## Transmitta l o f Oniah aLeadSite Pain t Stabilizatio n Fil e Folde r Sai d#7hS^y t

Date : "7" ^ —7 0 Address : J2V3 /

S.3 B ^ ^ ' Contractor : Cit

v o f Omah aYear : ^-<^f O 

## Pain t Stabilizatio n Propert y Fil e Folde r

Document s (•M^or k Writ e U p • igne dAcces s Agreemen

t fo r subjec t propert y Pre-Renovation for

msignedby Propert

y Owne r Pre-Renovation For

mfo r Occupant/Tenant , ifapplicabl e _L^aintin g Agreement/Cit y o f Omah aPurchas e Orde

r Settlemen t documents (i.e. , fo

r damage o r t o replac e plants , etc. ) Renovatio n Recordkeepin

g Checklis t

signedby Certifie

dRenovato

r «-^ropert y informatio

n fro mDouglas Count

y Assessor' s Offic

e Othe r (describe) : f^ctftl ^

Cit y o f Omah aRepresentative Signatur

e Dat e

ntativ f .Qicrnnfiirf * I 1 

### EP A Representative Signatur

e ' ' Dat e 3026246 1 

# ilOHHBDHI I Superfun d

# CIT Y O F OMAH A PURCHASIN G - ROO M 100 3 181 9 FARNA M STREE T OMAHA . N E 68183-100 3 F/\X # 402-444-542 3 

### Purchas e Orde r

VENDOR : MARCO S PROFESSIONA L PAINTIN G

MARCOASALAZA R 251 4 J S T OMAHA , N E 6810 7 f PURCHAS E ORDE R NO . 116657 8 . REVISIO N 0 PAG

E 1 1 J SHIPTO : CITYOFOMAH A HOUSIN G & COM M DE V R M #111 1 181 9 FARNA M STREE T 0MAHA,NE.6818 3 N

. / BIL L TO : CIT Y O F OMAH A FINANC E DISBURSEMENT S ROO M #100 7 181 9 FARNA M STREE T OMAHA.N E 6818 3

/^CUSTOME R ACCOUN T NO . I VENDO R NO . 8156 9 ORIGINA L PURCHAS E ORDE R - VENDOR' S COP Y (SE E INSTRUCTION S BELOW ) DAT E O F ORDER /

BUYE R 15-JUN-1 0 H HUR T REVISE D DATE//BUYE R PAYMENTTERM S IMMEDIAT E SHI P VI A F.O.B . DESTINATIO N FREIGH T TERM S > REQUESTOR/DELIVE R T O M/VRUCA , T MARI E CONFIR M T O / TELEPHON E

- < ITE M PAR T NUMBE R / DESCRIPTIO N DELIVER Y DAT E QUANTIT Y UNr T UNITPRIC E EXTENSIO N Al l price s an d amount s o n thi s orde r ar e expres s s d i n : U S Doi;a r EP APAIN T STABILIZATIOt J PROGRA M GROU P 1 3 0 2 3 01 : S 35T H AV E O . SHI P TO : . i Addres s a t to p o f pag e NEEDED : 12-JUN-l O

EP APAINT.STABILIZATIO N PROGRAM GROU P 13 0 2341 : S . 33RDS T i O SHI P TO : • . : Addres s a t to p o f pag e NEEDED : 12-JUN-l O 1,077.0 0 N

2,177.0 0 N

SHI P TO : Addriss s show n atX3ve . I f sttipmen t i s delaye d o ran y item s no t available , advis e a t once . Pur chas e orde rnumt>e rmus t appea ro n al l invoices , packages , packin g lists , bil l o f lading , an d correspondence . SHIPPIN G CHARGE S T O B E PREPAID . I F APPLICABL E AN D ADDE D T O INVOICED , cop y to be fur nishe d wit h Invoice . T/0 ( EXEMPTION : Th e Cit y o f Omah a i s exemp t fro m Federa l Excis e Taxe s an d th e Nebrask a an d City o f Omah a Sale s Taxes . Federa l I.D . 476006304 ; STAT E I.D . 01-0316768 ; Fue l Dealer s Uc . 91-0316768 . Tota l ( 3:254.0 0 )

Cil y Purchaslii g A |

### Plannin g Department Omaha/Dougla s Civi

c Cente r Inspector : Stev e Zivn y 181 9 Fama mStreet , Suit

e 100 3 r>oto - 1/0/ 1 n Omaha , Nebrask a6818 3 uate . J/y/l U (402)444-515 0 Telefa x (402 ) 546-071 4 

### Name : Danie l L . & Lor aBunk^ . Cunningham , RA , F.SAM E 

### jiSsmue.Mtyo

r Addrcss : 234 1 S SS^''StTcc t °''"'^ ' OMAH A EXTERIO RPAIN T STABILIZATIO N PROGRA M

FO RTH E EP A OMAH A LEA D SIT E Th e Contrac t

bi ddocument s consis t

ofth e followin g sections : • Genera l Responsibilitie s fo

r th e Contracto

r an dOccupant . . • Lea dHazar dControl Plan , Interi

mConfro ! of

Lea dBase dPain t Hazards . Th e Contracto r

Shall : • Compl y wit h HUD' s "Guideline s fo

r the Evaluation an

dControl o

f Lead-Base d Pain t Hazard s in Housing. " (Copie s ar e availabl e a

t th e Plaimin g Department. ) • Compl y wit h Standard s calledfo

r i n the "Construction an

dRehabilitation Specifications , Housin

g an dCommunit

y Developmen

t Division , Cit

y o f Omaiha , Nebraska. " (Copie s ar

e available a

t the Planning Department. ) • Compl y wit h th e Stat e ofNebraskaHealt

h an dHuma n Sei-vice s Regulation an

d Licensure , Titl e 17 8 Chapte r 2 3 Lea dBas e Pain

t Regulations . • Coordinat

e dail y constructio n schedule wit h th e occupan t • Submi t informatio n cu t sheet s fo r al l substitution s o

r approve dequal s prio

r t o writte n approva l o f the Construction Specialist . • Repai r o r replac e all item s damage

do r disturbeddurin

g pain t stabilizatio n activities . • Kee p woi: k sit e an dsurrounding are afree fro

maccumulation s o

f wast e material s o r rubbish cause

db y the wor k a t al l times . • Upo n dail y completion o f

work : clea

n u p all rubbish , exces s material , equipment, an detc. , tha t i s connectedv/it

h th e work, an dleave al l part s ofth e wor

k areas i n a neat , sanitary , lea

dsaf e an dpresentable condition . • Complet

e thi s project

within 3 0 calenda

r days . Th e Occupant'Owne

r Shal l • Remov e an dstor e awa y an y persona l propert y withi n twent y (20 ) fee t ofth e area t o b e remediated . • Provid e acces s t o electricit y an dwate r throughou t th e pain t stabilization process , o Ensur e tha t al l householdmember

s sta y a t leas t te n fee t awa y fro mal l wor k areas an dals o kee p al l pet s a t leas t te n fee t awa y a t al l time s until th

e wor k has bee n complete dan dth e are aha s passe

davisua l inspection . ^



### Initial s <01 ^234 1 S 33r dS t (Continued ) 

## Lea dHazar dContro l Plan Interi mContro l o f

Lea dbase dPain t

Hazard s Pain t Stabilizatio n • Stabiliz e al l previousl y painte dexterio r wood , brick , meta

l o r concret e surface s o f

th e dwellin g t o includ e bu t no t limite dto th e siding , fascia , eaves , trim , windo w trim , shutters , gutters , railings , downspouts , doo r tri m an dfoundation . D O NO T INCLUD E WINDOW S O RMA N DOORS . D O NO T INCLUD E CEMENTITIOU S SIDING . • Prepar e an dpain t

al l previousl y painte dsurface s b y followin g th e Saf e Wor k Practice s protoco l for

EP A exterio r

lea dbase dpain t

stabilization . • . Al l pain t

color s t o matc h existin g pain t pattem . Prim e an dappl y tw o coat s o f approve dfinish coat . (Refer t o Plannin g Dept . approve dpain t list) . • I F SPRAYED , ON E COA T SHAL L B E BACK-BRUSHE D O R BACK-ROLLED . 

