## Transmitta l o f

Oniah aLea d Site Pain t Stabilizatio n Fil e Folde r
Said#.g/^^ ^ Date : ^-^^7-/ 0 Address : /^/ V <>-^ ^ 37 ^ Contractor : CityofOmah aYear : p- ^ J ^ 

## Pain t Stabilizatio n Propert y Fil e Folde r Document s ;x^or k Writ e U p f—^Signe d Acces s Agreemen t fo r

subject propert y Pre-Renovation for msigned b y Propert y Owne r Pre-Renovation For mfo r

Occupant/Tenant , ifapplicabl e />f^intin 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. ) Renovation Recordkeepin g Checklis t signed b y Certifie d Renovato r L/Propert y informatio n fromDouglas Count y Assessor' s Offic e _j/Othe r (describe) : ^oM j 

### J ^ ChahUJi ^ 

# r Own n orJ i Tip ^

7*i —3-7C5^/ g Cit y o f Omah aRepresentativ e Signatur e Dat e 

## I Jcy ^ I )CLI(MJI^ ^ 

# 3/W^^/^ EP A Representativ e Signatur e . Dat e 3026246 9 

# 1111111111 1 Superfun d

### EP A Pain t Stabilization Progra m Cit y

of Omah aPlanning Departmen t Housin g an d Communit y Developmen t Divisio n Chang e Orde r Purchas e Orde r

U6474 0 Grou p No . 77 Project : Davi d E. Anderson Chang e Orde r

No . 1 101 4 S. 26t h St . Date : 4/26/201 0 Contractor : G- & M. Painting Co. , Inc . 1370 7 Cumin g

St Omaha , NE 6815 4 Th e Confrac t is change d

as follows : No Electricit yat Property . Generato r

neede d

to complet e project .

Th e origina l confrac t amoun t was :$1,480.0 0 Ne t change by previosul y authorized Change Orders : ~ $0.0 0 Th e confrac t amoun t prior to thi s Chang e Orde r

was : $i ,480.0 0 Th e Confrac t will be increased by thi s Change Orde r in the amoun t of : $250.0 0 Th e ne w contrac t amoun t including thi s Chang e Orde r

wil l be : $ 1,730.0 0 Th e Contrac t tim e wil l be changed by 0 days . Th e dat e

of substantia l completion as ofth e dat e

of thi s Change Orde r

therefor e is : 4/12/201 0 CONXJWTOR : ^ /''^y^ ' ^-^IT Y OF OMAHA : J ISignatur Signatur e e > 4Tgi/ g )::>"z/oi' i ^ By 

# ¥/^/7 0 Dat eDat :/


### cc :Edwar d Dantzle r Maria n Tod d

# CIT Y O F OMAH A PURCHASIN G - ROO M 100 3 

### Purchas e Orde r

181 9 FARNA M STREE T PAG E PURCHAS E ORDE R NO . REVISIO N OMAHA , N E 68183-100 3 3 • 1 116474 0 FAX# 402-444-542 3 SHI P TO : CIT Y O F OMAH A HOUSIN G & COM M DE V R M #111 1 181 9 FARNA M STREE T OMAHA.N E 6818 3 G& M PAINTIN G C O IN C > 

# 7 VENDOR : BIL L TO : 1370 7 CUMIN G S T CIT Y O F OMAH A FINANC E OMAHA , N E 6815 4 DISBURSEMENT S ROO M #100 7 181 9 FARNA M STREE T OMAHA.N E 6818 3 ORIGINA L PURCHAS E ORDE R • VENDOR' S COP Y (SE E INSTRUCTION S BELOW ) CUSTOME R ACCOUN T NO . VENDO R NO . DAT E O F ORDER / BUYE R REVISE D DATB/BUYE R 9129 8 05-APR-1 0 H HUR T 04-OCT-1 0 H HUR T PAYMEN T TERM S SHI P VI A F.O.B .

