## TRANSMITTA LO FOMAH ALEA D SIT E PAIN TSTABILIZATIO NFIL EFOLDE R SAI D # : 3> 3 '^(^ O Date : Address : 

## 3>% 9 

# N 1 7 6 h LB PStabilizatio nContractor : PRUDEN TTECHNOLOGIES , INC . Year : 200 9 PAIN TSTABILIZATIO N PROPERT Y FIL EFOLDE RDOCUMENT S ^ Vide o o f propert y (DVD) : Pre-Stabilizatio n& Post-Stabilizatio nVideo s uExecutiv eSummary I K

Signe dAcces s Agreemen t Form Ife K Advanc e Notic e For m M Pre-Stabilizatio nVide o Agreemen t For m M Acces s Tracldn g For m « Propert y Acces s Assessmen t For m ^ Neighbo r Acces s Agreemen t For m i? ^ Pain t Matc hFor m ^ Pre-Stabilizatio nPropert y Safety Assessmen t For m H Worli-Sit e Hazard s Analysi s Checklis t H Photographs : Pre-Stabilizatio nPropert v Hazar dAssessmen t Photograph s H Dougla s Count y Assesso r Propert y informatio n Q ^ Propert y Completio nAgreemen t For mSigne db y Propert y Owne r D Propert y Close-Ou t Chec k Lis t Signe dB y EP A Pruden t technologies , Inc . Signatur e 

### Dat e

EP ASignatur e 

# 4 ^

3005512 9 

# i Superfun dTECHNOiLOGIBS , IN C 

# Propert y Summary Date : H/~/200 9 LB PSTABILIZATIO NEPACONTRAC T EP-R7-08-0 7 Mont hof : No v Property Address : 390 9 N1 7 St . SAI D # : 3356 0 A . Executiv e Summarv : a . Issue s Encountered : NON E b . Issue s Resolved : NON E c . Uniqu e Findings : NON E d . Othe r Relevant Information : i . Acces s Date : 9/23/2009 ii . Work Began : 10/08/2009 iii . Close-Out Date : 10/15/2009 B . Enclosures ; 1 . Pre-Stabilizatio nVide o 2 . Post-Stabilizatio nVideo 3 . Signe dAcces s Agreement Form 4 . Advance-Notic e Form 5 . Pre-Stabilizatio nVide o Agreement Form 6 . Acces s Trackin g Form 7 . Propert y Acces s Assessment Form 8 . Neighbo r Acces s Agreement Form 9 . Propert y Pain t Matc hForm 10 . Pre-Stabilizatio nPropert y Safet y Assessment Form 11 . Work-Site Hazard s Analysi s Checklis t 12 . Pre - Stabilizatio nPropert y Hazar dAssessment Photograph s 13 . Dougla s County Assessor Propert y Informatio n 14 . Signe dPropert y Completio nAgreement Form 15 . Propert y Close-Ou t Chec k Lis t Signe dB y EPAPAG E 01/B 5 09/23/200 9 19:3 5 40259U.07 9

Pruden t Teclwologiea , Inc . CPrndent ) i s unde rcontrac t (Contrac t ^ EP-R7-08-07 ) wit h fh « U . S . Environmenta l Protectio n Agenc > (EPA ) t o stabiliz e Lea d Base d Pain t (LBP ) a t a numbe rofpropertie s locate d i n Omaha , Nebraska , includin g th e propert ylocate d at_^<^<g> ^ j ^ f-f ^ '^ ^ Th e EP Arequest s you rpermission , r o allo wPruden t t o perlbr m LB P Stabilizatio n a t thi s property . B ysignin g ttil s fonn , th e propert yowne rgrant s permissio n t o Pruden t ( o perfor m acHvitte s relate d t o LB P Stabilizatio n includin g scrapin g pain t an d paintin g o fth e reference d property . Further , tii e owner/tenan t verifie s tha t the yhav e receive d d wLB P pamphle t "Renovat e Righl. " B ysignin g thi s doeuinen t I agre e t o allo wa n EP Acontracto rt o conduc t a $oi l cleanu p a t m ypropert yfoilowin g completio n o f lead-base d pain t stabilization , i fth e soi l cleanu p ha s no t alread ybee n performed . I understan d tha t th e stabilizatio n contracto r canno t provid e assurance s o fwhic h contracto rwil l b e boun d t o th e soi l cleanup . I ftjithe runderstan d tha t th e soi l cleanu p contracto rwil l mak e al l reasonabl e effort s t o addres s concern s tha t I , ai i th e propert yowner , ma yhav e regardin g soi l cleanu p a t m yproperty , f^i^Yes . I hav e rea d an d understan d th e paragrap h above . 

