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DEPARTMENT OF HOMELAND SECURITY O.M.a Na.1660-0017 <br /> FEDERAL EMERGENCY MANAGENIENT AGENCY PAGE OF Expires December 31, <br /> 2011 <br /> RENTED EQUIPMENT SUMMARY RECORD <br /> APPLICANT PAIDhit}. PROJECT NO, DISASTER <br /> LOCATIONMITE CATEGORY PERIOD COVERING <br /> DESCRIPTION OF WORK PERFORMED <br /> TYPE OF EQUIPMENT DATES AND RATE PER HOUR TOTAL DATEANDANIOUNT <br /> Indicate size,Capacity,Horsepower HOURS USED WIDIR "'OUT COST VENDOR INVOICE NO, PAID CHECK <br /> Make and Model as Appropriate OPIR <br /> --------------------— <br /> GI D TOTAL <br /> I CERTIFY THAT THE ABOVE INFORMATION WAS OBTAINED FROM PAYROLL RECORDS,INVOICES,OR OTHER DOCUMENTS THAT ARE AVAILABLE FOR AUDIT. <br /> CERTIFIED TITLE DATE <br /> FEAT Form 90-125,FEB 09 <br />