1111

FEDERAL EMERGENCY MANAGEMENT AGENCY PROJECT WORKSHEET REVIEW Taskforce 3(~g

DR-1952-CA

New PW Ref Iy 1M P~ I (limit of 7 characters including spaces) or Version fiL-----------___

PACIPO Sivll-n+amp11- 1 Date submitted initial review J I) J Date forwarded to JFO )

ApplicantE 2SI AF0Re~i~W

1$

DAMAGE DESCRIPTION

WORK COMPLETED LAT amp LONG

WHERE WHEN WHAT [COMPLETE 3-DI [21 WHY WHAT CAUSED DAMAGE Q-- IMPACT WHAT WORK IS COMPLETED SITE PLAN amp PHOTO ALIGNMENT PRIOR DAMAGE

WORK COMPLETED - NOTED WORK TO BE COMPLETED - NOTED

SCOPE OF WORK ALL DAMAGED ELEMENTS CONSIDERED BASIS FOR PROJECTED COST - NOTED CONSTRUCTION METHOD EXPLAINED

MITIGATION ATIACHED NOT FEASIBLE (If not feasible state why in scope of work) MITIGATION IS PART OF DCODES amp STANDARDS DGOOD CONSTRUCTION PRACTICES DOTHER MITIGATION POLICY 15 D OR

D 0 LIST

(Check which one applies) OR BIC (Attached blc analysis) 0

COMMENTS

FLOODPLAIN MANAGEMENT [EO 11988] WETLANDS Project is in floodplain FIRM identified Additional action required COMMENTS

Historic over 50 Years old [2J ~ Is it located in a Histoncal District

8 Step process attached [gt$5000]

Date

o

HISTORIC Changed pre-disaster condition ~

Is it listed on State or Federal Registers COMMENTS ~~~4L-~____________________~~____- Project is compliant pproved by Date

NEPA Statutorily excluded D Changed pre-disaster condition G Histonc over 50 Years old

0iA

What permits are expeqed and from which regulatory NEPA I other Agencies COMMENTS ~~~~4~______________________~~_____

Date

~ Insurance ard~ju~s~tm~en~t~m~ad~e-L-L--In~su~ra~nceecreiqu~ire~d-[ob~ta~in=ampm~aintain~]-____-1 INSURANCE No insurance notation made COMMENTS

None Required Additional Actions Required

14

Proect is compliant pproved by Date

~~~~r~~L~ea_d_e_r_R_E_V_iE_W_middotmiddot_____ ----Ui4_llte~Y4L----ltf-_13----i--l_ Date-V FEMA TFL Date Comments __~__tL~~~~~L-~_________________________________________________________________

QGENERAL COMMENTS GOST SPREAD SHEET DMAPS TOTAL SHTS q + co Ilt E

USE FOR REMOTE PROJECT APPROVAL AND TRANSMITTAL

FEMA Fo 90 91 DEC 08~ US DEPARTMENT OF HOMELAND SECURITY

FEDERAL EMERGENCY MANAGEMENT AGENCY

PROJECT WORKSHEET PAPERWORK BURDEN DISCLOSURE NOTICE

Public reporting burden for this form is estimated to average 90 minutes per response Burden means the time effort and financial resources expended by persons to generate maintain disclose or to provide information to us You may send comments regarding the burden estimate or any aspect of the collection including suggestions for reducing the burden to Information Collections Management US Department of Homeland Security Federal Emergency Management Agency 500 C Street SW Washington DC 20472 Paperwork Reduction Project (OMS Control Number 1660-0017) You are not required to respond to this collection of information unless a valid OMS number appears in the upper right comer of this form NOTE Do not send your completed questionnaire to this address

DECLARATION NO PWREFNO DATE FIPS NO CATEGORY EMMIE NO

FEMA 1952 DR CA EVWD-1 041111 071-0014E-OO A

APPLICANT WORK COMPLETED AS OF

East Valiey Water District DATE PE CENT 030411 I 100

DAMAGED FACILITY COUNTY

Debris San Bernardino

LOCATION LATITUDE LONGITUDE

Plant 146 3410894 -11717378

Was this site previously damaged Ves No euro Unsure

DAMAGE DESCRIPTION AND DIMENSIONS THIS PW IS WRITTEN TO ADDRESS ITEM 1 OF THE EAST VALLEV WATER DISTRIC~tJST OF PROJECTS PW EVWD-1G WILL ADDRESS THE PERMANENT WORK AT PLANT 146 h l re+e(ISmiddotmiddot ~~I

jU-l f ~ f Heavy rains from the event caused mud flows that entered ~he ~y flowing thru the gate into the facility The facflfty is a concrete block walled area with water pumps in two areas The total area within the walled facility is approx 37500 SF and the debris covered approx 60 of the area at 3 feet deep(approx 2500CV of debris)

SCOPE OF WORK Fund at 75

COMPLETED WORK

The Applicant used a contractor selected by the bid process to pick up the 2500 CY of mud debris and deliver it to 7900 Boulder Ave -Highand Ca where the City of Highland has provided written permission to EWVD to deposit debris

0~ PROJECT COST

ITEM CODE NARRATIVE QUANTITY UNIT UNIT PRICE COST COMPLETED WORK $ -

1 9001 Contract 1 LS $ 783088 $ 783088 $ --$ -

-shy

$ -$ -

middot7 $ -4)66 9901 Direct Administration costs 100 LS $ 9054 $ 9054

$ - ~--

$1-shy --__--shy 1-- $

--- ~-

-SUBTOTAL FROM COST CONTINUATION PAGElS) $ -

ill h f Ibull TOTAL PROJECT COST $ 792142

PREPARED BY Robert Ray APJ IG~ 1tIJlI TITLE Project Specialist

FEMA PAC CREW LEADER Tim Smith J STATE PAC CREW LEADER fi

Dave Rogers

APPLICANT Gary Sturdivan --~ TVfZUA dL 0 DATE ~ PHONE 909-806-4087

National PW Template V22 FetlOJary 2011 Excel 2007 REPLACES ALL PREVIOUS VERSIONS r 7

FEMA Om ~O_~1 tl5C 08

US DEPARTMENT OF HOMELAND o~unl FEDERAL EMERGENCY MANAGEMENT AGENCY

PROJECT WORKSHEET I NOTICE

IpUbliC burden for this form is estimated to average 90 minutes per response Burden means the time effort and financial resources expended by persons ~tI~i~taimiddot~ I ~r to provi~e information to us You may send comments regarding the burden estimate or any aspect of the collection including suggestions fo r~~~~~the Iburden to InfOrm~tlon C~lIectlOnS Management US Department of Homeland Security Federal Emergency Management Agency 500 C Street SW Washington DC 20472 lri~ Redudi0rr~~~~~MB Control Number 1660--0017) You are n~~~~qUired to respond to this collection of information unless a valid OMS number appears in the uppe loom Do 001 sod yo I s to addlaquo

tATION NO PW REF NO DATE FIPS NO -A -UKY -EMMIENo FEMA 1952 DR CA EVWDmiddot1 041111 071middot0014Emiddot00 A

n WORK TED AS OF

lEast Valley Water District _OAT 100

) FACILITY

IDebris [san Bernardino

LOCATION LATITUDE LONGiffi5E Plant 146 3410894 middot11717378

Iwas this site previousy damaged rYes r No r Unsure

N~ iTHISPW-rS WKII I eN TO ITEM 1 OF THE EAST VALLEY WATER UICi I KI- LlSTOF TS PWtvvvIFle WILL

THE PERMANENT WORK AT PLANT 146

Heavy rains from the event caused mud flows that entered Plant 146 a well water pumping facility by flowing thru the gate into the faCility ~ris facilitY is a concrete bock w~led area with water pumps in two areas The total area within the waUed facility is approx 37500 SF and the covereo approx 60 of the area at 3 feet deep(approx 2500CY of debris)

K

Fund at 75 WORK

IThe Applicant used a contractor selected by the bid process to pick up the 2500 CY of mud debris and deliver it to 7900 Boulder Ave 1igr1o Ca where the City of Highland has provided written pemnission to EVWD to deposit debris

TCOST ITEM ODE NAKKA IIIiE_ Ql UNIT UNI PRICE -COST

TED WORK middot 1 9001 1 LS $

middot middot middot middot middot

2 I 9901 i 1 cests 100 LS $ 89 8903 middot middot middot

SiJBTor FROivI COST CONTINUATION F middot

J I i) 11 TOTAL PROJECT COSl 791991

BY RObrtRavO~~ y O ITlTLE Project Specialist

IFEMA PAC CREW LEADER Tim Smith 1 rld ISTATE PAC CREW LEADER Dave Rogers

nO e GalY IDATE IpHONE 909-806-4087

ooin y 2011 E)ltcel 2007 K~~ ~~O

FEDERAL EMERGENCY MANAGEMENT AGENCY

SCOPE NOTES APPLICANT PWREF NO CATEGORY FIPS NO DISASTER

East Valley Water District EVWD-1 A 071-0014E-OO 1952 1 CA

Check next to appropriate comment for Data Specialist to add to the Scope of Work Topic Comment

Complete records and cost documents for all approved work must be maintained for at least 3 Record Retention years from the date the last project was completed or from the date final payment was

received whichever is later

P The subgrantee is requesting direct administrative costs that are directly chargeable to Direct this specific project Associated eligible work is related to administration of the PA

Administrative project only and in accordance with 44CFR 1322 These costs are treated consistently Costs and uniformly as direct costs in all federal awards and other subgrantee activities and are

not included in any approved indirect cost rates No Mitigation Opportunities Identified because r PW is for Emergency Work - Mitigation not eligible