## A

Dat e Ifyo u hav e an yquestion s abou t th e LB P stabilizatio n planne d fo ryou rproperty , pleas e contac t Prudent' s Custome r Relatjons/Offic e Manape rfo rth e Lea d Base d Pain t Stabilization , Mrs . Slianno n Holt , at (402 ) 504-100 4 o r(401W12-0223 . Genera l question s abou t th e Omah a Lea d Sit e cleanu p ca n b e directe d t o th e EP APubli cInfbrmatio n Center s a t (402 ) 7 3 T * 304 5 (Sout h Omah a offlce ) o r(402 ) 991-958 3 (Non h Omah a ofTice) . Propert yAcces s Grante d By : 

# g^m^,- ^

TJn L sor t

(Pleas ePrin t Name ) Propert yOwne rSignature : V'^JT^?'^^"^'^'^^^''^^^'*'* ^ 

# <:=^/^/^ ? (Date )

tOS

O W9n i Parkway . Suit s 40 8 290 5 N . 24" ' Street , Suit e 30 8 424 2 Mtdlca l Ortva , Suit r425 8 (ansa s City , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , T X 7822 9 >hon« : (816 ) iiMIt i :8x : ($19 ) 363-370 7 Phon* : (402)904-100 4 Fax : (402)804-100 $ Phone : (210)822-988 8 Pax : (210 ) 579-8S7 7PAG E 02/0 5 i ^ l 09/23/200 9 19:3 5 402591^7 9

inswiNc . PROPERT YINFORMATIO N rwurer ^ i TI I ^ ^ (T o be eomfietS i b yre<iidtn t and ' and/o rpropertyowner^^^jilaaaLCrint ) RESIDEN TNAIME : /owne r^ Rente r RESIDEN TADDRESS: ^ <r . I F RENTAL . PROPERT V OWNE D BY : OWNER' S MAIUN G ADDRESS : OWNER' S TELEPHON E NUMBER-HOME : {^/y2)^j^'7(0^^t / WORK : _J 1 . NUMBE R O F OCCUPANT S UNDE R 7 YEAR S OLD : TL ? NUMBE R O F OCCUPANT S 7 YEAR S OL D AN D OLDER : NUMBE R O F CHILDRE N UNDE R 7 YEAR S OL D WHO M PLAYI N TH E YAR D FO R 5 HOUR S O R MOR E PE R WEEK : COMMENTS O R SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTRYGATES , ETC. )



# U o 0<'^< f AUTIKJRIT YFO R KNVIRONMENTA L RKSPONS E ACIIONS : Th e uciivitics to b e implemenied b yEP Aunde rthi s Hgreem«n t w c pursuan t t

o Scaio n K M ofCERCJ-A . 4 2 U. S C . 960* . liPA' * ngl u ofacces s to th e propenyl. ( pr(>vidc d fo ri n Sectio n 104(c ) ot'CF.RCl.A . 4

2 (J.S . C 9605(c) . whic h provides entr yfo r"detemiinin g th e nee d fo rresponse , o rchoosin g o rtakin g an yr0.^pons e actio n unde rthi s title , o r oihcrwi Kenforcin g th e provision s ofth e title. "

(06 0 Wor d Pirkway , Suite 40 8 2S0 S N . 24 " &tre«l . SuHe M 8 424 2 MMilca l Drtv0 , Sutto 428 0 Kanaa a City . IM O 8411 4 Omaiia . Nebra«k « 0811 0 Sa n Antonio . T X 7822 9 Phon K(816 ) 363>370 3 Phone : (402)804.1004 Ptione : (210)822-8888 .Cflx: (818 ) 363-370 7 Fax : (402 1 504.10Q S09/23/200 9 19:3 5 40259M07 9 ^ P^G E03/0 5 i9M 0

nCHNQLOGns , INC . 

