Transmittal of Omaha Lead Site 

Paint Stabilization File Folder 

Said# ^'^ty i Date: (S?-<^^-f7 

Address: .giaJ-^- m i ^, ^ t Si~ 

Contractor; CityofOmaha Year: ^ ^ ^/ 

Paint Stabilization 

Property File Folder Documents 

iXWork Write Up 

_ly^gne d Access Agreement for subject property 

Pre-Renovation form signed by Property Owner 

Pre-Renovation Form for Occupant/Tenant, ifapplicable 

LX^ainting Agreement/City of Omaha Purchase Order 

Settlement documents (i.e., for damage or to replace plants, etc.) 

Renovation Recordkeeping Checklist signed by Certified Renovator 

Property information from Douglas County Assessor's Office 

Other (describe): rko^ S ' ._ 

T^h"*' 3-7r-jc ^ 

City of Omaha Represejjtative Signature Date 

3773^01X 

EPA Representative Signature )ate 

30262505 

Superfund 
CITY OF OMAHA 

PURCHASING - ROOM 1003 Purchase Order 

1819 FARNAM STREET 

PURCIMSE ORDER NO. 

OMAHA. NE 68183-10.03 

1174424 FAX# 402-444-5423 

SHIPTO: 

CITYOFOMAHA 

HOUSING A COMM DEV RM #1111 

1819 FARNAM STREET 

OMAHA,NE 68183 

VENOOR: 

G&MPAINTINGCOINC -< >. BILL TO: 13707 CUMING ST ClTY OF OMALIA FINANCE OMAHA, NE 68154 DISBURSEMENTS ROOM #1007 

1819 FAftNAM STREET 

OMAHA,NE 68183 

ORIGINAL PURCHASE ORDER • VENDOR'S COPY (SEE INSTRUCTIONS BELOW) 

CUSTOMER ACCOUNT NO. VENDOR NO. DATE OF ORDER/BUYER REVISED DATE//BUYER 

91298 11.MAY-11 HHURT 

PAYMENTTERMS 

SHIP VIA F.O.B. 

DESTINATION 

FREIGHTTERMS REQUESTOR/DELIVER TO CONFIRM TO / TELEPHONE 

MARTINEZ, MARGARET P 

> • < ITEM PART NUMBER/DESCRIPTION • DELIVERYDATE QUANTITY UNIT UNITPRICE EXTENSION 

All prices and amounts on this order are express id in : US Del! ar 


NEEDED: 1,640.00 N 


MAY-11, 
 EPA PAINT STABILIZATION/1 


PROGRAM GRP # 195 ­ 3123 LAFAYETTE AVE 


O SHIP TO: 


Address at .top of page 


NEEDED: 
 1,835.00 N
 I 07-MAy-ll 


EPA PAINT STABILIZATION 


PROGRAM GRP #195 - 2025 


MIAMI ST • io SHIP TO:	 i 


Address at top of pa^e 


NEEDED: 1,950.00 N 

07-MAY-ll 

EPA PAINT STABILIZATION 


PROGRAM GRP #195 - 312P 


CASS ST i 


o SHIP TO:	 i 


Address at top of page 


SHIPTO: /Address shown above. If shipment Is delayed or any Items not available, advise at once. Purchase order number must appear on all Invoices, packages, packing lists, bill of lading, and correspondence, 

SHIPPING CHARGES TO BE PREPAID. IF APPLICABLE AND ADDED TO INVOICED, copy lo be fijrnlshed wilh Invoice. 

Total ( . 5'6^S.00 ) 

TAX EXEMPTION: .The City of Omaha Is exempt from Federal Excise Taxes and the Nebraska and City of 

Omaha Sales Taxes. Federal I.D. 476006304; STATE I.D. 01-0316768; Fuel Dealers Uc. 91-0316768. Clly Purchaiing Agenl \fxntr 
Planning Department 

Inspector: Tom Roza Omaha/DougbsCivicCcntcr 

r>ofo. /) I on n 1.819 FaMim Street, SuiK noo 

Date : 4-1-2011 Omnha,Ncb;asl. 68183 

(402)444-5150 

Name: Shawn Bass TM=.,<402)*«« 

o^oroTM.. Address: 2025 Miami St n.E.c.:^.^.„,K^,s^E 

Jim Sutue, Mayor 

OMAHA EXTERIOR PAINT STABILIZATION PROGRAM 

FOR THE EPA OMAHA LEAD SITE 

The Contract bid documents consist of the following sections: 

• General Responsibilities for the Contractor and Occupant. 