Mitigation r Work already completed and no add-on mitigation is feasible r Mitigation not technically feasible R1 Applicant has decided not to incorporate mitigation

CEF This project was estimated using the Cost Estimated Format (CEF)

This project was not estimated using the CEF because

CEF - Not Used Ri The PW is a small project r The PW is for Emergency Work r The work is greater than 90 complete at the time of inspection

r

r

r

r

r

r

r

r

PREPARED BY Robert Rav ITITLE Project Specialist National PW Template V22 February 2011 Excel 2007

FEMA Fonn 90-120

FEDERAL EMERGENCY MANAGEMENT AGENCY

SPECIAL CONSIDERATIONS DISASTER I APPLICANT NAME I PWREFNOI FIPS NO I DATE

1952 I CA I East Valley Water District EVWD-1 I 071-0014E-OOI I 04111111

1 Does the damaged facility or item of work have insurance andor is it an insurable risk (eg buildings equipment vehicles etc)

( Yes No rmiddot Unsure

2 Is the damaged facility located within a floodplain or coastal high hazard area or does it have an impact on a floodplain or wetland

rYes r No r Unsure

3 Is the damaged facility or item of work located within or adjacent to a Coastal Barrier Resource System Unit or an otherwise Protected Area

rYes r No n Unsure

4 Will the proposed facility repairsreconstruction change the pre-disaster condition (eg footprint material location capacity use or function)

rYes r No r Unsure

5 Does the applicant have a hazard mitigation proposal or would the applicant like technical assistance for a hazard proposal

rYes r No r Unsure

6 Is the damaged facility on the National Register of Historic Places or the state historic listing Is it older than 50 years Are there more similar buildings near the site

rYes r No r Unsure Facility Constructed In

7 Are there any pristine or undisturbed areas on or near the project site Are there large tracts of forestland

rYes r No C Unsure

8 Are there any hazardous materials at or adjacent to the damaged facility andor item of work

rYes r No r- Unsure

9 Are there any other environmentally or controversial issues associated with the damaged facility andor item of work

rYes r No r Unsure

PREPARED BY [Robert Ray National PW Toomplate V22 Foobruary 2011 Excel 2007

FEDERAL EMERGENCY MANAGEMENT AGENCY

COST SUMMARY RECORD APPLICANT PWREF NO CATEGORyi F[PS NO D[SASTER

East Vallev Water District EVWD-1 A 1 071-0014E-OO 19521 CA CLA[M COST COMMENTS (FEMA USE ONLY) ELlG[BLE COSTS

FORCE ACCOUNT LABOR $ shy $ shyREGULAR TIME

FORCE ACCOUNT LABOR $ shy $ shyOVERTIME

FORCE ACCOUNT $ shy $ shyEQU[PMENT

MATER[ALS $ shy $ shy

RENTAL EQU[PMENT $ shy $ shy

CONTRACTS $ 783088 $ 783088

TOTAL $ 783088 $ 783088

[ certify that the above information was transcribed from timesheets payroll records equipment log invoices stock records or other documents which are available for audit Certified by Tit[e Date

Safety Requ[atory Affairs Officer Apoiicants records have been reviewed and found correct with the exceotions as noted Garv Sturdivan

Nationa PW Template V22 February 2011 Excel 2007

FEMA Fo 90 91 DEC 08~ US DEPARTMENT OF HOMELAND SECURITY

FEDERAL EMERGENCY MANAGEMENT AGENCY

PROJECT WORKSHEET PAPERWORK BURDEN DISCLOSURE NOTICE

Public reporting burden for this form is estimated to average 90 minutes per response Burden means the time effort and financial resources expended by persons to generate maintain disclose or to provide information to us You may send comments regarding the burden estimate or any aspect of the collection including suggestions for reducing the burden to Information Collections Management US Department of Homeland Security Federal Emergency Management Agency 500 C Street SW Washington DC 20472 Paperwork Reduction Project (OMS Control Number 1660-0017) You are not required to respond to this collection of information unless a valid OMS number appears in the upper right comer of this form NOTE Do not send your completed questionnaire to this address

DECLARATION NO PWREFNO DATE FIPS NO CATEGORY EMMIE NO

FEMA 1952 DR CA EVWD-1 041111 071-0014E-OO A

APPLICANT WORK COMPLETED AS OF

East Valiey Water District DATE PE CENT 030411 I 100

DAMAGED FACILITY COUNTY

Debris San Bernardino

LOCATION LATITUDE LONGITUDE

Plant 146 3410894 -11717378

Was this site previously damaged Ves No euro Unsure

DAMAGE DESCRIPTION AND DIMENSIONS THIS PW IS WRITTEN TO ADDRESS ITEM 1 OF THE EAST VALLEV WATER DISTRIC~tJST OF PROJECTS PW EVWD-1G WILL ADDRESS THE PERMANENT WORK AT PLANT 146 h l re+e(ISmiddotmiddot ~~I

jU-l f ~ f Heavy rains from the event caused mud flows that entered ~he ~y flowing thru the gate into the facility The facflfty is a concrete block walled area with water pumps in two areas The total area within the walled facility is approx 37500 SF and the debris covered approx 60 of the area at 3 feet deep(approx 2500CV of debris)

SCOPE OF WORK Fund at 75

COMPLETED WORK

The Applicant used a contractor selected by the bid process to pick up the 2500 CY of mud debris and deliver it to 7900 Boulder Ave -Highand Ca where the City of Highland has provided written permission to EWVD to deposit debris

0~ PROJECT COST

ITEM CODE NARRATIVE QUANTITY UNIT UNIT PRICE COST COMPLETED WORK $ -

1 9001 Contract 1 LS $ 783088 $ 783088 $ --$ -

-shy

$ -$ -

middot7 $ -4)66 9901 Direct Administration costs 100 LS $ 9054 $ 9054

$ - ~--

$1-shy --__--shy 1-- $

--- ~-

-SUBTOTAL FROM COST CONTINUATION PAGElS) $ -

ill h f Ibull TOTAL PROJECT COST $ 792142

PREPARED BY Robert Ray APJ IG~ 1tIJlI TITLE Project Specialist

FEMA PAC CREW LEADER Tim Smith J STATE PAC CREW LEADER fi

Dave Rogers

APPLICANT Gary Sturdivan --~ TVfZUA dL 0 DATE ~ PHONE 909-806-4087

National PW Template V22 FetlOJary 2011 Excel 2007 REPLACES ALL PREVIOUS VERSIONS r 7

FEMA Om ~O_~1 tl5C 08

US DEPARTMENT OF HOMELAND o~unl FEDERAL EMERGENCY MANAGEMENT AGENCY

PROJECT WORKSHEET I NOTICE

IpUbliC burden for this form is estimated to average 90 minutes per response Burden means the time effort and financial resources expended by persons ~tI~i~taimiddot~ I ~r to provi~e information to us You may send comments regarding the burden estimate or any aspect of the collection including suggestions fo r~~~~~the Iburden to InfOrm~tlon C~lIectlOnS Management US Department of Homeland Security Federal Emergency Management Agency 500 C Street SW Washington DC 20472 lri~ Redudi0rr~~~~~MB Control Number 1660--0017) You are n~~~~qUired to respond to this collection of information unless a valid OMS number appears in the uppe loom Do 001 sod yo I s to addlaquo