NE T 3 0 DAY S DESTINATIO N FREIGH T TERM S REQUESTOR/DELIVE R T O CONFIR M T O / TELEPHON E Man y > < ITE M PAR T NUMBE R / DESCRIPTIO N DELIVER Y DAT E QUANTITY UNI T UNITPRIC E EXTENSIO N Al l price s an d amount s o n thi s orde r ar e expres s 5 d in . :, U S Doi : a r NEEDED : 1,730.0 0 N 03-APR-l O C/ 0 # 1 DATE D 4/26/1 0 APPLIE D O N4/26/1 0 T O INCREAS E SOW B Y $250i0j D EP APAINT STABILIZATIo k PROGRA M GROU P 7 7 101 4 S 26T H S T C SHI P TO : • Addres s a t to p o f pab e

DELIVE R TO : ZIVNY , STEVE ND (1,730.00 ) NEEDED : •1,870.0 0 N 03-APR-l O EP APAINT STABILIZATIO N PROGRA M GROU P 7 7 11 6 S i 36T H ST . o SHIP ' TO : Addres s a t to p o f pag e DELIVE R TO : ZIVNY , STEVE ND (1,870.00 ) NEEDED : 1,930.0 0 N 03-APR-l O EP APAINT STABILIZATIO N PROGRA M GROU P 7 7 475 5

SHIPTO : Addres s show n above . I f shipmen t i s delaye d o ran y item s no t available , advis e a t once . Pur­ chas e orde rnumbe rmus t appea ro n al l invoices , packages , packin g lists , bil l of lading , an d correspondence . Tota l ( Continue d ) SHIPPIN G CHARGE S T O B E PREPAID . I F APPLICABL E AN D ADDE D T O INVOICED , cop y t o b e fur ­ nishe d wit h invoice . TA X 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 Nebraska an d City of Omah a Sale s Taxes . Federa l I.D . 476006304 ; STAT E I.D : 01-0316768 ; Fue l Dealers-Lie . 91-0316768 . Cii y Purchasin g Agent. ' Buye rPlannin g Departmen t Inspector : Stev e Zivn y Omaha/Dougla s civi c Center Date : 1/29/1 0 ^^^'^A""^^v,"u'^l!''!.l?2 ^ Omaha , Nebrask a6818 3 (402)444-515 0 

## Name : Davi dE . Anderso n Telefax(402)546-07i 4 cityofo„..h . Address : 1014 S 26*' ^ Street R-E.cunni„ghar..RA.F.sAJvi E Ji mSuttle , Mayo r 

### OMAH A EXTERIO RPAIN T STABILIZATIO N PROGRA M FO RTH E EP A OMAH A LEA D SIT E Th e Contract bi d document s consis t ofth e followin g sections : •Genera ! P.esponsibilitis s for th e Contracto r an d Occupant . •Lead Hazar d Contro l Plan , Interi mContro l o f Lea dBase d Pain t Hazards . 

### The Contracto r

Shall : •Compl y wit h HUD' s "Guideline s for th e Evaluatio n an d Contro l o f Lead-Base d Pain t Hazard s i n Housing. " (Copie s ar e availabl e at th e Plaimin g Department. ) •Compl y with Standard s calle d for i n th e "Constructio n an d Rehabilitatio n Specifications , Housin g an d Community Developmen t Division , Cit y o f Omaha , Nebraska. " (Copie s ar e available.at th e Plannin g Department. )

. • Compl y with th e Stat e ofNebrask aHealth an d Human Service s Regulatio n an d Licensure , Titi e 17 8 Chapte r 2 3 Lead Bas e Pain t Regulations . •Coordinat e dail y constructio n schedul e with th e occupan t •Submi t informatio n cu t sheet s for al l substitution s o r approve d equal s prio r to writte n approval o f th e Constructio n Specialist , •Repai r O

r replac e al l item s damage d o r disturbe d durin g pain t stabilizatioi i activities . •Kee p wor k

sit e an d surroundin g are afre e fro maccumulation s o f wast e material s o r

rubbis h cause d b y th e wor k

a t al l times. •Upo n dail y completio n o f work : clean u p al l rubbish , exces s material , equipment , an d etc. , tha t i s connecte dvvit h th e work , an d leav e al l part s ofth e wor k

area s i n a neat , sanitary , lea d saf e an d presentabl e condition . •Complet e thi s projec t withi n 3 0 calenda r days . Th e Occuparit/Owner Shal l •Remov e an d stor e away an y persona l property withi n twenty (20 ) feet ofth e are a t o b e remediated . •Provid e acces s t o elecfricit y an d wate r throughou t th e pain t stabilizatio n process . •Ensure tha t al l househol d member s stay a t leas t te n fee t awa y fromal l wor k

area s an d als o kee p al l pet s a t leas t te n feet away a t al l times unti l th e wor k

ha s be^n complete d an d th e are aha s passe d avisua l inspection . Initial s

### 101 4 S.26'*'Sfree t (Continued) 

## Lea d Hazar d Contro l Pla n InterimControl o f Lea d based Pain t Hazard s Pain t Stabilizatio n •Stabiliz e al l previousl y paintedexterior wood, bric k

o

r

concret e surface s ofth e dwelling t o includ e bu t not limitedt o the siding , fascia , eaves , trim , window trim , gutters , downspouts , doo r

tri man dfoundation . D O NO T INCLUD E DOOR S O RWINDOWS . •Prepar e an d pain t al l previousl y painte dsurface s b y followin g th e Saf e Wor k