### Lea dBase dPain t

Wast e Lead-base dpain t

wast e mus t

b e handle da s follow s • Al l pain t

chip s an dcomponen t

debri s mus t

b e doubl e bagge dfo

r disposal . • Clean pain t

chip s fro mgroun daroun dperimete r o f dwellin g before starting , durin g an dafte

r th e project . • Al l lea dpainte dcomponent s an ddebri s mus t b e remove dfromth e sit e dail y unles s otherwis e approve db y th e constructio n specialist . • Al l lead-base dpain t

debri s (chip s an dcomponents ) mus t b e dispose do f

in amunicipal soli dwast e landfill . Property Owne r

Dat e Propert y Owner Dat e Witnes s Dat e Occupan t (ifapplicable ) Dat e Occupan t (ifapplicable ) Dat e

### Exterior Lead-basedPain

t Stabilizatio n Progra

mManagedb

y the Cit y of Omahafo r EP A Region 7 OmahaLea

dSit e Th e purpos e o f

thi s progra mi s t o preven t yard s wher e lead-contaminate dsoi l i s cleane d u p frombecomin g re-contaminate db y deterioratin g exterio r lead-base dpaint . Thi s i s no t ahom e repai r

program . Whic h Home s Are Eligible ? • Home s wher e soi l clean-u p ha s bee n o r wil l b e don e an da

n EP A contracto r

ha s identifie ddeterioratin g exterio r lead-base dpaint . • Home s ar e eligibl e onl y b y referral fromth e EPA . What wor k wil l b e done ? • Loos e an dflaking lead-base dpain t wil l b e remove dsafely fro mfascia , eaves , siding , trim , windo w trim , doo r tri man dfoundation . • Surface s wil l b e prime dan dpainte dt o matc h existin g pain t colo r a s closel y a s possible . What wil l no t b e done ? • Surface s whic h hav e n o pain t wil l no t b e treated . • Window s o r

door s wil l no t

b e included . • Rotte n woo dwil l no t

b e replaced . • N o housin g repai r

wil l b e done . Wh o wil l perfor

mth e work ? • EP A contractor s wil l tes t pain t o n exterio r

hous e surface s an dgiv e th e result s t o th e Cit y o f Oniah aPain t

Stabilizatio n Program . • Cit y Constructio n Specialist s vvil l prepar e awor

k plan andcontac t

th e property owner for permissio n t o proceed . • Wor k wil l b e competitivel y bi db y approved , traine dcontractors . Whe n wil l th e wor

k b e done ? • Thi s progra mbega n i n 200 7 an dwil l continu e fo r severa l years . • Th e Cit

y staf f wil l prioritiz e home s base do n th e presenc e ofchildre n unde r ag e si x ifknow n an dth e severity ofth e problem . Pain t Stabilizatio n i s voluntar y an dwil l b e don e onl y wit h permissio n ofth e owner , Initial s K/fb ^Consen t fo r Acces s t o Propert y RIGH T O F ENTRY T O PREMISE S Granto r (th e propert

y owner ) consent s t o an dauthorize s th e Unite dState s Environmental Protectio n Agenc y (USEPA ) o r

it s authorize drepresentatives , collectivel y th e Grantise , t o enter an dperfor

m certai n environmental respons e activitie s upo n th e followin g describe dpremises : Owner' s Name : Owner Name(s) : Danie l P Burk e & Lor aBurke Davtime Phone : 341-200 1

Addresse s o f

Propertie s Covere dby thi s Agreemen t Propert y Addres s 234 1 S . 33rdSt . City/State/Zi p Cod e Omaha , N E 6810 5