tATION NO PW REF NO DATE FIPS NO -A -UKY -EMMIENo FEMA 1952 DR CA EVWDmiddot1 041111 071middot0014Emiddot00 A

n WORK TED AS OF

lEast Valley Water District _OAT 100

) FACILITY

IDebris [san Bernardino

LOCATION LATITUDE LONGiffi5E Plant 146 3410894 middot11717378

Iwas this site previousy damaged rYes r No r Unsure

N~ iTHISPW-rS WKII I eN TO ITEM 1 OF THE EAST VALLEY WATER UICi I KI- LlSTOF TS PWtvvvIFle WILL

THE PERMANENT WORK AT PLANT 146

Heavy rains from the event caused mud flows that entered Plant 146 a well water pumping facility by flowing thru the gate into the faCility ~ris facilitY is a concrete bock w~led area with water pumps in two areas The total area within the waUed facility is approx 37500 SF and the covereo approx 60 of the area at 3 feet deep(approx 2500CY of debris)

K

Fund at 75 WORK

IThe Applicant used a contractor selected by the bid process to pick up the 2500 CY of mud debris and deliver it to 7900 Boulder Ave 1igr1o Ca where the City of Highland has provided written pemnission to EVWD to deposit debris

TCOST ITEM ODE NAKKA IIIiE_ Ql UNIT UNI PRICE -COST

TED WORK middot 1 9001 1 LS $

middot middot middot middot middot

2 I 9901 i 1 cests 100 LS $ 89 8903 middot middot middot

SiJBTor FROivI COST CONTINUATION F middot

J I i) 11 TOTAL PROJECT COSl 791991

BY RObrtRavO~~ y O ITlTLE Project Specialist

IFEMA PAC CREW LEADER Tim Smith 1 rld ISTATE PAC CREW LEADER Dave Rogers

nO e GalY IDATE IpHONE 909-806-4087

ooin y 2011 E)ltcel 2007 K~~ ~~O

FEDERAL EMERGENCY MANAGEMENT AGENCY

SCOPE NOTES APPLICANT PWREF NO CATEGORY FIPS NO DISASTER

East Valley Water District EVWD-1 A 071-0014E-OO 1952 1 CA

Check next to appropriate comment for Data Specialist to add to the Scope of Work Topic Comment

Complete records and cost documents for all approved work must be maintained for at least 3 Record Retention years from the date the last project was completed or from the date final payment was

received whichever is later

P The subgrantee is requesting direct administrative costs that are directly chargeable to Direct this specific project Associated eligible work is related to administration of the PA

Administrative project only and in accordance with 44CFR 1322 These costs are treated consistently Costs and uniformly as direct costs in all federal awards and other subgrantee activities and are

not included in any approved indirect cost rates No Mitigation Opportunities Identified because r PW is for Emergency Work - Mitigation not eligible

Mitigation r Work already completed and no add-on mitigation is feasible r Mitigation not technically feasible R1 Applicant has decided not to incorporate mitigation

CEF This project was estimated using the Cost Estimated Format (CEF)

This project was not estimated using the CEF because

CEF - Not Used Ri The PW is a small project r The PW is for Emergency Work r The work is greater than 90 complete at the time of inspection

r

r

r

r

r

r

r

r

PREPARED BY Robert Rav ITITLE Project Specialist National PW Template V22 February 2011 Excel 2007

FEMA Fonn 90-120

FEDERAL EMERGENCY MANAGEMENT AGENCY

SPECIAL CONSIDERATIONS DISASTER I APPLICANT NAME I PWREFNOI FIPS NO I DATE

1952 I CA I East Valley Water District EVWD-1 I 071-0014E-OOI I 04111111

1 Does the damaged facility or item of work have insurance andor is it an insurable risk (eg buildings equipment vehicles etc)

( Yes No rmiddot Unsure

2 Is the damaged facility located within a floodplain or coastal high hazard area or does it have an impact on a floodplain or wetland

rYes r No r Unsure

3 Is the damaged facility or item of work located within or adjacent to a Coastal Barrier Resource System Unit or an otherwise Protected Area

rYes r No n Unsure

4 Will the proposed facility repairsreconstruction change the pre-disaster condition (eg footprint material location capacity use or function)

rYes r No r Unsure

5 Does the applicant have a hazard mitigation proposal or would the applicant like technical assistance for a hazard proposal

rYes r No r Unsure

6 Is the damaged facility on the National Register of Historic Places or the state historic listing Is it older than 50 years Are there more similar buildings near the site

rYes r No r Unsure Facility Constructed In

7 Are there any pristine or undisturbed areas on or near the project site Are there large tracts of forestland

rYes r No C Unsure

8 Are there any hazardous materials at or adjacent to the damaged facility andor item of work

rYes r No r- Unsure

9 Are there any other environmentally or controversial issues associated with the damaged facility andor item of work

rYes r No r Unsure

PREPARED BY [Robert Ray National PW Toomplate V22 Foobruary 2011 Excel 2007

FEDERAL EMERGENCY MANAGEMENT AGENCY

COST SUMMARY RECORD APPLICANT PWREF NO CATEGORyi F[PS NO D[SASTER

East Vallev Water District EVWD-1 A 1 071-0014E-OO 19521 CA CLA[M COST COMMENTS (FEMA USE ONLY) ELlG[BLE COSTS

FORCE ACCOUNT LABOR $ shy $ shyREGULAR TIME

FORCE ACCOUNT LABOR $ shy $ shyOVERTIME

FORCE ACCOUNT $ shy $ shyEQU[PMENT

MATER[ALS $ shy $ shy

RENTAL EQU[PMENT $ shy $ shy

CONTRACTS $ 783088 $ 783088

TOTAL $ 783088 $ 783088

[ certify that the above information was transcribed from timesheets payroll records equipment log invoices stock records or other documents which are available for audit Certified by Tit[e Date

Safety Requ[atory Affairs Officer Apoiicants records have been reviewed and found correct with the exceotions as noted Garv Sturdivan

Nationa PW Template V22 February 2011 Excel 2007

FEMA Om ~O_~1 tl5C 08

US DEPARTMENT OF HOMELAND o~unl FEDERAL EMERGENCY MANAGEMENT AGENCY

PROJECT WORKSHEET I NOTICE

IpUbliC burden for this form is estimated to average 90 minutes per response Burden means the time effort and financial resources expended by persons ~tI~i~taimiddot~ I ~r to provi~e information to us You may send comments regarding the burden estimate or any aspect of the collection including suggestions fo r~~~~~the Iburden to InfOrm~tlon C~lIectlOnS Management US Department of Homeland Security Federal Emergency Management Agency 500 C Street SW Washington DC 20472 lri~ Redudi0rr~~~~~MB Control Number 1660--0017) You are n~~~~qUired to respond to this collection of information unless a valid OMS number appears in the uppe loom Do 001 sod yo I s to addlaquo

tATION NO PW REF NO DATE FIPS NO -A -UKY -EMMIENo FEMA 1952 DR CA EVWDmiddot1 041111 071middot0014Emiddot00 A

