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FEDERAL EMERGENCY MANAGEMENT AGENCY

FORCE ACCOUNT EQUIPMENT SUMMARY RECORD

Page               of

1. APPLICANT

2. PA ID

3. PW #

4. DISASTER NUMBER

5. LOCATION/SITE

6. CATEGORY

7. PERIOD COVERING

to

8. DESCRIPTION OF WORK PERFORMED

TYPE OF EQUIPMENT

OPERATOR'S NAME

DATES AND HOURS USED EACH DAY

COSTS

INDICATE SIZE, CAPACITY, HORSEPOWER, MAKE AND MODEL AS APPROPRIATE

EQUIPMENT CODE NUMBER

DATE

 

 

 

 

 

 

 

TOTAL HOURS

EQUIPMENT RATE

TOTAL COST

 

 

 

HOURS

 

 

 

 

 

 

 

 

$

$

 

 

 

 

HOURS

 

 

 

 

 

 

 

 

$

$

 

 

 

 

HOURS

 

 

 

 

 

 

 

 

$

$

 

 

 

 

HOURS

 

 

 

 

 

 

 

 

$

$

 

 

 

 

HOURS

 

 

 

 

 

 

 

 

$

$

 

 

 

 

HOURS

 

 

 

 

 

 

 

 

$

$

 

 

 

 

HOURS

 

 

 

 

 

 

 

 

$

$

 

GRAND TOTALS

 

 

$

I CERTIFY THAT THE ABOVE INFORMATION WAS OBTAINED FROM PAYROLL RECORDS, INVOICES, OR OTHER DOCUMENTS THAT ARE AVAILABLE FOR AUDIT.

CERTIFIED

TITLE

DATE

FEMA Form 90-127, NOV 98