FEMA Forms - FF 90-135- PDA Subgrantee Form

U.S. DEPARTMENT OF HOMELAND SECURITY EMERGENCY PREPAREDNESS AND RESPONSE DIRECTORATE TEAM Team Leader nitials/Date PRELIMINARY DAMAGE ASSESSMENT - POTENTIAL SUBGRANTEE PUBLIC ENTITY/POTENTIAL SUBGRANTEE PUBLIC ENTITY/POTENTIAL SUBGRANTEE INFORMATION CONTACT & TELEPHONE NO. POPULATION COUNTY/PARISH ADDITIONAL CONTACT(S) & TELEPHONE NO(s) SITE ESTIMATE SUMMARY CATEGORY CRITICAL FACILITIES AND OTHER DAMAGES EMERGENCY WORK A B Debris Emer. prot. Emergency Work sub-total PERMANENT WORK INSPECTED # of Sites Estimated Cost PROJECTED # of Sites Estimated Cost # of Sites TOTAL Estimated Cost Roads and bridges sub-total Water control D facilities sub-total E Buildings and equipment sub-total Utilities F sub-total G Rec./other Permanent work sub-total TOTAL FEMA Form 90-135, JUN 03 Continue on the reverse side. DISASTER IMPACTS List detours/critical facilities damaged. Describe any health and safety issues. Did previous state or local hazard mitigation measures reduce otherwise eligible costs? (If yes, please explain) Comments: