HomeMy WebLinkAboutPROJECT WORKSHEET - CATEGORY C - 5/16/2007 ,
FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0151
PROJECT WORKSHEET Expires April 30, 2001
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DECLARATION NO: PROJECT NO. FIPS NO. DATE CATEGORY
FEMA- 1688 -DR- IA MLD018 013-82425-00 5/16/2007 C
DAMAGE FACILITY WORK COMPLETE AS OF:
Traffic sognal control box hit by lightning 5/16/2007 : 0 %
APPLICANT COUNTY
CITY OF WATERLOO BLACK HAWK
LOCATION LATITUDE LONGITUDE
CITY WIDE 42.52374 -92.35783
DAMAGE DESCRIPTION AND DIMENSIONS:
On 2-23 during the severe winter storm, lightning struck and damaged a traffic signal box at the intersection of Broadway and
Burton. The cabinet and controller inside were both heavily damaged and is need of replacement.
SCOPE OF WORK:
During the severe winter storm from 2-23 to 3-2-07, lightning struck and damaged beyond repair a traffic signal control
cabinet and controller mounted inside. The city has done some work on this site to get the lights working. WORK TO BE
COMPLETED: The city has received an estimate from Brown Traffic Products Inc. in the amount of$9925.00 for replacement
of the cabinet and controller. Other in stock parts to replace items damage bring the total to$10,668.82 to replace the
damaged equipment.
Does the Scope of Work change the pre-disaster condition at site? Q Yes n No
Special Consideration issues included? 0 Yes n No Hazard Mitigation proposal included? Yes n No
Is there insurance coverage on facility? n Yes n No
PROJECT COST
ITEM CODE NARRATIVE QUANTITY/UNIT UNIT PRICE COST
WORK TO BE COMPLETED / $ -
1 9007 Force account labor 1 / LS $ 1,918.77 $ 1,918.77
2 9008 Force account equipment 1 / LS $ 1,072.40 $ 1,072.40
3 9009 Materials 1 / LS $ 10,421.94 $ 10,421.94
/ $ - $ -
. / $ - $
/ $ - $ -
/ $ -
/ $ - $ -
/ $ - $ -
/ $ - $ -
/ $ - $
ts,,,,..kve„4.6 Ca.12-"i— TOTAL COST $ 13,413.11
PREPARED BY: DEAN TITLE: P TE PAC
FEMA Form 90-91, SEP 98
FEDERAL EMERGENCY MANAGEMENT AGENCY
SPECIAL CONSIDERATIONS QUESTIONS
1. APPLICANTS NAME 2. FIPS NUMBER 3. DATE
City of Waterloo 013-82425-00 5/17/2007
4. PROJECT NAME 5. LOCATION
MLD018 Broadway and Burton
Form must be filled out-for each project
1. Does the damaged facility or item of work have insurance and/or is it an insurable risk? (e.g.,buildings, equipment, vehicles, etc.)
EiYes 1=1 No 0 Unsure Comments
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?
0 Yes 0 No 0 Unsure Comments A creek in the city runs trhough the structure
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?
0 Yes 0 No ❑ Unsure Comments
4. Will the proposed facility repairs/reconstruction change the pre-disaster condition? (e.g.,footprint,material,location, capacity,use or function)
0 Yes E No 0 Unsure Comments
5. Does the applicant have a hazard mitigation proposal or would the applicant like technical assistance for a hazard proposal?
Yes El No 0 Unsure Comments
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?
EiYes E No 0 Unsure Comments
7. Are there any pristine or undisturbed areas on,or near,the project site? Are there large tracts of forestland?
Yes a No iii Unsure Comments
8. Are there any hazardous materials at or adjacent to the damaged facility and/or item of work?
ElYes 0 No 0 Unsure Comments
9. Are there any other environmentally or controversial issues associated with the damaged facility and/or item of work'?
IllYes 0 No 0 Unsure Comments
PREPARED Bl''`-ne (a a...4_t 'TITLE: t-O C;,
FEMA Form 90-120, NO8
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