n WORK TED AS OF

lEast Valley Water District _OAT 100

) FACILITY

IDebris [san Bernardino

LOCATION LATITUDE LONGiffi5E Plant 146 3410894 middot11717378

Iwas this site previousy damaged rYes r No r Unsure

N~ iTHISPW-rS WKII I eN TO ITEM 1 OF THE EAST VALLEY WATER UICi I KI- LlSTOF TS PWtvvvIFle WILL

THE PERMANENT WORK AT PLANT 146

Heavy rains from the event caused mud flows that entered Plant 146 a well water pumping facility by flowing thru the gate into the faCility ~ris facilitY is a concrete bock w~led area with water pumps in two areas The total area within the waUed facility is approx 37500 SF and the covereo approx 60 of the area at 3 feet deep(approx 2500CY of debris)

K

Fund at 75 WORK

IThe Applicant used a contractor selected by the bid process to pick up the 2500 CY of mud debris and deliver it to 7900 Boulder Ave 1igr1o Ca where the City of Highland has provided written pemnission to EVWD to deposit debris

TCOST ITEM ODE NAKKA IIIiE_ Ql UNIT UNI PRICE -COST

TED WORK middot 1 9001 1 LS $

middot middot middot middot middot

2 I 9901 i 1 cests 100 LS $ 89 8903 middot middot middot

SiJBTor FROivI COST CONTINUATION F middot

J I i) 11 TOTAL PROJECT COSl 791991

BY RObrtRavO~~ y O ITlTLE Project Specialist

IFEMA PAC CREW LEADER Tim Smith 1 rld ISTATE PAC CREW LEADER Dave Rogers

nO e GalY IDATE IpHONE 909-806-4087

ooin y 2011 E)ltcel 2007 K~~ ~~O

FEDERAL EMERGENCY MANAGEMENT AGENCY

SCOPE NOTES APPLICANT PWREF NO CATEGORY FIPS NO DISASTER

East Valley Water District EVWD-1 A 071-0014E-OO 1952 1 CA

Check next to appropriate comment for Data Specialist to add to the Scope of Work Topic Comment

Complete records and cost documents for all approved work must be maintained for at least 3 Record Retention years from the date the last project was completed or from the date final payment was

received whichever is later

P The subgrantee is requesting direct administrative costs that are directly chargeable to Direct this specific project Associated eligible work is related to administration of the PA

Administrative project only and in accordance with 44CFR 1322 These costs are treated consistently Costs and uniformly as direct costs in all federal awards and other subgrantee activities and are

not included in any approved indirect cost rates No Mitigation Opportunities Identified because r PW is for Emergency Work - Mitigation not eligible

Mitigation r Work already completed and no add-on mitigation is feasible r Mitigation not technically feasible R1 Applicant has decided not to incorporate mitigation

CEF This project was estimated using the Cost Estimated Format (CEF)

This project was not estimated using the CEF because

CEF - Not Used Ri The PW is a small project r The PW is for Emergency Work r The work is greater than 90 complete at the time of inspection

r

r

r

r

r

r

r

r

PREPARED BY Robert Rav ITITLE Project Specialist National PW Template V22 February 2011 Excel 2007

FEMA Fonn 90-120

FEDERAL EMERGENCY MANAGEMENT AGENCY

SPECIAL CONSIDERATIONS DISASTER I APPLICANT NAME I PWREFNOI FIPS NO I DATE

1952 I CA I East Valley Water District EVWD-1 I 071-0014E-OOI I 04111111

1 Does the damaged facility or item of work have insurance andor is it an insurable risk (eg buildings equipment vehicles etc)

( Yes No rmiddot Unsure

2 Is the damaged facility located within a floodplain or coastal high hazard area or does it have an impact on a floodplain or wetland

rYes r No r Unsure

3 Is the damaged facility or item of work located within or adjacent to a Coastal Barrier Resource System Unit or an otherwise Protected Area

rYes r No n Unsure

4 Will the proposed facility repairsreconstruction change the pre-disaster condition (eg footprint material location capacity use or function)

rYes r No r Unsure

5 Does the applicant have a hazard mitigation proposal or would the applicant like technical assistance for a hazard proposal

rYes r No r Unsure

6 Is the damaged facility on the National Register of Historic Places or the state historic listing Is it older than 50 years Are there more similar buildings near the site

rYes r No r Unsure Facility Constructed In

7 Are there any pristine or undisturbed areas on or near the project site Are there large tracts of forestland

rYes r No C Unsure

8 Are there any hazardous materials at or adjacent to the damaged facility andor item of work

rYes r No r- Unsure

9 Are there any other environmentally or controversial issues associated with the damaged facility andor item of work

rYes r No r Unsure

PREPARED BY [Robert Ray National PW Toomplate V22 Foobruary 2011 Excel 2007

FEDERAL EMERGENCY MANAGEMENT AGENCY

COST SUMMARY RECORD APPLICANT PWREF NO CATEGORyi F[PS NO D[SASTER

East Vallev Water District EVWD-1 A 1 071-0014E-OO 19521 CA CLA[M COST COMMENTS (FEMA USE ONLY) ELlG[BLE COSTS

FORCE ACCOUNT LABOR $ shy $ shyREGULAR TIME

FORCE ACCOUNT LABOR $ shy $ shyOVERTIME

FORCE ACCOUNT $ shy $ shyEQU[PMENT

MATER[ALS $ shy $ shy

RENTAL EQU[PMENT $ shy $ shy

CONTRACTS $ 783088 $ 783088

TOTAL $ 783088 $ 783088

[ certify that the above information was transcribed from timesheets payroll records equipment log invoices stock records or other documents which are available for audit Certified by Tit[e Date

Safety Requ[atory Affairs Officer Apoiicants records have been reviewed and found correct with the exceotions as noted Garv Sturdivan

Nationa PW Template V22 February 2011 Excel 2007

FEDERAL EMERGENCY MANAGEMENT AGENCY

SCOPE NOTES APPLICANT PWREF NO CATEGORY FIPS NO DISASTER

East Valley Water District EVWD-1 A 071-0014E-OO 1952 1 CA

Check next to appropriate comment for Data Specialist to add to the Scope of Work Topic Comment

Complete records and cost documents for all approved work must be maintained for at least 3 Record Retention years from the date the last project was completed or from the date final payment was

received whichever is later

P The subgrantee is requesting direct administrative costs that are directly chargeable to Direct this specific project Associated eligible work is related to administration of the PA

Administrative project only and in accordance with 44CFR 1322 These costs are treated consistently Costs and uniformly as direct costs in all federal awards and other subgrantee activities and are

not included in any approved indirect cost rates No Mitigation Opportunities Identified because r PW is for Emergency Work - Mitigation not eligible