# Advance dnotic e needed . Afte r

signin g th e acces s you allo w Pruden t t o begi nLea dBase d Pain t StabiUzation . Al l Plants , weed s an dan y vehicle s o r item s o n openporc h(enclose dporche s will NO T b e stabilized ) mus t be remove dprio r t o stabilization . Al l Pet s mus t b e ou t of yar ddurin g stabilization . Ho w muc hnotic e d o you nee dt o hav e abov e mentione dtask s completed ? Ifyo u ar e alandlor dyo u wil l nee dt o contac t th e tenan t a s Pruden t Technologie s will onl y informyou . D o you hav e an y pet s tha t resid e inyard ? NO Notic e needed : 3 P^/ ^ f^'<^ ^ ^ ^ Numbe r t o cal l t o giv e notice : ^O ZPoP " oyv / Whomw e ar e givin g notic e to : ^ C 'Sohnsa ^ C:>C^A^& \ 

# Hom e Owner^ s Signatur e

808 0 War d Parkway . Suit e 40 S 250 5 N . 24' " Slrast . Suit e 30 8 424 2 Medica l Drive . Suit e 42S 0 Kansa s City . M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio . T X 7t22 0 Plione: (816) 363*3703 Phone : (402 ) 804>100 4 Phone : (210)B22'9U 8 Pax ; (816)363-3707 Pax : (402)904-100 9 Fax : (210) S79-657 7^ PftG E04/0 5 09/23/200 9 19:3 5 40259^7 9 

# m PRE-STABILIZATIO NVIDE O FORM IUNDERSTAND THA TPRUDEN TTECHNOLOGIE S WIL L BECOMIN G OUT TO SHOO TAPRE-STABIUZATIO NVIDE OAT MY PROPERTY , TH EVIDE O IS JUS T ATOO LUSED TO DOCUMEN TTH ECURREN T PROPERT Y STATUS/CONDITION . APOS TVIDE O WIL LALS O BE SHO TPRIO R TO COMPLETIO N OFSTABILIZATION . OWNER S NAME : "^^rfxt S "I^Us^ " 

# 3^0 ^ K 17^ St^ 0^\^<^ , ^ ^ PROPERT Y ADDRES S 

# : BVID/SAID 

# : 53 5 6^ HOMEOWNER S SIGNATURE : < PRUDEN TREPRESENTATIV *JTATIV E ESI G SIGNATURE : Q |\ o ^ C< LS ^ C k « <" AN Y CONDITION S NEE D TOBEAWAR E OFBEFOR ESHOOTIN G VIDEO : (LE . PETS , NOTIC ENEEDED) : 

# Pn^ ­

808 0 Waf« l Parkway , Suit e 40 8 250 5 N. 24* " Straa i Suit e 30 8 424 2 Medica l Drive , Suit s 426 0 Kanaa s City , MO 6411 4 Omaha , Nebraak a 6811 0 Sa n Antonio . TX 7822 8 Phona : (816 ) 363-370 3 Phent ; (402 ) 804-10O 4 Phone : (210 ) 822-858 8 Fax ; (816 ) 363-370 7 Fax ; (402)604*100 8 Fax : (210 ) 67»-687 7TECHNOLOGIBS^ ] 

### ;su . 

## ACCES S INFORMATIO NTRACKIN GSHEE T 

# * ^ l BVID : 5>3>S)^ ^ PROPERT Y ADDRESS : S^<^ ^ /O' ' Property Owne dBy : (If new propert y owner)

Owner s Phon e No's : Home : - Work : Cell : - — Fax : — Acces s Contractor : AS WPDAME S PEOthe r (Prudent ) DAT E TIM E ACCESSO R CONRAC T DETAI L 

# IM h^ 

# iu^^. ^ ^1%^f-»--Tj '

' f

f 

# J

Comments :

808 0 War d Parkway , Suit e 40 5 250 5 N . 24' " Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omalia , Nebrask a 6811 0 Sa n Antonio , T X 7822 9 Phone : (816 ) 363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax:(816)363-370 7 Fax : (402)504-100 5 Fax:(210)579-657 7TECHNOLOGIES. ] 

# Acces s Assessment Form : (Mus t b e complete dfor ever y property . Informatio nmus t b e obtaine dfromapropert y wal k thru , no t given by owner ) I s th e propert y stucc o o r asbestos ? I f

yes , i s an y o f th e stucc o o r asbesto s damage do r cracked ? I f

yes , sto p a s w e can' t stabiliz e thi s property . I t require s specia l preparatio n techniques . I t wil l b e returne dt o EP Aan dthe y wil l assig na t alate r date . -\y O Doe s thi s propert y requir e lot s o f scrapping ? Doe s thi s propert y requir e alif t o r scaffoldin g t o reac huppe r levels ? Doe s thi s propert y hav e lot s o f plant s o r item s i narea s wher e paintin g i s required ? 

