Form FEMA Form 009-0-12 FEMA Form 009-0-12 Force Account Equipment Summary Record

DEPARTMENT OF HOMELAND SECURITY
FEDERAL EMERGENCY MANAGEMENT AGENCY
FORCE ACCOUNT EQUIPMENT SUMMARY RECORD
APLICANT

PA ID NO.

LOCATION/SITE

PAGE

OF

PROJECT NO.

DISASTER

CATEGORY

PERIOD COVERING

O.M.B. No. 1660-0017
Expires April 30, 2013

DESCRIPTION OF WORK PERFORMED

TYPE OF EQUIPMENT
INDICATE SIZE, CAPACITY, HOURSEPOWER,
MAKE AND MODEL AS APPROPRIATE

DATES AND HOURS USED EACH DAY
EQUIPMENT
CODE
NUMBER

OPERATOR'S
NAME

DATE

COSTS
TOTAL EQUIPMENT TOTAL
HOURS
RATE
COST

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

FEMA Form 009-0-127, (4/2010)

TITLE

PREVIOUS EDITION OBSOLETE

DATE

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