Mitigation r Work already completed and no add-on mitigation is feasible r Mitigation not technically feasible R1 Applicant has decided not to incorporate mitigation

CEF This project was estimated using the Cost Estimated Format (CEF)

This project was not estimated using the CEF because

CEF - Not Used Ri The PW is a small project r The PW is for Emergency Work r The work is greater than 90 complete at the time of inspection

r

r

r

r

r

r

r

r

PREPARED BY Robert Rav ITITLE Project Specialist National PW Template V22 February 2011 Excel 2007

FEMA Fonn 90-120

FEDERAL EMERGENCY MANAGEMENT AGENCY

SPECIAL CONSIDERATIONS DISASTER I APPLICANT NAME I PWREFNOI FIPS NO I DATE

1952 I CA I East Valley Water District EVWD-1 I 071-0014E-OOI I 04111111

1 Does the damaged facility or item of work have insurance andor is it an insurable risk (eg buildings equipment vehicles etc)

( Yes No rmiddot Unsure

2 Is the damaged facility located within a floodplain or coastal high hazard area or does it have an impact on a floodplain or wetland

rYes r No r Unsure

3 Is the damaged facility or item of work located within or adjacent to a Coastal Barrier Resource System Unit or an otherwise Protected Area

rYes r No n Unsure

4 Will the proposed facility repairsreconstruction change the pre-disaster condition (eg footprint material location capacity use or function)

rYes r No r Unsure

5 Does the applicant have a hazard mitigation proposal or would the applicant like technical assistance for a hazard proposal

rYes r No r Unsure

6 Is the damaged facility on the National Register of Historic Places or the state historic listing Is it older than 50 years Are there more similar buildings near the site

rYes r No r Unsure Facility Constructed In

7 Are there any pristine or undisturbed areas on or near the project site Are there large tracts of forestland

rYes r No C Unsure

8 Are there any hazardous materials at or adjacent to the damaged facility andor item of work

rYes r No r- Unsure

9 Are there any other environmentally or controversial issues associated with the damaged facility andor item of work

rYes r No r Unsure

PREPARED BY [Robert Ray National PW Toomplate V22 Foobruary 2011 Excel 2007

FEDERAL EMERGENCY MANAGEMENT AGENCY

COST SUMMARY RECORD APPLICANT PWREF NO CATEGORyi F[PS NO D[SASTER

East Vallev Water District EVWD-1 A 1 071-0014E-OO 19521 CA CLA[M COST COMMENTS (FEMA USE ONLY) ELlG[BLE COSTS

FORCE ACCOUNT LABOR $ shy $ shyREGULAR TIME

FORCE ACCOUNT LABOR $ shy $ shyOVERTIME

FORCE ACCOUNT $ shy $ shyEQU[PMENT

MATER[ALS $ shy $ shy

RENTAL EQU[PMENT $ shy $ shy

CONTRACTS $ 783088 $ 783088

TOTAL $ 783088 $ 783088

[ certify that the above information was transcribed from timesheets payroll records equipment log invoices stock records or other documents which are available for audit Certified by Tit[e Date

Safety Requ[atory Affairs Officer Apoiicants records have been reviewed and found correct with the exceotions as noted Garv Sturdivan

Nationa PW Template V22 February 2011 Excel 2007

FEMA Fonn 90-120

FEDERAL EMERGENCY MANAGEMENT AGENCY

SPECIAL CONSIDERATIONS DISASTER I APPLICANT NAME I PWREFNOI FIPS NO I DATE

1952 I CA I East Valley Water District EVWD-1 I 071-0014E-OOI I 04111111

1 Does the damaged facility or item of work have insurance andor is it an insurable risk (eg buildings equipment vehicles etc)

( Yes No rmiddot Unsure

2 Is the damaged facility located within a floodplain or coastal high hazard area or does it have an impact on a floodplain or wetland

rYes r No r Unsure

3 Is the damaged facility or item of work located within or adjacent to a Coastal Barrier Resource System Unit or an otherwise Protected Area

rYes r No n Unsure

4 Will the proposed facility repairsreconstruction change the pre-disaster condition (eg footprint material location capacity use or function)

rYes r No r Unsure

5 Does the applicant have a hazard mitigation proposal or would the applicant like technical assistance for a hazard proposal

rYes r No r Unsure

6 Is the damaged facility on the National Register of Historic Places or the state historic listing Is it older than 50 years Are there more similar buildings near the site

rYes r No r Unsure Facility Constructed In

7 Are there any pristine or undisturbed areas on or near the project site Are there large tracts of forestland

rYes r No C Unsure

8 Are there any hazardous materials at or adjacent to the damaged facility andor item of work

rYes r No r- Unsure

9 Are there any other environmentally or controversial issues associated with the damaged facility andor item of work

rYes r No r Unsure

PREPARED BY [Robert Ray National PW Toomplate V22 Foobruary 2011 Excel 2007

FEDERAL EMERGENCY MANAGEMENT AGENCY

COST SUMMARY RECORD APPLICANT PWREF NO CATEGORyi F[PS NO D[SASTER

East Vallev Water District EVWD-1 A 1 071-0014E-OO 19521 CA CLA[M COST COMMENTS (FEMA USE ONLY) ELlG[BLE COSTS

FORCE ACCOUNT LABOR $ shy $ shyREGULAR TIME

FORCE ACCOUNT LABOR $ shy $ shyOVERTIME

FORCE ACCOUNT $ shy $ shyEQU[PMENT

MATER[ALS $ shy $ shy

RENTAL EQU[PMENT $ shy $ shy

CONTRACTS $ 783088 $ 783088

TOTAL $ 783088 $ 783088

[ certify that the above information was transcribed from timesheets payroll records equipment log invoices stock records or other documents which are available for audit Certified by Tit[e Date

Safety Requ[atory Affairs Officer Apoiicants records have been reviewed and found correct with the exceotions as noted Garv Sturdivan

Nationa PW Template V22 February 2011 Excel 2007

FEDERAL EMERGENCY MANAGEMENT AGENCY

COST SUMMARY RECORD APPLICANT PWREF NO CATEGORyi F[PS NO D[SASTER

East Vallev Water District EVWD-1 A 1 071-0014E-OO 19521 CA CLA[M COST COMMENTS (FEMA USE ONLY) ELlG[BLE COSTS

FORCE ACCOUNT LABOR $ shy $ shyREGULAR TIME

FORCE ACCOUNT LABOR $ shy $ shyOVERTIME

FORCE ACCOUNT $ shy $ shyEQU[PMENT

MATER[ALS $ shy $ shy

RENTAL EQU[PMENT $ shy $ shy

CONTRACTS $ 783088 $ 783088

TOTAL $ 783088 $ 783088

[ certify that the above information was transcribed from timesheets payroll records equipment log invoices stock records or other documents which are available for audit Certified by Tit[e Date

Safety Requ[atory Affairs Officer Apoiicants records have been reviewed and found correct with the exceotions as noted Garv Sturdivan

Nationa PW Template V22 February 2011 Excel 2007

Applicant EValley Water Dis Project Reference EVWD-1 FIPS 071-0014E-OO