Practice s protocol fo r

EP A exterio r

lea dbase dpain t stabilization . •Al l pain t color s to matc h existing pain t pattern . Prim e an dappl y tw o coat s o f

approve d finis h coat . (Refe r

t

o Plamiin g Dept . approve d pain t list) . •I F SPRAYED , ON E COA T SHAL L B E BACK-BRUSHE D O R BACK-ROLLED . 

### Lea d Based Pain t Wast e Lead-base d pain t wast e mus t b e handle d a s follow s oAl l pain t chip s an d componen t debri s must be double baggedfo r

disposal . •Clea n pain t chip s fro mgroun daroundperimete r

p f dwelling befor e starting , during an dafte r

th e project . •Al l lea d painted components an ddebri s mus t b

e remove dfro mth e sit e dail y unles s otherwis e approve dby th e consfructio n specialist . •Al l lead-based paint debri s (chip s an dcomponents ) must be dispose do f

i

n amunicipa l soli d wast e landfill . Dat e 'roperty . Owne r Witnes sDat e Occupan t (if applicable )Dat e Occupan t (ifapplicable )Dat e

### Exterior Lead-based Pain t Stabilizatio n Progra mManage d b y th e Cit y o f Omah afo r

EP A Regio n 7 OmahaLea d Sit e Th e purpos e o f

thi s progra mi s t o preven t yard s wher e lead-contaminatedsoil i s cleane d u

p fro mbecomin g re-contaminated b y deteriorating exterio r

lead-basedpaint . Thi s i s no t ahome repai r program . Whic h Home s Ar e Eligible ? •Home s wher e soil clean-u p has bee n o r

will b e don e an da n EP A contracto r

ha s identified deteriorating exterio r

lead-basedpaint . •Home s ar e eligibl e onl y b y referra l fro mthe EPA , Wha t wor k

will b e done ? •Loos e an d flaking lead-base dpain t wil l be remove dsafel y fro mfascia , eaves , siding , trim , window trim , doo r

triman dfoundation . •Surface s wil l b e prime d an d paintedt o matc h existing pain t colo r

a s closel y as possible . Wha t will no t b e done ? •Surface s whic h have n o pain t vvil l not be treated . •Window s o r

door s will not b e included . •Rotte n woo d will no t b e replaced . •No housing repai r

wil l b e done . Wh o wil l perfor mth e work ? oEP A contractor s wil l tes t pain t on exterio r

hous e siu-face s an dgiv e th e result s t o th e Cit y o f

Omah aPain t Stabilization Program . •Cit y Construction Specialist s will prepar e awor k

pla n an dcontac t the propert y ov/ne r

fo r permission t o proceed . •Wor k

will be competitivel y bidby approved , trainedconfractors . Whe n will th e wor k

be done ? •Thi s progra mbega n i n 2007 an dvyil l continue fo r

severa l years . •Th e Cit y staf f

will prioritiz e home s base do n di e presenc e o f

childre n unde r

ag e six i f

know n an d the severit y o f

th e problem . Pain t Stabilizatio n i s voluntary an d wil l be don e onl y wit h permission ofth e owner .

Initial s /yj^-T ^Consen t fo r Acces s t o Propert y RIGH T O F ENTRY T O PREMISE S Granto r (th e property owner ) consent s t o an d authorize s th e Unite d State s Environmental Protectio n Agenc y (USEPA ) o r it s authorize d representatives , collectivel y th e Grantee , t o ente r an d perfor m certai n environmental respons e activitie s upo n th e followin g describe d premises : Owner' s Name : Davtime Phone : Owner Name(s) : Davi d E . Anderso n 553-156 5

Addresse s o f Propertie s Covere d b y thi s Agreemen t Propert y Addres s . City/State/Zi p Cod e 101 4 S . 26th St . Omaha , N E