# yes . Doe s thi s propert y hav e an y significan t structura l damage ? I f

yes , EXPLAIN ?

808 0 War d Parkway , Suit e 40 5 250 5 N . 24* ^ Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , T X 7822 9 Phone : (816 ) 363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax:(816)363-370 7 Fax : (402)504-100 5 Fax : (210 ) 579-657 7TECHNOLOGIES , IN C 

## Doe s thi s propert y hav e agarage ? 

# V O I f

yes , describ e locatio no f garage . Doe s thi s propert y hav e aluminu msiding ? I f

yes , i s i t origina l factor y finis ho r ha s i t bee npainte dover ? 

# A

/

0 Doe s thi s propert y hav e an y othe r typ e o f structura l components ? (I.e . roo f shingle s a s siding) ? 

# A / 0 I f

yes , EXPLAIN ? I s thi s propert y vacan t or(occupied ? Ar e ther e an y pet s a t thi s property ? 

# rJ€ ) Ar e ther e an y lo w hangin g powe r lines ?

808 0 War d Parkway , Suit e 40 5 250 5 N . 24* ^ Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , T X 7822 9 Phone : (816 ) 363-370 3 Phone : (402)504-100 4 Phone : (210)822-968 8 Fax : (816 ) 363-370 7 Fax : (402)504-100 5 Fax : (210 ) 679.867 7

### OOLOGIES . INC . 2 . T O B EFILLE D OU T ONL Y I FCH.ANGINC ; COLO R 

### PROPERT Y ADDRESS : ?.^0 ^ H 1 1 S^ " 

## BVID : 33 5 ^ Q Pain t Pain t Locatio n Pain t Descriptio n Ye s N o Sidin g 

# .'ser/ou/ s &rgL yS IA / - (^1,S ^

S^k ^ X SolTi t 

# S W- 6:^SC' - fVihV ^

p;n'.<.V i 

# X Fasci a 

# x • Si^ - 6^5 ^ "-^ft n Come rTri m 

# S W- 6^54- ^ ^G^l n X Windo wTrim s 

## S<i^ ' InVror o r?[g> r| g - <:.Wg-L^ff , r^:n!< t 

# X Doo rTrim s 

### S ^Y» ^ e . ^ Fron t Porc h Ceilin g 

### c^ l C ^ c[O S f< ^ 

# X Fron t PorchCeilin g Beam s 

# S WG2S £ j - ^\ac t Fron t Porc h Floo r 

# K J L Fron t Porc h Railing s 

# ^\ac WSW-6^58-^^. ' 1£ 1 

# X Fron t Porc h Step s 

# SW6^5 ^

^.:aKt n ^^/Sif N 

# A Sidin g Baseboard s 

# K A Foundatio n 

# KU^(« - '^w/ -6>5a-5a^; n X 

# RftPc KLg.}k<: ^ f^U/^i ^ S^y - ^2-59 - g2i^{ n > C 

## O.fDlOf l fno(^^^n-Mf^po^hpr)?v-, - 2)\nP^, ' f)\0 ' /(9A6 ^ 

# r

I AGRE ET O TH ECOLOR S INDICATE D ABOVE . IUNDERSTAN TTHA T I CANNO T CHANG ETH ESELECTE D COLOR S LATE RO NA S PRUDEN T WOUL D HAV EPURCHASE D TH EPAIN TSPECIFICALL Y FO RTH E REFERENCE D PROPERTY . ALS O IUNDERSTAN D THA TCOLOR S SELECTE D



# .A N4A Y NO T LOOK . EXACTL Y A S I T I S SHOW NO NSWATCHE S AFTE R 

# 4 * PAINTIN GO NM Y PROPERTY . .0 i > 

# V Homeowne r signatur e 

## Date:CP^/2i^/^ 9 O 808 0 War d Parkway . Suit e 40 5 I N . 24' " Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio . T X 7822 9 Phone : (816 ) 363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax : (816 ) 363-370 7 Fax : (402)504-100 5 Fax : (210) 579-657 "TBCHNOLOGIBS . IN C 

## NEIGHBORHOO D PROPERT Y ACCES S FORM I S THEREANEIGHBORIN GPROPERT Y THA TNEED S T O B EACCESSED ALONG WIT H ASSIGNE D PROPERT Y T O COMPLET ESTABILIZATIO NPROCESS ?