Date Activity Name Job Title Reg Hrs Reg Rate Ben Rate Labor Cost

Equipme nt ID Size FEMACC

Hrs 1 Mileage Rate

Equip Cost

314111 Site Visit Gary Sturdivan

Safety and Reg Affairs Director

1 $4578 6390 $7503 2008 GMC Sierra Truck

34 ton 8801 1 $1400 $1400

$000 $000 $000 $000 $000 $000 $000 $000 $000 $000 $000 $000 $000 $000 $000 $000 $000 $000 $000 $000 $000 $000 $000 $000 $000 $000 $000 $000 $000 $000 $000 $000 $000 $000 $000 $000 $000 $000 $000 $000

Subtotal $7503 $1400 TOTAL OF LABOR AND EQUIPMENT $8903

I CERTIFY THAT THE INFORMATION ABOVE WAS TRANSCRIBED FROM PAYROLL RECORDS OR OTHER DOCUMENTS WHICH ARE AVAILABLE FOR AUDIT CERTIFIED BY I TITLE I DATE

---shy

Fringe Benefit Calculations

There are other ways to calculate Fringe Benefits this is only one

Applicant East Valley Water District

FIPS No 071-0014E-OO

Disaster Number 1952

Name of Employee IAII employees I All calculations are based on the amount that onlv the emplover pavs

Most figures can be obtained from accounting dept

1Blocks that you fil1 in = I Regular Time Overtime See note 1

Work hrs per year (2080 hrs is normal work year) 2080 Pay Hour $ Basic Pay Annualized $

Vacation - daysyear days middot Holidays - daysyear days bull Sick Leave - daysyear days Retirement ( of annual salary) bull Social Security - fixed rate Unemployment - fixed rate Workmans Comp bull Health Insurance $ mo employee bull Life Insurance $ mo employee 00 Dental $ mo emp loyee bull Vision $ mo employee bull 401KPIan

bull

middot Total Percent = 1

p391 ltmiddotmiddotmiddot16

Typical ranges 30-60 7-30

I certify that the information above was transcribed from payroll records or other documents which are available for audit

Certified by

Title

Note 1 Vacation Holidays Sick Leave and Insurance are not figured into overtime benefits 401 K plans or similar type plans sometimes are not included in Overtime Retirement Unemployment and Workmans Comp are sometimes included in overtime benefits

FEDERAL EMERGENCY MANAGEMENT AGENCY

CONTRACT SUMMARY RECORD APPLICANT PW REF NO CATEGORY FIPS NO DISASTER

East Valley Water District EVWD-1 A 071-0014E-OO I 1952 I CA

i Vendor Description of work peliormed Invoice No Dates Worked Total Invoice Total Claim Comments

Amount Amount

Roquet Paving Inc Clean dirt and debris from Plant-146 and

10311 156711 $783088 $783088haul to Hiqhland dumpsite

Total Cost $783088

Total From All Pages $783088 Certified By Title Date

Gary Sturdivan Safety Requlatory Affairs Officer I certify that the above information was transcribed from daily logs vendor Invoices or other documents which are available for audit ~IIII PW ~h N Template V2 ry 2011 Excel M17

CONTRACTS PAGE 1 OF 1

APPLICANT

FEDERAL EMERGENCY MAAAGEMENT AGENCY

BACKUP DOCUMENTATION DECLARATION NO PWREF NO DATE FIPS NO CATEGORY EMMIE NO

CA EVWO-1 071-0014E-OO041111 A

COUNTY

East Valley Water District San Bernardino

TITLE Project Specialist PREPARED BY Robert Ray National PIN Template V22 February 2011 Eltcel 2007

~~ IVcentG~~~ED lt - [)~ Jtf~ Roquet PavIng Inc ~ IJAN 212011 ~ INVbICE PO Box 887 Colton CA 92324 lf$ Watermiddot (909) 783-4477 - Fax (909) _ 2lt 1-shy783-0267 jJ ~

8-(G~

BisttItt -

JOB LOCATION

Plant 146 Highland CA

DATE ~ 11112011 010311

I] --shy

~

BILL TO

East Valley Water District PO Box 3427 San Bernardino CA 92413

TERMS JOB COMPLETION DATE

Upon Completion 11712011

DESCRIPTION

Clean din and debris from area in front of plant and inside plant and haul to Highland dumpsite

0105111 - Wednesday JD210 LE Loader - 3 hrs $IIO4llhour CAT Skidster with broom - 4 hrs $11500Ihour 3 Axle Dump - 4 hrs$12199Ihour 3 Axle Dump - 3 hrs$12199Ihour

0]0611 - Thursday _BATCH -REE n PIRIDD

J(CY)o JCflk9l( ) J(JD210 LE Loader - 8 hrs $11 041lhour JD210LE Loader- 8 hrs $110Allhour Cat Skidster with broom - 8 hrs $11500Ihour 3 Axle Dump - 8 hrs $121991hour 3 Axle Dump - 4 hrs $12199Ihour Labor 1 man - 4 hrs $5446

OIl071l1-Friday CAT Skidster with broom - 700 hrs $11500Ihour Labor 2 men - 7 hrs $5446Ihour Move in amp out 2 hrs$125001hr

4 COM SIGNED ~-3

)l Thank you for your business Total

JOB NUMBER

0101-11

AMOUNT

33123 46000 48796 36597

TP J 88328

88328 92000 97592 48796 21784

80500 76244 25000

PLETfD (I DATE 1--

$783088

Fringe Benefit Calculations

There are other ways to calculate Fringe Benefits this is only one

Applicant East Valley Water District

FIPS No 071-0014E-OO

Disaster Number 1952

Name of Employee IAII employees I All calculations are based on the amount that onlv the emplover pavs

Most figures can be obtained from accounting dept

1Blocks that you fil1 in = I Regular Time Overtime See note 1

Work hrs per year (2080 hrs is normal work year) 2080 Pay Hour $ Basic Pay Annualized $

Vacation - daysyear days middot Holidays - daysyear days bull Sick Leave - daysyear days Retirement ( of annual salary) bull Social Security - fixed rate Unemployment - fixed rate Workmans Comp bull Health Insurance $ mo employee bull Life Insurance $ mo employee 00 Dental $ mo emp loyee bull Vision $ mo employee bull 401KPIan

bull

middot Total Percent = 1

p391 ltmiddotmiddotmiddot16

Typical ranges 30-60 7-30

I certify that the information above was transcribed from payroll records or other documents which are available for audit

Certified by

Title

Note 1 Vacation Holidays Sick Leave and Insurance are not figured into overtime benefits 401 K plans or similar type plans sometimes are not included in Overtime Retirement Unemployment and Workmans Comp are sometimes included in overtime benefits

FEDERAL EMERGENCY MANAGEMENT AGENCY

CONTRACT SUMMARY RECORD APPLICANT PW REF NO CATEGORY FIPS NO DISASTER

East Valley Water District EVWD-1 A 071-0014E-OO I 1952 I CA

i Vendor Description of work peliormed Invoice No Dates Worked Total Invoice Total Claim Comments

Amount Amount

Roquet Paving Inc Clean dirt and debris from Plant-146 and

10311 156711 $783088 $783088haul to Hiqhland dumpsite

Total Cost $783088

Total From All Pages $783088 Certified By Title Date

Gary Sturdivan Safety Requlatory Affairs Officer I certify that the above information was transcribed from daily logs vendor Invoices or other documents which are available for audit ~IIII PW ~h N Template V2 ry 2011 Excel M17

CONTRACTS PAGE 1 OF 1

APPLICANT

FEDERAL EMERGENCY MAAAGEMENT AGENCY

BACKUP DOCUMENTATION DECLARATION NO PWREF NO DATE FIPS NO CATEGORY EMMIE NO

CA EVWO-1 071-0014E-OO041111 A

COUNTY

East Valley Water District San Bernardino

