Form FEMA Form 90-125 FEMA Form 90-125 Rented Equipment Summary Record

DEPARTMENT OF HOMELAND SECURITY
FEDERAL EMERGENCY MANAGEMENT AGENCY

PAGE

RENTED EQUIPMENT SUMMARY RECORD
APPLICANT

PA ID NO.

LOCATION/SITE

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

OF

PROJECT NO.

DISASTER

CATEGORY

PERIOD COVERING

DESCRIPTION OF WORK PERFORMED

TYPE OF EQUIPMENT
Indicate size, Capacity, Horsepower
Make and Model as Appropriate

DATES AND
HOURS USED

RATE PER HOUR
W/OPR

W/OUT
OPR

TOTAL
COST

VENDOR

INVOICE NO.

DATE AND AMOUNT
PAID

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

FEMA Form 90-125, FEB 06

TITLE

DATE

CHECK NO.

PAPERWORK BURDEN DISCLOSURE NOTICE
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any suggestions for reducing this burden to: Information Collections Management, Department of Homeland Security, Federal Emergency Management Agency, 500 C Street, SW, Washington, DC, 20472, Paperwork Reduction
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