I FI TIS , GE T ACCES S FRO M AL LREQUIRED NEIGHBORHOO D PROPERTIES .

808 0 War d Parkway , Suit e 40 5 250 5 N . 24* " Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , TX 7822 9 Phone : (816 ) 363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax : (816 ) 363-370 7 Fax : (402)504-100 5 Fax : (210 ) 579-657 7^^^ ^ TECHNOU>GIES > IN C 

## PRE-STABILIZATIO NPROPERT Y SAFETY ASSESSMENT FORM PROPERT Y ADDRESS : 'b^^ ^ ^ )nS,T BVID/SAID : ^^&6 0 PRUDEN TASSESSMEN TREPERSENTATIVE : 

# ^_J A^(^\ ^ REPERSENTATIV EREMARKS/FINDINGS : (POWER-LINEPROXIMIT Y T O PROPERTY , SCAFFOLDING / LADDERS / LIFT S NEEDED , UNSAF EAREAS , UNSAF ENEIGHBORHOOD...ETC. )

808 0 War d Parkway , Suit e 40 5 250 5 N . 24* ^ Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , T X 7822 9 Phone : (816 ) 363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax : (816 ) 363-370 7 Fax : (402)504-100 5 Fax : (210 ) 579-657 7• ^ 

### TECHNOLOGIES. ] 

# Checklis t for th e Worksit e Hazar dAnalysi s Address : 

# v3^o ? A/ , p" ^ ^ Crew : Date : Ite m Correctiv e Actio n Overhea dLine s 

# \c^aAM^'^^^J)i^t<A ^ In-transi t Vehicl e Clearanc e Level s aroun dhig hwire s Vehicl e Clearanc e aroun d hig hwire s whe nworkin g Phon e line s 

# lE^poS^ J J.)l^f^KQ ^ U^i/Y- ^ Cabl e line s Ga s Lin e Wate r Lin e Sewe r Lin e Septi c Tan k Propane/Butan e Acces s to/o nPropert y Neighbo r Acces s Require d Hig hTraffi c Are a Garag e Structure s Drivewa y Sidewal k 

# cjx^^- ^ Foundatio n Retaining . Wall ff

wall 

### s s 

### i'cncei ^ Tree s 

# S 'JCU ^ 

# ;jiX^V^o ^ Genera l Conditio nof yar d Damage dAreas : sin k 

# -i^^fepi^^^ . holes/rotte dwoo d 

# A^iv^rfr i 

# :.^g^(l ^ Sprinkle r Syste m 

# td - Pet s Insect s \)HLji ^ ^e>i5e ^ .^jtJ^f ^

^yc>Y4~ ^ Weathe r Condition s Unsaf e drivin g condition s Unsaf e neighborhoo i 

# ^"^S^l^u^ acto r

808 0 V9ar9 Parkj^fTSult e 40 5 250 5 N. 24' " Street , Suit e 30 8 424 e Medica l Drive , Suit e 425 0 Kansa s CityJ|(J06411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , TX 7822 9 Phone : (816)^63-370 3 Phone : (402)504-100 4 Phojie : (210)822-958 8 Fax : (816 ) 363-370 7 Fax : (402)504-100 5 ax : (210 ) 579-657 7

^

## Inc . (Prudent ; i f

unde r coarrac . rfz e t-ca dBase dP2 - '' 9P ) a t a permissio nr o allo w Pruden t t r pcrt a

### PAG E 85/8 5 09/23/200 9 19:3 5 402 5 9^7 9 

# Curren t Sampl e Pre-Renovatio n For m Effectiv e unti l Apri l 2010 . Confirmatio n o f Receip t o f Lea d Pamphle t y £I hav e receive d a cop yof th e pamphlet , Renovat e Right : importan t Lea d Hazard Informatio n fo rFamilies , Chil d Care Providers an d School s informin g m e o f th e potentia l ris k o f i:he lea d hazard exposure fro m renovatio n activityt o b e performe d i n m ydwellin g unit . I receive d thi s pamphle t before th e wor k began . 

