQUIPMENT FEMA DATE AND HOURS WORKED

CAPACITY & HP AS APPROPRIATE CODE

TOTAL HOURS

I CERTIFY THAT THE DATA PROVIDED HERE WAS TRANSCRIBED FROM DOCUMENTS AND RECORDS AVAILABLE FOR AUDIT.

CERTIFIED BY TITLE

0

FORCE ACCOUNT EQUIPMENT #2 0

0

0

0

CATEGORY

PROJECT NO.

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FOR

0 FE

0

EMPLOYEE NAME AND DATE AND HOURS WORKED EACH DAY T

JOB DESCRIPTION DATE HREGULAR

O/TREGULAR

O/TREGULAR

O/TREGULAR

O/TREGULAR

O/TREGULAR

O/TREGULAR

O/TREGULARO/T

REGULARO/T

REGULARO/T

REGULARO/T

REGULARO/T

REG PAY -$ X FRINGE RATE OF 7.65% = -$ TOTAL HOURS

O/T PAY -$ X FRINGE RATE OF 7.65% = -$

TITLE

I CERTIFY THAT THE DATA PROVIDED HERE WAS TRANSCRIBED FROM DOCUMENTS AND RECORDS AVAILABLE FOR AUDIT.

CERTIFIED BY

TOTAL OT (ONLY) WITH FRINGE -$

0

LOCATION OF WORK:

SCOPE OF WORK:

CATEGORY

FORCE ACCOUNT LABOR RECORD

0

TOTAL LABO

PROJECT NO.

0

0

0

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FOR

0 F

0

EMPLOYEE NAME AND DATE AND HOURS WORKED EACH DAY

JOB DESCRIPTION DATE REGULARDOUBLE

REGULARDOUBLE

REGULARDOUBLE

REGULARDOUBLE

REGULARDOUBLE

REGULARDOUBLE

REGULAR

DOUBLEREGULARDOUBLE

REGULARDOUBLE

REGULARDOUBLE

REGULARDOUBLE

REGULARDOUBLE

REG PAY -$ X FRINGE RATE OF 7.65% = -$ TOTAL HOURS

DOUBLE PAY -$ X FRINGE RATE OF 7.65% = -$

TITLE

I CERTIFY THAT THE DATA PROVIDED HERE WAS TRANSCRIBED FROM DOCUMENTS AND RECORDS AVAILABLE FOR AUDIT.

0

0

LOCATION OF WORK:

SCOPE OF WORK:

CATEGORY

-$

0

TOTAL LABO

PROJECT NO.

0

0

FORCE ACCOUNT LABOR RECORD

CERTIFIED BY

DOUBLE TIME (ONLY) WITH FRINGE

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FOR

LOCATION OF WORK:

SCOPE OF WORK:

TYPE OF EQUIPMENT FEMA DATE AND HOURS WORKED

CAPACITY & HP AS APPROPRIATE CODE

TOTAL HOURS

I CERTIFY THAT THE DATA PROVIDED HERE WAS TRANSCRIBED FROM DOCUMENTS AND RECORDS AVAILABLE FOR AUDIT.

CERTIFIED BY TITLE

0

FORCE ACCOUNT EQUIPMENT 0

0

0

0

CATEGORY

PROJECT NO.

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FOR (applic

LOCATION OF WORK: 0 FEMA 19

SCOPE OF WORK: 0

VENDOR DESCRIPTION QUANTITY UNIT TOTAL DATE CHECK DATE SOURCE OF DA

PRICE COST BOUGHT NUMBER USED INVOICE ST

$ -

$ -

$ -

$ -

$ -

$ -

TOTAL COST -$

CERTIFIED BY TITLE DATE

I certify that the above information was transcribed from daily logs,vendor invoices, stock cards, or other documents which are available for audit.

0

0

FORCE ACCOUNT MATERIALS 0

CATEGORY

PROJECT NO.