• Lead Hazard Control Plan, Interim Control of Lead Based Paint Hazards. 

: The Contractor Shall: 

• Contractor and all subcontractor(s) shall complete and submit a "Citizenship 

Attestation"7 "Emplovee Classification" form to the Planning Department; per 

State requirements, before final payment can be issued. 

• Comply with HUD's "Guidelines for the Evaluation and Controlof Lead-Based Paint 

Hazards in Housing." (Copies are available at the Planning Department.) 

• Comply with Standards called for in the "Construction and Rehabilitation Specifications, 

Housing and Community Development Division, City of Oniaha, Nebraska." (Copiesare 

availabie at the Planning Department.) 

• Comply with the State ofNebraska Health and Human Services Regulation and 

Licensure, Title 178 Chapter 23 Lead Base Paint Regulations. 

• ' Coordinate daily construction schedule with the occupant . 

• Submit information cut sheets for all substitutions or approved equals prior to written 

approval of the Construction Specialist. 

• Repair or replace all items damaged or disturbed during paint stabilization activities. 

• Keep work site and surrounding area free from accumulations of waste materials or . 

rubbish caused by the work at all times. 

• Upon daily completion of work: clean up all rubbish, excess material, equipment, and 

etc.; that is connected with the work, and leave all parts ofthe work areas in a neat, 

sanitary, lead safe and presentable condition. 

• Complete this project within 30 calendar days. 

The Occupant/Owner Shall 

Remove and store away any person'al'propFrty'w'itFinTwiJntyXZO)'feef o 

remediated. 

P.rovide access to electricity and water throughout the paint stabilization process. 

Remove volunteer trees and vegetation from the drip line of ithe roof, and cut back 

shrubs and bushes at least t>vo feet from the house. 

Ensure that all houisehold members stay at least ten feet away from all work areas and 

also keep all pets at least ten feet away at all times until thework has been completed and 

the area has passed a visual inspection. 

Initials J D 
• Exterior Lead-based Paint Stabilization Program Managed by the City, of 

Omaha for EPA Region 7 

Omaha Lead Site 

The purpose of this program is to prevent yards where lead-contaminated soil is cleaned 

up from becoming re-contaminated by deteriorating exterior lead-based paint. This is 

not a home repair program. 

Which Homes Are Eligible? 

• Homes where soil clean-up has been or will be done and an EPA contractor has 

identified deteriorating exterior lead-based paint. 

• . Homes are eligible only by referral from the EPA. 

What work will be done? 

• Loose and flaking lead-based paint will be removed safely from fascia, eaives, 

siding, .trim, window trim, door trim and foundation. 

• Surfaces will be primed and painted to match existing paint color as closely as 

possible. 

What will not be done? 

• Surfaces which have no paint will not be treated. 

• . Windows or doors will not be included. 

• Rotten wood will not be replaced. 

• Np housing repair will be done. 

. Who willperform the work? 

o EPA contractors will test paint on exterior house surfaces and give the results to 

the City of Omaha Paint Stabilization Program. 

• . City ConstructionSp'ecialists will prepare a work plan and contact the property 

owner for permission to proceed. 

• Work will be competitively bid by approved, trainedcontractors. 

When will the work be done? 

• This program began in 2007 and will continue for several years. 

• 

The City staff will prioritize homes based on the presence ofchildren under age 

six ifknown and the severity ofthe problem. .._._._ ; 

Paint Stabilization is voluntaiy and will be done only with permission ofthe owner. 

Initials <i ft 
Address: 2025 MIAMI ST

 ' 

Consent for Access to Property (Page 2) 

3. Planning and implementing the response action on the Grantor's propert}'. This will include 

1) removal of loose or flaking paint identified by EPA using lead-safe methods in compliance 

with HUD/EPA regulations and 2) repainting according to the attached specifications: 

TERM • 

This access agreement shall be operable for the period of time it takes to complete the 

environmental response activities. Upori completion of the response actions, all rights and 

privileges given by the Grantor shall cease on that date, unless extended by a subsequent 

agreement. 