# TT a OSQ^JS . 

### J<?.hr>' S S^O - 

# <39'/^j/'^ 9 Printe dnam eof recipien t Dat e Self-Certffioatio n Optio n (fo rtenant-occupie d dwelling s only ) — I fth e lea d pamphle t wa s delivere d bu t a tenan t signaiur e wa s not obtainable , yo u ma ychec k th e appropriat e bo xbelow . Q Refusa l t o sig n —I certifytha t I have mad e a goo d fait h effor t t o delive rth e pamphlet . Renovat e Right : Imporian t Lea d Hazard Informatio n fo rFamilies . Chil d Care Providers an d Schools , t o th e renta l dwellin g uni t liste d belo wat th e dat e an d tin ^ indicate d an d that th e occupan t refuse d t o sig n th e confirmatio n ofreceipt . I furthe rcertifytha t I have lef t a cop yo fth e pamphle t a t th e uni t wit h th e occupant . '^|/^navailabl e fo rsignatur e —l certifytha t l hav e mad e a goo d fait h effor t t o delive rth e pamphlet . Renovat e Right : Importan t Lea d Hazar d Informatio n fo r Families . ChU d Care providers an d Schools , t o th e n&ntal dwellin g uni t liste d belo wan d tha t th e occupan t wa s unavailabl e t o sig n th e confirmatio n o f receipt . I furthe rcertif ytha t I have lef t a cop yofth e pamphle t a t th e uni t b yslidin g i t unde rth e doo n 

# dc^ocf ­ i[AUl ( f6Vs ­ 

# -^/^3 / ' « T Printe d nam e o f perso n certifyin g Attempte d deliver y dat e an d tim e lea d pamphle t deliver y Signature o f perso n certifyin g lea d pamphle t deliver y

Uni t Addres s Not e Regardin g Mailin g Optio n — As a n alternative t o deliver yi n person , yo u ma ymai l th e lea d pamphle t t o th e owne rand/o rtenant . Pamphle t mus t b e maile d a

t least . 7 day s before renovatio n (Documen t wit h a certificat e of mailin g fnj m th e post office) .Dougla s County Accoun t Informatio n Pag e 3 of 3 Yea rBuil t 191 0 Detai l Typ e Ad d O n Applianc e Basemen t Fixtur e Fixtur e Garag e Porc h Porc h Yea r Remodele d 0 Percen t Remodele d 0 % Detai l Descriptio n Fenc e Chai n Lin k Allowanc e Bsmn t Bloc k 8 f t Bas e Fixture s Bat h Ful l Detache d En d Scree n En d Scree n Adjuste d Yea r Physica l Ag e Buil t 191 0 9 9 Unit s 1. 0 1. 0 958. 0 1. 0 1. 0 324. 0 147. 0 25. 0

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R070166000 0 9/16/200 9Dougla s Count y Accoun t Informatio n Pag e 2 of 3 Grantee : Valid/Invalid : Vali d Exclusio n Reason : Sale s Date : 1999-04-0 6 Dee d Type : Book : 212 7 Page : 42 7 Price : $10,000.0 0 Grantor : Grantee : Valid/Invalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.1 4 6400. 0 1. 0 160. 0 40. 0 N o Improvemen t Informatio n Buildin g 1 3«Q»N1T$T secon d rlofl f SKOM l t ii »!>•" » i » I2f f I I I FintFba r i r t57.S«q.t . l- U i r « 11 »

llf f 1 1/ 2 STOR Y' » SinMModitl l K7J5*«.a . CLIC KTO ENLARG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : 1474. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Fai r Uni t Type : Condition : Fai r

Buil t As : 1 1/ 2 Stor yFi n Cond o Squar e Footage : 0. 0 HVAC : Force d Ai r Rooms : 7. 0 Exterior : Fram e Sidin g Units : 1. 0 Interior : Drywal l Baths : 1. 0 Roo fCover : Compositio n Shingl e Bedrooms : 4. 0

