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PRC?.IF;t:T WOR SIIF:F I'
<br /> INSTRUCTIONS
<br /> The Project ytiorkshout trust be completed for each identified damaged pro cet ,S project may itichr is damages more than one site.
<br /> After completing all Proact th orka}ne=wts,subrint the work shuets to ye=ar Pribbe Asst tane2 k.ao rdinaator,
<br /> Identif+r fns information
<br /> Disaster: htdreate tkte disaster declaraticiii ninii�r€as e%tahlkhcd kv l-T Nfjy(i z 'FE NIA t 13(i-DR Ted ztc,).
<br /> Protect No.-. Indicate the pr lent desr�l4ratrcm ntunber you established to track the project in yOur system 6x. 1,3,3,etc,).
<br /> PA,ID No" Indicate your Putlic Assistance identification ate tber on,this space. This is optional,
<br /> Dater lndicatte the date the NsorLsheet was prepared in l 1'vtltl"iY Y fcmn tt.
<br /> C'atcgorys hicheattc Ilic category,offhc prgcc t according to FEMA ap^ci ied work categories(i.c,A,Ii,C,D,fi,F,ti):Tins is optional.
<br /> Applicant: Pvanic of the government or other legal t`ettiq,to which the fiends will be awarded_
<br /> County: Mane of lite county o herr:the(Lun.aged facility is loeaLed,
<br /> }1 lees E set ntttliap8 cc*niu es,era hea6e"A Seths C" a i[}"'
<br /> Dan>a�ePaeility: [denseCvthe facility and descTil its basic runctionsen}pre-chsaestrconditron..
<br /> Work Complete as of: Inciicare the date the work was riser scd iii the format of'r414t/I M141/DD/YY a=nd the percentage of'work completed to that date.
<br /> Locaffam This itcrn cart range rany�v here fvetm art"addre s,""'intcesceai+ar%of" "1 rink ti}utli of cat "ha`cotmtly°wwidc' If d airmt;cs we in
<br /> different iceastions or different counhcs phase fist each Imaafnon Include latitude and longittick ofthe project ifknown.
<br /> Darm-t a Description and Dlrtiensions Describe die disaster-€elated damage to the facility,including the cause of the damage and the area or
<br /> coniprments aft}-eted,
<br /> licope of Work l.rst,worl that has heck cnaaafalet t1 an l ss"d rk to he cnn l lcfed vv hte}t,as n hey to r lr tlr aiH a to rekaicd daaa ag
<br /> Does the Scope of Work,change the pre-disaster conditions of the site: If the tv'ark descnt e)under tkie 5ecpe�C 4�ork cf ar g th sat
<br /> conditions(ix-lrterear esidecra_ascs the Siwe or fiinctacan(74`111C facility or dldacs not replace damage cdnnpiment,in kind"Pith like materials),check(x);
<br /> yes Ifthe Scope of York returns the site to its pre-disaster configin atioar,capacity and dimensions check(a)no.
<br /> Special Ccrnsidenafio It tI'ae ptcaleet iracliules rr sur abl tvcuk,rid ar is al7ected IHy ertvarur ret rte l( l p.al} r l storric c irirertus c}neck()althea'
<br /> the Y aar No ham so that alllara pnatc aehoia c.att k nintnated tc scold€}ela) iii fttndiryg Refer oto.Kafir cleat✓ffaxrt$bofh Lar Hither infoemaaion.
<br /> Hazard Mittgation: Ifthe I+re-dh3a.ter co id haus at fine ate cast tie changed to lirevettt or ictittc; fit di.a ter-related damage,check(x)Yes. If nao
<br /> opporturnhes for harmrd mitigation exist check,(x)rnc Appropriate action will be initiated ami avoid delays In IundarcRefer tm+tpplicaanr
<br /> Ira ndbook for farrther intorniatten.
<br /> Is there insurance cover-ae on this facility: Fodend late requires that FENIA be notified ofaty entilternent for proceeds to repior dimmer-related
<br /> daHinagea fienrt arts rauice ar tt nY dUter scrtan.
<br /> Check(x)yes r1 ally I'unrdrn!or picac:ecks cart be received for the work;vvnthin the Sectile ofA'uik ficnrt
<br /> anysource beside FEMA_
<br /> Hroiect Cost
<br /> Item: 1 `*,3,etc.7 Use a fttttiict il£vrttas as raec:scary to rricltida:all rterris.
<br /> Code: If usntg the FEMA coast codes`place the appropriate rurniber here:.
<br /> Narrative: Indicate th;work-,rtattenal or service that beast describes the work(i.e."force account labor overhrne','42 an.RCP";'sheet Took
<br /> ruplaccolent R,etc-
<br /> )-Quantity/Unit; List the.nnoautt of urnts and the tasiit cif measure t dR`ey' I'rIt,"61a',etc.).
<br /> Unit Price: Indicate the price per emit.
<br /> Cost- This steam can he developed fromt coast to date,contracts,haus,aipphc:ant's experience,in that particular repair work,books which tend
<br /> thernselves to work estimates,:such as RS Mearns,or tri=using const codes supplied by FEMA.
<br /> Total Co Record to9at ct,,,sl oaf the pu tec1..
<br /> Prepared I3y: Record the name,title,acid signatatre of the persona completing the Project Nvorl sheet'-
<br /> Applicant Rep Record the name,title,and signataare ofApplicatat's representative.
<br /> Records Requirements
<br /> Please revaevv th <dppd,c rzr d 11ruidb(wk,F ,M 323 for detailed instructions and exaniples;
<br /> For all caornpletedwork,the applicant moist keep the hollowing records
<br /> *Force accou nt taboo docuanentation shee=ts identifying the employee,hours worked,date and locatiorr,
<br /> *Forccr account equipment do+cumentatnon sheets identifying specific etgtripnient,eoperetor usage by hoo-ur mile.and asst used,
<br /> *vlacteriaal docinnentation slicers identifying tine type of material,quantity used and oast;
<br /> 'Copies of all contracts for work and any lea e°rcHttll equipment cost's,
<br /> per all estinhited weak.keep calcnlahc3us,gtranhty estimates,priding information,etc as part of the record,to document tine'Costaeshn.ate"raa
<br /> which funding is la iatg requested-
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