0

0

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FOR (applic

LOCATION OF WORK: 0 FEMA 19

SCOPE OF WORK: 0

VENDOR DESCRIPTION QUANTITY UNIT TOTAL DATE CHECK DATE SOURCE OF DAT

PRICE COST BOUGHT NUMBER USED INVOICE STO

$ -

$ -

$ -

$ -

$ -

$ -

TOTAL COST -$

CERTIFIED BY TITLE DATE

I certify that the above information was transcribed from daily logs,vendor invoices, stock cards, or other documents which are available for audit.

0

0

FORCE ACCOUNT MATERIALS #2 0

CATEGORY

PROJECT NO.

0

0

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FOR

Certified By: Title: Date:

0PROJECT NO.0

VendorDate &

hours used

Rate p/hour

w/operator

LOCATION OF WORK: FEMA0 CATEGORY 0

Total CostInvoiceNumber Date paid

0RENTED EQUIPMENT RECORD

wo/operator

SCOPE OF WORK:

Type of Equipmentmake, model, size, capacity, HP

Total Cost

0 1/0/1900

I certify that the above information was transcribed from daily logs, vendor invoices, or other documents which are available for audit.

0

-$

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APPLICANT

SCOPE OF WORK DETAILED ON THIS ESTIMATE SHEET:

PROJECT OR SITE NO.

0

CALCULATIONS OF WORK TO BE DON

0

ITEM

ORSITE

NUMBE

R

FEMACO

DE DESCRIPTION

LENG

TH(FT)

WIDTH

(FT)

DEPTH(FT)

Q U

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HAZARD MITIGATION PROPOSAL (HMP) 19XX

DATE

1/0/1900

ESTIMATE OF WORK

FEMA

COST

CODE MATERIAL AND/OR DESCRIPTION QUANTITY UNITS UNIT PRICE COST

NET TOTAL COST--------> (IN ADDITION

TO PROJECT WORKSHEET TOTAL) -$

PREPARED BY: TITLE:

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DECLARATION NO.

FEMA- 19XX -NY

FEMA Form 90-91D, SEP 98

0APPLICANT COUNTY

1/0/1900

0 0

0

FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0151

PROJECT WORKSHEET Photo Sheet Expires April 30, 2001

PROJECT NO. FIPS NO. DATE

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CATEGORY

0

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CAT.

SITENO.

DATE:

19XXFEMA

0

BRIEF DESCRIPTION OF DAMAGE ESTIMATED COST

INFORMATION FORWARDED TO THE FIELD COORDINATOR?

ADDITIONAL DAMAGE SITES REMAIN TO BE ESTIMATED?

COMMENTS

FEDERAL EMERGENCY MANAGEMENT AGENCY

APPLICANT SUBMITTAL FORM SUMMARY (ALL SITES)

SPECIALCONSIDERATION

ALL KNOWN DAMAGE SITES HAVE BEEN ESTIMATED AND THE

TOTAL SITES W ITH CONSIDERATIONS

APPLICANT

APPLICANTS REPRESENTATIV

00

DATE

TELEPHONE NUMBER

1/0/19000

SIGNATURE OF AUTHORIZED REPRESENTATIVE

1/0/1900

TOTAL THIS PAGE:TOTAL OF ATTACHED PAGES:

GRAND TOTAL OF THIS SUBMITTAL

-$

-$ 0

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7150 DOCK WOOD PILE SUPPORT (2" DECK) SF

7160 DOCK FLOATING (PREFAB) SF

7170 SOD REPLACEMENT SY

7180 POSTS GUARD (4" WOOD) REPLACEMENT EA

7190 PUMP OUT TOILET VAULTS EA

7200 SIGNS WOOD (PAINTED LETTERS) SF7210 SIGNS WOOD (ROUTERED LETTERS) SF

7220 STONE DUST (FOR BASEBALL DIAMONDS) CY

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31.00

15.40

5.85

4.80

100.00

21.0031.00

22.00