; Form-4---Multi-sites-one-project-v3
Documents
Resources
Learning Center
Upload
Plans & pricing Sign in
Sign Out
Your Federal Quarterly Tax Payments are due April 15th Get Help Now >>

Form-4---Multi-sites-one-project-v3

VIEWS: 1 PAGES: 1

  • pg 1
									NATURAL DISASTER RELIEF AND RECOVERY ARRANGEMENTS
Restoration of Essential Public Assets
                                                                                                                                                             Multi sites, one project submission                                                                                                                                                                                                                                FORM 4

                        NDRRA Event:
                                                                                                                                                                                                                   Please tick
                                                                                                                                                                                                                               Submission Type                                          Actuals / Estimates
                        Agency / Local Government Area
                        Asset / Road Name                                                                                                                                                                                         Emergent work                                            Actuals
                        Road Number
                        Site Number                                                                                                                                                                                               Restoration work                                         Estimates


      Asset Description / Service Level

                        Insert a CLEAR and specific description / service level of the damaged asset. Eg: Single lane sealed road, Q20 immunity
      Cause of Damage

                        Insert a CLEAR and concise description of what the cause of damage was.

               Chainage / GPS Coordinates
                                                                                                                                                                                                                    Proposed/Completed Restoration & specification of Engineering Standards / Building Codes (where
           Start             Finish            Dist (km)         Photo Ref                                                    Description of Asset Damage                                                                                                                                                                                                             Unit                 Qty                  Rate                 Value (excl GST)
                                                                                                                                                                                                                                                              changing)
                                                                                                                                                                                                                                                                                                                                                                                                                                                    $0.00
                                                                                                                                                                                                                                                                                                                                                                                                                                                    $0.00
                                                                                                                                                                                                                                                                                                                                                                                                                                                    $0.00
                                                                                                                                                                                                                                                                                                                                                                                                                                                    $0.00
                                                                                                                                                                                                                                                                                                                                                                                                                                                    $0.00
                                                                                                                                                                                                                                                                                                                                                                                                                                                    $0.00
                                                                                                                                                                                                                                                                                                                                                                                                                                                    $0.00
                                                                                                                                                                                                                                                                                                                                                                                                                                                    $0.00
                                                                                                                                                                                                                                                                                                                                                                                                                                                    $0.00
                                                                                                                                                                                                                                                                                                                                                                                                                                                    $0.00
                                                                                                                                                                                                                                                                                                                                                                                                                                                    $0.00
                                                                                                                                                                                                                                                                                                                                                                                                                                                    $0.00
                                                                                                                                                                                                                                                                                                                                                                                                                                                    $0.00
                                                                                                                                                                                                                                                                                                                                                                                                                                                    $0.00
                                                                                                                                                                                                                                                                                                                                                                                                                                                    $0.00
                                                                                                                                                                                                                                                                                                                                                                                                                                                    $0.00
                                                                                                                                                                                                                                                                                                                                                                                                                                                    $0.00
                                                                                                                                                                                                                                                                                                                                                                                                                                                    $0.00
                                                                                                                                                                                                                                                                                                                                                                                                                                                    $0.00
                                                                                                                                                                                                                                                                                                                                                                                                                                                    $0.00
                                                                                                                                                                                                                                                                                                                                                                                                                                                    $0.00
                                                                                                                                                                                                                                                                                                                                                                                                                                                    $0.00
                                                                                                                                                                                                                                                                                                                                                                                                                                                    $0.00
                                                                                                                                                                                                                                                                                                                                                                                                                                                    $0.00
                                                                                                                                                                                                                                                                                                                                                                                                                                                    $0.00
                                                                                                                                                                                                                                                                                                                                                                                                                                                    $0.00
                                                                                                                                                                                                                                                                                                                                                                                                                                                    $0.00
                                                                                                                                                                                                                                                                                                                                                                                                                                                    $0.00
                                                                                                                                                                                                                                                                                                                                                                                                                                                    $0.00
                                                                                                                                                                                                                                                                                                                                                                                                                                                    $0.00
                                                                                                                                                                                                                                                                                                                                                                                                                                                    $0.00
                                                                                                                                                                                                                                                                                                                                                                                                                                                    $0.00
                                                                                                                                                                                                                                                                                                                                                                                                                                                    $0.00
                                                                                                                                                                                                                                                                                                                                                                                                                                                    $0.00
                                                                                                                                                                                                                                                                                                                                                                                                                                                    $0.00
                                                                                                                                                                                                                                                                                                                                                                                                                                                    $0.00
                                                                                                                                                                                                                                                                                                                                                                                                                                                    $0.00
                                                                                                                                                                                                                                                                                                                                                                                                                                                    $0.00
      Insert additional lines as required                                                                                                                                                                                                                                                                                                                                                                         Total:                          $0.00
      We certify that the proposed/completed restoration works are required as a result of an activated natural disaster event and complies with Submission Guide and Queensland Disaster Relief and Recovery Arrangements. We certify that the photographs supplied are a true and accurate record of the damage sustained to the asset at
      the specified location(s). We certify that no ordinary wages/salaries have been included in this submission, nor any other costs that are ineligible under the NDRRA arrangements. We certify that funding approved will only be used for the specified restoration for this site(s). We certify that the CEO and/or accountable officer has cited
      all supporting documentation and it is a true and accurate record of the damage sustained to the asset at the specified location(s). We certify that all the amounts claimed are exclusive of GST.

           Estimator:                                                                                                                                                                               Signature:                                                                                                                                                                                                 Date:           ______/______/______

 Accountable Officer:                                                                                                                                                                               Signature:                                                                                                                                                                                                 Date:           ______/______/______

                         This information is being collected for the purposes of funding, management and reporting of reconstruction activities. This information is collected pursuant to Part 2, Division 2 of the Queensland Reconstruction Authority Act 2011. The information may be disclosed to the Commonwealth Government and Qld Government agencies, departments and statutory authorities involved with reconstruction activities.




                                                                                                                                                                                                                           Page 1 of 1

								
To top