Form FEMA Form 90-124 FEMA Form 90-124 Materials Summary Record

DEPARTMENT OF HOMELAND SECURITY
FEDERAL EMERGENCY MANAGEMENT AGENCY
MATERIALS SUMMARY RECORD
PA ID NO.

APPLICANT
LOCATION/SITE

PAGE

O.M.B. No. 1660-0017
Expires October 31, 2008

OF

PROJECT NO.

DISASTER

CATEGORY

PERIOD COVERING

DESCRIPTION OF WORK PERFORMED

VENDOR

DESCRIPTION

QUAN.

UNIT
PRICE

TOTAL
PRICE

DATE
PURCHASED

DATE
USED

GRAND TOTAL
I CERTIFY THAT THE INFORMATION WAS OBTAINED FROM PAYROLL RECORDS, INVOCIES, OR OTHER DOCUMENTS THAT ARE AVAILABLE FOR AUDIT.
CERTIFIED

FEMA Form 90-124, FEB 06

TITLE

DATE

INFO FROM
(CHECK ONE)
INVOICE STOCK

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