Generator Worksheet - PEMA



Power Generation Worksheet- for emergency power generation only

Instructions for Worksheet:

Prepare separate worksheet for each individual site requesting alert and notification systems.

In order to ensure timely processing of your application, please number and prioritize all sites.

Priority #      Is this a critical facility? yes____ no____

Prepare separate worksheet for each individual property requesting back-up power generation.

Include certification of the emergency power generation capacity needed for structure. This certification should include the criteria used for determination, along with the calculated safety factor. A professional engineer, Power Company representative or the generator manufacturer’s representative shall submit the certification (See Attached Data Sheet).

Site Information:

1. Site Name:      

2. Street Address (including city, state, zip code, latitude/longitude, and county) or Physical/Legal Location:      

3. Population Affected

Provide the number of each type of structure (listed below) in the project area. Include all structures in project area.

      residential properties

      businesses / commercial properties

      public buildings

      schools / hospitals / houses of worship

      for 5% water and wastewater generator projects list the number of customer connections

4. How long was site without power?      

5. Do you currently have back-up power for this site?       If so, what type?      

6. Explain Situation (attach separate sheet)

D. Structure Information:

1. Date of Construction      

2. Kilowatt/Hour Usage      

3. Will the generator be mounted on the building?       On the ground in a separate

Housing?      

4. Will the generator be hardwired? ______

E. Scope of Work-(Provide on separate piece of paper and attach)

F. Budget

In this section, provide the details of all costs of the project. An accurate and reasonable cost estimate is essential. List all items and costs in line item fashion.

Do not include contingency costs in the budget.

Materials

Item ___Dimension Quantity Cost per Unit Total Cost

     

a. Labor (Include equipment costs -- please indicate all "soft" or in-kind matches)

Description Hours Rate Cost

     

b. Fees Paid Include any other costs associated with the project

Description of Task Hours Rate Cost

     

Total Estimated Project Cost $     

c. Funding Sources (round figures to the nearest dollar) The maximum FEMA share for HMGP projects is 75%. The other 25% can be made up of State and Local funds as well as in-kind services. HMGP funds may be packaged with other Federal funds, but other Federal funds (except for Federal funds which lose their Federal identity at the State level – such as CDBG) may not be used for the State or Local match.

|Estimated FEMA Share |$      |      |% of Total |

Non-Federal Share

|Estimated Local Share |$      |      |% of Total |

(Include In-Kind Value)

List Funding Sources      

|Estimated State Share |$      |      |% of Total |

List Funding Sources      

|Estimated Other Agency Share |$      |      |% of Total |

Identify Other Non-Federal Agency      

Other Non-FEMA Federal Funds $      Do Not Include In Total

Identify Other Federal Agency      

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pema λ HAZARD MITIGATION GRANT PROGRAM λ REQUIRED DATA

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