TITLE Project Specialist PREPARED BY Robert Ray National PIN Template V22 February 2011 Eltcel 2007

~~ IVcentG~~~ED lt - [)~ Jtf~ Roquet PavIng Inc ~ IJAN 212011 ~ INVbICE PO Box 887 Colton CA 92324 lf$ Watermiddot (909) 783-4477 - Fax (909) _ 2lt 1-shy783-0267 jJ ~

8-(G~

BisttItt -

JOB LOCATION

Plant 146 Highland CA

DATE ~ 11112011 010311

I] --shy

~

BILL TO

East Valley Water District PO Box 3427 San Bernardino CA 92413

TERMS JOB COMPLETION DATE

Upon Completion 11712011

DESCRIPTION

Clean din and debris from area in front of plant and inside plant and haul to Highland dumpsite

0105111 - Wednesday JD210 LE Loader - 3 hrs $IIO4llhour CAT Skidster with broom - 4 hrs $11500Ihour 3 Axle Dump - 4 hrs$12199Ihour 3 Axle Dump - 3 hrs$12199Ihour

0]0611 - Thursday _BATCH -REE n PIRIDD

J(CY)o JCflk9l( ) J(JD210 LE Loader - 8 hrs $11 041lhour JD210LE Loader- 8 hrs $110Allhour Cat Skidster with broom - 8 hrs $11500Ihour 3 Axle Dump - 8 hrs $121991hour 3 Axle Dump - 4 hrs $12199Ihour Labor 1 man - 4 hrs $5446

OIl071l1-Friday CAT Skidster with broom - 700 hrs $11500Ihour Labor 2 men - 7 hrs $5446Ihour Move in amp out 2 hrs$125001hr

4 COM SIGNED ~-3

)l Thank you for your business Total

JOB NUMBER

0101-11

AMOUNT

33123 46000 48796 36597

TP J 88328

88328 92000 97592 48796 21784

80500 76244 25000

PLETfD (I DATE 1--

$783088

FEDERAL EMERGENCY MANAGEMENT AGENCY

CONTRACT SUMMARY RECORD APPLICANT PW REF NO CATEGORY FIPS NO DISASTER

East Valley Water District EVWD-1 A 071-0014E-OO I 1952 I CA

i Vendor Description of work peliormed Invoice No Dates Worked Total Invoice Total Claim Comments

Amount Amount

Roquet Paving Inc Clean dirt and debris from Plant-146 and

10311 156711 $783088 $783088haul to Hiqhland dumpsite

Total Cost $783088

Total From All Pages $783088 Certified By Title Date

Gary Sturdivan Safety Requlatory Affairs Officer I certify that the above information was transcribed from daily logs vendor Invoices or other documents which are available for audit ~IIII PW ~h N Template V2 ry 2011 Excel M17

CONTRACTS PAGE 1 OF 1

APPLICANT

FEDERAL EMERGENCY MAAAGEMENT AGENCY

BACKUP DOCUMENTATION DECLARATION NO PWREF NO DATE FIPS NO CATEGORY EMMIE NO

CA EVWO-1 071-0014E-OO041111 A

COUNTY

East Valley Water District San Bernardino

TITLE Project Specialist PREPARED BY Robert Ray National PIN Template V22 February 2011 Eltcel 2007

~~ IVcentG~~~ED lt - [)~ Jtf~ Roquet PavIng Inc ~ IJAN 212011 ~ INVbICE PO Box 887 Colton CA 92324 lf$ Watermiddot (909) 783-4477 - Fax (909) _ 2lt 1-shy783-0267 jJ ~

8-(G~

BisttItt -

JOB LOCATION

Plant 146 Highland CA

DATE ~ 11112011 010311

I] --shy

~

BILL TO

East Valley Water District PO Box 3427 San Bernardino CA 92413

TERMS JOB COMPLETION DATE

Upon Completion 11712011

DESCRIPTION

Clean din and debris from area in front of plant and inside plant and haul to Highland dumpsite

0105111 - Wednesday JD210 LE Loader - 3 hrs $IIO4llhour CAT Skidster with broom - 4 hrs $11500Ihour 3 Axle Dump - 4 hrs$12199Ihour 3 Axle Dump - 3 hrs$12199Ihour

0]0611 - Thursday _BATCH -REE n PIRIDD

J(CY)o JCflk9l( ) J(JD210 LE Loader - 8 hrs $11 041lhour JD210LE Loader- 8 hrs $110Allhour Cat Skidster with broom - 8 hrs $11500Ihour 3 Axle Dump - 8 hrs $121991hour 3 Axle Dump - 4 hrs $12199Ihour Labor 1 man - 4 hrs $5446

OIl071l1-Friday CAT Skidster with broom - 700 hrs $11500Ihour Labor 2 men - 7 hrs $5446Ihour Move in amp out 2 hrs$125001hr

4 COM SIGNED ~-3

)l Thank you for your business Total

JOB NUMBER

0101-11

AMOUNT

33123 46000 48796 36597

TP J 88328

88328 92000 97592 48796 21784

80500 76244 25000

PLETfD (I DATE 1--

$783088

APPLICANT

FEDERAL EMERGENCY MAAAGEMENT AGENCY

BACKUP DOCUMENTATION DECLARATION NO PWREF NO DATE FIPS NO CATEGORY EMMIE NO

CA EVWO-1 071-0014E-OO041111 A

COUNTY

East Valley Water District San Bernardino

TITLE Project Specialist PREPARED BY Robert Ray National PIN Template V22 February 2011 Eltcel 2007

~~ IVcentG~~~ED lt - [)~ Jtf~ Roquet PavIng Inc ~ IJAN 212011 ~ INVbICE PO Box 887 Colton CA 92324 lf$ Watermiddot (909) 783-4477 - Fax (909) _ 2lt 1-shy783-0267 jJ ~

8-(G~

BisttItt -

JOB LOCATION

Plant 146 Highland CA

DATE ~ 11112011 010311

I] --shy

~

BILL TO

East Valley Water District PO Box 3427 San Bernardino CA 92413

TERMS JOB COMPLETION DATE

Upon Completion 11712011

DESCRIPTION

Clean din and debris from area in front of plant and inside plant and haul to Highland dumpsite

0105111 - Wednesday JD210 LE Loader - 3 hrs $IIO4llhour CAT Skidster with broom - 4 hrs $11500Ihour 3 Axle Dump - 4 hrs$12199Ihour 3 Axle Dump - 3 hrs$12199Ihour

0]0611 - Thursday _BATCH -REE n PIRIDD

J(CY)o JCflk9l( ) J(JD210 LE Loader - 8 hrs $11 041lhour JD210LE Loader- 8 hrs $110Allhour Cat Skidster with broom - 8 hrs $11500Ihour 3 Axle Dump - 8 hrs $121991hour 3 Axle Dump - 4 hrs $12199Ihour Labor 1 man - 4 hrs $5446

OIl071l1-Friday CAT Skidster with broom - 700 hrs $11500Ihour Labor 2 men - 7 hrs $5446Ihour Move in amp out 2 hrs$125001hr

4 COM SIGNED ~-3

)l Thank you for your business Total

JOB NUMBER

0101-11

AMOUNT

33123 46000 48796 36597

TP J 88328

88328 92000 97592 48796 21784

80500 76244 25000

PLETfD (I DATE 1--

$783088

~~ IVcentG~~~ED lt - [)~ Jtf~ Roquet PavIng Inc ~ IJAN 212011 ~ INVbICE PO Box 887 Colton CA 92324 lf$ Watermiddot (909) 783-4477 - Fax (909) _ 2lt 1-shy783-0267 jJ ~

8-(G~

BisttItt -

JOB LOCATION

Plant 146 Highland CA

DATE ~ 11112011 010311

I] --shy

~

BILL TO

East Valley Water District PO Box 3427 San Bernardino CA 92413

TERMS JOB COMPLETION DATE

Upon Completion 11712011

DESCRIPTION

Clean din and debris from area in front of plant and inside plant and haul to Highland dumpsite

0105111 - Wednesday JD210 LE Loader - 3 hrs $IIO4llhour CAT Skidster with broom - 4 hrs $11500Ihour 3 Axle Dump - 4 hrs$12199Ihour 3 Axle Dump - 3 hrs$12199Ihour

0]0611 - Thursday _BATCH -REE n PIRIDD

J(CY)o JCflk9l( ) J(JD210 LE Loader - 8 hrs $11 041lhour JD210LE Loader- 8 hrs $110Allhour Cat Skidster with broom - 8 hrs $11500Ihour 3 Axle Dump - 8 hrs $121991hour 3 Axle Dump - 4 hrs $12199Ihour Labor 1 man - 4 hrs $5446

OIl071l1-Friday CAT Skidster with broom - 700 hrs $11500Ihour Labor 2 men - 7 hrs $5446Ihour Move in amp out 2 hrs$125001hr

4 COM SIGNED ~-3

)l Thank you for your business Total

JOB NUMBER

0101-11

AMOUNT

33123 46000 48796 36597

TP J 88328

88328 92000 97592 48796 21784

80500 76244 25000

PLETfD (I DATE 1--

$783088