Granto r understand s that

thi s gran t

doe s not limi t EPA' s righ t

o f acces s unde r

th e Comprehensiv e Environmenta l Respons e an dLiabilitv Ac t rCERCLA") . 4 2 USC . & 9601-9675 . o r anv other law . PURPOS E O F ACCES S Th e purpos e o f

th e respons e actio n i s t o stabiliz e loos e o r flaking exterio r

lead-base dpain t

o n residentia l properties , includin g day-care facilities , where remediatio n o f lea dcontaminate dsoi l ha s o r wil l tak e place . Samplin g o f soi l ma y b e conducted . Thi s consen t shal l allo w Grante e ont o Grantor' s property an dfiirther, provide s th e Grante e th e righ t t o perfor man y an dal l enviromnental respons e action s an dactivitie s i t deem s appropriate . ENVIRONMENTA L RESPONS E ACTION S Th e environmenta l respons e action s t o b e performe do n subjec t propert y ma y includ e th e followin g activities : 1 . Locatin g equipmen t

and/o r machiner y o n subjec t

property i n preparatio n fo r an din th e cours e o f th e respons e activities . 2 . Obtainin g sample s fro mGrantor' s property .

(1 ) 2/12/200 7Address : 234 1 S . 33rdSt .

Consen t for Acces s to Property fPag e 2 ) 3 . Plannin g an dimplementin g th e respons e actio n o n th e Grantor' s property . Thi s wil l includ e 1 ) removal o f

loos e o r flaking pain t

identifie dby EP A usin g lead-saf e method s i n complianc e wit h HUD/EP A regulation s an d2 ) repaintin g accordin g t o th e attache dspecifications . TER M Thi s acces s agreemen t

shal l b e operable . fo

r th e perio do f

tim e i t take s t o complete th e environmenta l respons e activities . Upo n completio n o f th e respons e actions , al l right s an d privilege s give n b y th e Granto r shal l ceas e o n tha

t date , unles s extende db y asubsequent agreement . AGREEMEN T NO T T O INTERFERE Granto r agree s no t

t o interfere wit

h any o f th e activitie s undertake n b y Grante e a t th e Property , tampe r with an y o f

Grantee' s property , o r

tak e an y action s regardin g th e us e ofth e Propert y whic h wil l endange r

human health o r

welfar e o r th e environment , o r

allo w other s t o us e th e Propert y i n suc h marme

r durin g th e ter

mo f thi s consent . Granto r

agree s t o provid e notic e an dacop y o f thi s agreemen t t o prospectiv e purchasers , lessees , assigns , o r grantee s o f

th e property o r

any portio n o f it . Granto r

agree s t o provid e 30-da

y notic e t o EPA prio r

t o an y transfer o f ownershi p right s to th e property . SAMPLIN G RESULT S Grante e agree s t o provid e Granto r with th e result s o f

an y an dall samplin g and/o r

analysi s resultin g fro mGrantee' s respons e activitie s o n th e property . PRIO RCONDITION S AGREEMEN T . Th e granto r

agree s t o th e condition , o f th e property prio r

t o remediatio n an dindicate s o n Pag e 3 an y item s t o b e remove db y th e Granto r before activitie s commence . RESTORATIO N O F PROPERT Y Excep t for th e abov e state dpain t

stabilization , th e Grante e agree s tha t sai dpropert

y wil l b e restore d a s nearl y a s possibl e t o it s original stat e andconditio n a s foun dimmediatel y precedin g th e begirmin g o f

activitie s authorize db y thi s Agreement , follovwn g completio n o f

th e respons e activities .

(2 ) .2/12/200 7Address : 234 1 S . 33r dSt. , Omaha , NE , 6810 5 CURREN T CONDITIO N / PROPOSE D RESPONS E ACTIVITIE S Th e purpos e o f

thi s sectio n i s t o provid e amutual agreemen t a s t o condition s o f

property prior

t o contracto r activities . Thi s wil l als o serv e a s documentatio n fo r th e purpos e o f

assurin g tha

t restoratio n activitie s ar

e complete dto th e satisfactio n o f th e property owne r

an dth e Unite dState s Envirorunenta l Protectio n Agenc y (EPA) . Item s to b e remove db v propertv owner prio r t o th e respons e activities :

• Ar/jt

- ttlgU S > PaLlK\itUE & F=PA;* A FT2t>.j r pfaR:s2J4 2 . 3 . 4 . 5 . Item s NO T to b e remove db v contracto r durin g removal activities : 