Roo fType : Hip/Gabl e Stories : 1. 5 Floorcover : Allowanc e Foundation : Bloc k Sprinkle rSquar e Footage : 0. 0 http://douglasne.mapping-onIine.com/DouglasCoNe/static/accountinfo.jsp?accountno=R070166000 0 9/16/200 9Dougla s Coimt y Accoimt Infomiatio n Pag e 1 of 3 Dougla s County , Nebrask a Propert yRecor d - R070166000 0 Prin t Reoor t NE WFeatur e - Parce l Dimension s availabl e ® scal e 0-5 0 f t wes t of52n d S t - ViewO O Ma p Infonnatio n i s vali d a s o f2009-9-1 5 Treasurer' s Ta xReoor t Ne wFeatur e «!4 i 'r

¥^ Aut o Sale s Searc h Owne r JOHNSO N JMAE S C ETA L 390 9 N 1 7 S T OMAH AN E 68110-000 0 Propert yInformatio n Ke yNumbe r 016 6 000 0 0 7 Accoun t Type : Residentia l Parce l Numbe r 070166000 0 Parce l Address : 390 9 N 1 7 S T OIUIAHAN E 68110-000 0 Lega l Description : BOULEVAR D PAR KAD D LO T1 2 BLOC K9 N 4 0 FT4 0 X 16 0 Valu e Informatio n Lan d Improvemen t Tota l 200 9 200 8 200 7 200 6 200 5 200 4 $7,000.0 0 $7,000.0 0 $7,000.0 0 $7,000.0 0 $7,000.0 0 $7,000.0 0 $33,300.0 0 $32,000.0 0 $32,000.0 0 $28,000.0 0 $10,300.0 0 $9,300.0 0 $40,300.0 0 $39,000.0 0 $39,000.0 0 $35,000.0 0 $17,300.0 0 $16,300.0 0 Sale s Informatio n Sale s Date : 2007-01-1 2 Dee d Type : W D Book : 200 7 Page : 00629 2 Price : $39,000.0 0 Grantor . HOUGHTO N DEWE YE ETA L Grantee : JOHNSO N JAME S C ETA L Valid/Invalid : Vali d Exclusio n Reason : Sale s Date : 1999-09-2 4 Dee d Type : D Book : 213 5 Page : 35 7 Price : $12,000.0 0 Grantor : http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R070166000 0 9/16/200 9

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### sjouma^ woii«-6^<'>- > S.N O 1 2 3 4 5 6 7 8 9 1 0 1 1 1 2 Performanc e Standards/ciose-Ou t Criteri a Wa s th e entir e 8tructure(s ) painte d wit h th e exceptio n o fth e stated , exclude d areas ? Thi s woul d includ e paintin g o fothe rassociate d feature s includin g fascia , eaves , siding , al l trim , porches , bo x beams , columns , rails , an d exterio rsurface s o fgarages . Wa s al l scrapin g an d othe rpreparatio n wor k complete d satisfactorily ? Wer e ai l require d area s o fth e structure(s ) prime d a s neede d an d painte d wit h tw o to p coats ? Ar e al l o fth e area s wher e contaminate d material s hav e bee n spille d thoroughl yvacuumed / cleaned ? Di d th e contracto rcollect/vacuu m al l fallin g an d scrape d pain t chip s o n th e entir e property , roadways , alleyways , publi cacces s area s an d als o remov e an yothe rgenerate d debris ? I s th e gras s are a tha t surround s th e structure(s ) i n reasonabl ygoo d condition ? Wa s th e pain t product s utilize d equivalen t t o a 3 0 yea r product/quality ? Ar e al l item s suc h a s polyethylen e sheeting , ladders , pain t brushes , cones , barrie rtap e et cproperi yremoved ? I s ther e an yevidenc e o fpropert ydamag e tha t wa s don e b yth e contractor ? An ypropert ydamag e need s t o b e complete d prio rt o th e EP AClose-Ou t Ar e ther e an ypropert yitem s tha t wer e temporaril yre-locate d b yth e contracto rtha t nee d t o b e move d back ? Ar e ther e an y(known ) lingerin g issue s wit h th e propert yowner(s ) tha t hav e bee n lef t unresolved ? Othe rConsiderations ? Propert yOwne rDiscussions ? Additiona l Wor k tha t i s Require d Ye s / < . 

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### Pruden t Representativ e Signature : Date : Propert yOwne rSignature : Date : 808 0 War d Parkway , Suit e 40 5 250 5 N . 24* " Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , TX 7822 9 Phone:(816)363-370 3 Fax : (816 ) 363-370 7 Phone : (402)504-100 4 Fax : (402)504-100 5 Phone : (210)822-958 8 Fax : (210 ) 579-657 7