FEDERAL EMERGENCY MANAGEMENT AGENCY
RENTED EQUIPMENT SUMMARY RECORD	Page	     	of	     		
		
1.	APPLICANT
     	2.	PA ID
     	3.	PW #
     	4.	DISASTER NUMBER
     	
5.	LOCATION/SITE
     	6.	CATEGORY
	7.	PERIOD COVERING
      to      	
8.	DESCRIPTION OF WORK PERFORMED
     	
TYPE OF EQUIPMENT
Indicate size, capacity, horsepower, make and model as appropriate	DATES AND HOURS USED	RATE PER HOUR	TOTAL COST	VENDOR	INVOICE NO.	DATE AND AMOUNT PAID	CHECK NO.	
		W/OPR	W/OUT OPR						
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GRAND TOTAL	     	
I CERTIFY THAT THE ABOVE INFORMATION WAS OBTAINED FROM PAYROLL RECORDS, INVOICES, OR OTHER DOCUMENTS THAT ARE AVAILABLE FOR AUDIT.	
CERTIFIED
     	TITLE
     	DATE
     	
FEMA Form 90-125, NOV 98