DEP Memorandum on Federal Reimbursement Documentation, September 18, 2001

NYC 9/11 Public Portal Document

Damage Survey Inspection Checklist Page of

WORK SITE: NAME:________________________________ DATE: State County City Town Village School RreDist PNP circle one _

To expedite the damage survey process, applicants are required to take the following steps BEFORE the arrival of inspectors. Documentation must be detailed and organized by each, worksite. Ensure a knowledgeable person (as identified on the NOI) accompany the survey team. KEEP ORIGINALS-MAKE COPIES Mark the location of each damage site on a suitable map and attach. Before and after photographs, site sketches, etc. available. List Damages by: Category (A-G) % of work perfonned approx, amount of damage $ Debris Removal Activities: location type --------------- volume quantity disposal site/s —— --------- Labor Costs (from Straight-time hrs:-------- payroll) fringe %_____ $_ Overtime hrs:--------- S: fringe %_____ $____ Use the Force Account Labor Record form and attach.

Equipment Costs: operator/dispatch logs--------------------------- mileage records --------------------------- hourly useage --------------------------- size & capacity ----------------------------------------- Rental? yes no If yes, attach rental contract Use the Force Account Equipment Record and/or Rental Equipment Record forms and attach.

Material Costs: the following information is required for each item item name: ____________________________ circle one inveutory purchased vendor ---------- invoice #______ or purchase order# _or c^hreceipt# Use the Materials Record form and attach. ---------Contract Costs: copy of contract vendors invoice - bid advertisement type of contract - Use the Contract Costs Record form and attach.

Insurance Policy/ies: attach See notes on reverse. 11/94

NYC-WTC_000152511