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Small Projects

FEDERAL EMERGENCY MANAGEMENT AGENCY PROJECT WORKSHEET

O.M.B. No. 3067-0151 Expires April 30, 2001

PAPERWORK BURDEN DISCLOSURE NOTICE Public reporting burden for this form is estimated to average 30 minutes. The burden estimate includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the needed data, and completing and submitting the form You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper righ corner of the forms. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing the burden Information Collection Management, Federal Emergency Management Agency, 500 C Street, SW, Washington, DC 20472,

Paperwork Reduction Project (3067-0151). NOTE: Do not send your completed form to this address.

DECLARATION NO:

PROJECT NO.

FIPS NO.

DATE

CATEGORY

FEMA- 1361 -DR- WA DAMAGE FACILITY MAPLE LANE CAMPUS APPLICANT

000-UKTGB-00

COUNTY

05/23/01 WORK COMPLETE AS OF:

05/23/01

:

0%

E

Approved

DAMAGE DESCRIPTION AND DIMENSIONS AS RESULT OF THE NISQUALLY EARTHQUAKE, FEBRUARY 28,2001, THE APPLICANT SUSTAINED DAMAGES TO 6 BUILDINGS AS DETAILED IN THE ATTACHED SUPPORTING DUCMENTATION. NO BUILDING SUSTAINED MORE THAN $5,000 DAMAGES. THE POWER PLANT HAS 6 LF OF CRACKING IN THE BRIC

SCOPE OF WORK POWER PLANT (POTENTIALLY HISTORICAL): BRICKS REUSED. IF REPLACEMENT IS NECESSARY THEY WILL MATCH IN KIND. MOTAR TO MATCH IN COLOR AND STRENGTH. TOOLING CONFIGURATION TO MATCH THE EXISTING MORTAR (6 LF). SEAL WITH WATERPROOF SEALANT. CASCADE & COLUMB

DEPARTMENT OF SOCIAL AND HEALTH SERVICES STATE-WIDE LOCATION 120311 OLD HIGHWAY 9, SW, CENTRALIA, WA 98531

LATITUDE

LONGITUDE

N46.79326

W123.02771

1

5256

MASONRY CRACK REPAIR/REPLACE SINGLE BR

3

/

EA

$

4.31

$

12.93

2

5257

MASONRY CRACK REPAIR/BRICK JOINTS

20

/

SF

$

5.32

$

106.40

3

5182

PAINT CONCRETE, DRYWALL, OR PLASTER

32

/

SF

$

0.83

$

26.56

4

5182

PAINT MASONRY WALL

288

/

SF

$

0.68

$

195.84

5

5252

PRIMER/SEALER COAT

288

/

SF

$

0.38

$

109.44

6

5255

MASONRY CRACK REPAIR/CMU BLOCK JOINTS

156

/

LF

$

2.37

$

369.72

7

9010

LABORER REGULAR TIME

5

/

HR

$

42.35

$

211.75

8

5248

PATCH/GROUT

3

/

LF

$

1.16

$

3.48

9

5249

CAULK JOINTS

300

/

LF

$

1.73

$

519.00

10

3001

MINIMUM ALLOWANCE

1

/

LS

$ 1,800.00

$

1,800.00

11

9995

WASHINGTON STATE SALES TAX

1

/

LS

$ 355.86

$

355.86

$ $

3,710.98

TOTAL COST

Yes

No

COST

Yes

No

Hazard Mitigation proposal included?

ITEM

CODE

PREPARED BY: J.Antilla, FEMA

REMARKS:

/

Does the Scope of Work change the pre-disaster condition at site?

UNIT PRICE

No No

NARRATIVE

Special Consideration issues included? Is there insurance coverage on facility?

Yes Yes

PROJECT COST

QUANTITY/UNIT

Federal cost-share for a small project is paid upon Project Worksheet approval and Payment Request submittal.

36

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