### 1 . 2 . .3 . 4 . 5 . . ADDITIONA L COMMENTS : ?vpc^iS 5

I hav e rea dth e foregoin g documen t an dunderstan dtha t

i t i s a n agreemen t

grantin g permissio n to th e Grante e t o ente r

th e abov e describe dpremise s fo r th e purpos e o f

conductin g environmental respons e activities , an dI agre e t o it s term s an dconditions . I acknowledg e tha t I hav e receive dth e pamphle t "Renovat e Right" . Grantor' s Signature:S...^,)--^;j|^ ^ Dat e ^ji^~f Q

(3 ) 2/12/200 7Dougla s County Accoun t Informatio n Pag e 1 of 3 Dougla s County , Nebrask a Propert y Recor d - R090481000 0 Informatio n i s vali d a s o f 2009-12-3 1 Prin t Repor t NE W Featur * - Parce l Dimension s availabl e Q scal e 0-5 0 R wes t o f 52n d S t - Vle W O H Map . Treasurer' s Ta x Repor t Ne w Featur e Wr*.'r* . Aut o Sale s Searc h Owne r .BURK E DANIE L P ETA L 234 1 S 3 3 S T OMAH A N E 66105-000 0 Propert y Informatio n Ke y Number : 048 1 000 0 0 9 Accoun t Type : Residentia l Parce l Number : 090481000 0 Parce l Address : 234 1 8 3 3 S T

OMAH A N E 68105-000 0 Lega l Description : CREIGHTON S 1S T AD D LO T 1 8 BLOC K7 4 9 X 14 0 Valu e Informatio n

Lan d Improvemen t Tota l 200 9 $13,700.0 0 $147,300.0 0 $161,000.0 0 200 8 $13,700.0 0 $147,300.0 0 $161,000.0 0 200 7 $13,700.0 0 $147,300.0 0 $161,000.0 0 200 6 $13,700.0 0 $124,500.0 0 $138,200.0 0 200 5 $13,700.0 0 $124,500.0 0 $138,200.0 0 200 4 $13,700.0 0 $124,500.0 0 $138,200.0 0 Saie s Informatio n

Sale s Date : 2003-02-1 4 Dee d Type : W D SooJ^ ; 223 5 Page : 1 6 Price : $146,000.0 0 Grantor : Grantee : Valld/lnvalld : Vali d Exclusio n Reason : Sale s Date : 1998-07-3 1 Dee d Type : Book : 209 7 Page : 53 4 Price : $73,000.0 0 Grantor : http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R09.. . 1/27/201 0Dougla s County Accoun t Informatio n Pag e 2 o f 3 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 5 6860. 0 1. 0 140. 0 49. 0 N o Improvemen t Informatio n Buildin g 1

CLIC KT O ENLARG E IIMAG E Wood Dec k 4( r ii r

JO C

i m " " »i y

frjtfBr t MJOB C

SMCRMfO w fMtrS W F

t WU '

30 0

Two Stor y CLIC KT O ENLARG E IMAG E Squar e Footage : 1782. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Ver y Goo d Buil t As : 2 Stor

y Cond o Squar e Footage : 0. 0 HVAC : Centra l Ai rt o Ai r Rooms : 7. 0 Exterior : Fram e Sidin g Units : 1. 0 Interior : Drywal l Baths : 2. 5 Roo f Cover : Compositio n Shingl e Bedrooms : 4. 0 Roo f Type : Hi p Stories : 2. 0 Floorcover : Allowanc e Foundation : Blocl < Sprinkle rSquar e Footage : 0. 0 Yea rBuil t Yea r

Remodele d Percen t

Remodele d Adjuste d Yea r Buil t Physica l Ag e 190 5 0 % 190 5 10 3 Deta/ 7 Typ e Detai l Descriptio n Unit s Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloci < 8 f t 942. 0 Basemen t Finishe d 700. 0 http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R09.. . 1/27/201 0

### Dougla s Count

y Accoun t Information Pag e 3 of 3 Fixtur e Fixtur e Fixtur e Porc h Porc h Bas e Fixture s Bat h Ful l Bat h Hal f Sla b Roo f Ceilin g Woo d Dec k 1. 0 2. 0 1. 0 234. 0 120. 0



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R09.. . 1/27/201 0