AGREEMENT NOT TO INTERFERE. 

Grantor agrees not to interfere with any of the activities undertaken by Grantee at the Property, 

tamper wth any of Grantee's property, or take any actions regarding tlie use ofthe Property which 

will endanger human health or welfare or the environment, or allow others to use the Property in 

such manner during the term of this consent. Grantor.agrees to provide notice and a copy of this 

agreement to prospective purchasers, lessees, assigns, or grantees of the property or any portion of 

it. Grantor agrees to provide 30-day notice to EPA prior to any transfer of ownership rights to the 

property. 

SAMPLING RESULTS • 

Grantee agrees to provide Grantor with tlie results of any and all sampling and/or analysis resulting 

from Grantee's response activities on the property. 

PRIOR CONDITIONS AGREEMENT 

The grantor agrees to the condition ofthe property prior to remediation and indicates on Page 3 any 

items to be removed by the Grantor before activities commence. 

RESTORATION OF PROPERTY 

Except for the above stated.paint stabilization, the Grantee agrees_that_sai_d property will be restored 

as nearly as possible to its original state and condition as found immediately preceding the 

beginning of activities, authorized by this Agreement,• following completion of the responseactivities. 

(2) 2/12/2007 
Douglas County Account Information Page 1 of3 

Douglas County, Nebraska Property Record - R0212300000 

Print Report 

View Interactive GIS Map Information is valid as of 2012-2-28 Treasurer's Tax Report 

New Feature -•-»- > Subdivision Saies Search 

Owner 

BASS SHAWN R 

2025 MIAMI ST 

OMAHA NE 68110-0000 

Property Informatio n 

Key Numlier: 1230 0000 02 

Account Type: Residential 

ParcelNumber 0212300000 

Parcel Address: 2025 MIAMI ST 

OMAHA NE 68110-0000 

Legal Description: LANDS SEC-TWN-RGE 10-15-13 SUB 8 SUB 3 LT 55 40 X 122 

Value Informatio n 

2011 

2010 

2009 

2008 

2007 

2006 

Land 

$4,300.00 

$4,300.00 

$4,300.00 

$4,300.00 

$4,300.00 

$4,300.00 

Improvement 

$19,400.00 

$19,400.00 

$19,400.00 

$19,400.00 

$25,300.00 

$25,300.00 

Total 

$23,700.00 

$23,700.00 

$23,700.00 

$23,700.00 

$29,600.00 

$29,600.00 

Land Informatio n 

Acres 

0.11 

SF 

4880.0 

Unlta 

1.0 

Depth 

122.0 

Width 

40.0 

Vacant 

No 

Improvemen t Informatio n 

Building 1 

http://douglasne.mapping-onIine.com/DouglasCoNe/static/accountinfo.jsp?accountno=R02... 3/14/2012 
Douglas County Account Information Page 2 of 3 

l»» Q) »•! 

2025 Mianni 

Fmtfhc i 

tO«00 Sq. Fl 1 1/2 Story Unfin 

SlaMtkclll l K»l»34 I I 

CLICK TO ENLARGE IMAGE 

Square Footage: 1060.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Fair 

Unit Type: Condition: Average 

Built As: 1 1/2 Story Unfin Condo Square Footage: 0.0 

HVAC: Central Air to Air Rooms: 5.0 

Exterior: Frame Siding Units: 1.0 

interior: Drywall Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 2.0 

Roof Type: Gable Stories: 1.5 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Built Year 

Remodeled 

Percent 

Remodeled 

Adjusted Year 

Built Physical Age 

1910 1989 0% 1910 100 

Detail Type Detail Description Unlta 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 700.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Porch EncI Screen 126.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R02... 3/14/2012 
Douglas County Account Information 

Page 3 of 3 

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The above map is powered by Google, and is intended to provide a general idea of a property's location. If you 

require a more exact property location, you may use the Interactive GIS Maps that are maintained by our 

office. 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R02... 3/14/2012