. . • Granto r understand s that thi s grant doe s no t limi t EPA' s righ t o f acces s unde r th e Comprehensiv e Environmenta l Respons e an d Liabilitv Ac t fCERCLA') . 4 2 USC . & 9601-9675 . o r an v othe r 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 d pain t o n residentia l properties , includin g day-care facilities , where remediatio n o f lea d contaminate d soi 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 onto . Grantor' s property an dfijrther, provide s th e Grante e th e righ t to perfor man y an d al l envirorunental 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 d o 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 d i n 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 : 101 4 S . 26t h St . Consen t for Acces s t o Propertv (Pag e 2 ) 3 .Plannin g and implementin g th e respons e actio n o n th e Grantor' s property . Thi s wil l includ e 1 ) remova l o f loos e or . flaking pain t identifie db y EP A usin g lead-saf e method s i n complianc e with HUD/EP A regulation s an d 2 ) repaintin g accordin g t o the attache d specifications . TERM Thi s acces s agreement , shal l b e operabl e fo r th e perio d o f tim e it take s t o complet e 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 that dafe , unles s extende d by asubsequent agreement . AGREEMEN T NO T T O INTERFERE Granto r agree s no t t o interfere with any o f th e activitie s undertake n b y Grante e at th e Property , tampe r wit h an y o f Grantee' s property , o r take an y action s regardin g th e us e ofth e Propert y whic h wil l endange r human healt h o r welfare o r th e environment , o r allo w other s t o us e th e Propert y i n suc h manne r durin g th e ter mo f thi s consent . Granto r agree s to provid e notic e an d acop 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 an y portio n o f it . Granto r agree s t o provid e 30-da y notic e t o EP A prio r t o an y frarisfer o f ownershi p right s to th e property . SAMPLIN G RESULT S Grante e agree s t o provid e Granto r wit h th e result s o f any an d al l samplin g and/o r analysi s resultin g fromGrantee' 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 conditio n ofth e property prio r t o remediatio n an d indicate s o n Pag e 3 any 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 fo r th e abov e state d pain t stabilization , th e Grante e agree s that sai d property wil l b e restore d a s nearl y a s possibl e t o it s origina l stat e an d conditio n a s found immediatel y precedin g th e beginnin g o f activitie s authorize d by thi s Agreement , followin g completio n o f th e respons e activities .

(2 )2/12/200 7Address : 101 4 S . 26t h St. ^ Omaha , NE , 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 amutua l agreernen t a s to condition s o f propert y prio r 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 are complete d t o th e satisfactio n o f th e property owne r an d th e Unite d State s Environmenta l Protectio n Agenc y (EPA) . Item s t o b e remove d b v propertv owne r prio r t o th e respons e activities : 1 . 2 . 3 . • 4 . 5 . Item s NO T to b e remove d b v contracto r durin g removal activities : 1­ 2 . 3 . 

### 4 . . 5 . ADDITIONA L COMMENTS :

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- \ D ' \lf>J<:^[Uv ^ •# • ^^GD(n

- 2f e p)vrJA\>^^^-WJL L (.Uwt'^ J Y<sA/ ^ <tu > SW ^ UJW-T C 

### I have rea d th e foregoin g documen t an dunderstan dtha t i

t

i s a n agreemen t grantin g permissio n t o the Grantee t o ente r

th e above describedpremise s fo r

th e purpos e o f

conductin g enviromnenta l respons e activities , an d I agre e to it s term s an dconditions . I acknowledge tha t I hav e receive dth e pamphle t "Renovat e Right " Grantor' s Signature : ^ ^ 7^!^^^^^^'^:^''^^^'' ^ Dat e .Zr/'/ O

(3 ) mm^ia nDougla s Count y Accoun t Informatio n Pag e 1 of 2 Dougla s County , Nebrask a Propert y Recor d - R171425000 0 Prin t Repor t NE W Featur e - Parce l Dimension s availabl e @ scal e 0-5 0 ft wes t o f 52n d S t - Vle W O H Ma p Informatio n i s vali d a s o f 2009-12-3 1 Treasurer' s Ta x Repor t Ne w Featur e -+->- + Aut o Sale s Searc h Owne r ANDERSO N DAVI D E 

# ^ T t 480 5 N 10 7 S T OMAHA.N E 68134-000 0 Propert y Informatio n Ke y Number : 142 5 000 0 1 7 Accoun t Type : Multipl e Re s Parce l Number : 171425000 0 Parce l Address : 101 4 S 2 6 S T OMAH A N E 68105-000 0 Lega l Description : MARSH S AD D LO T 4 BLOC K9 1/ 2 VA C ALLE Y AD J & LO T 4 BL K9 5 0 X 132. 5 Valu e Informatio n 200 9 200 8 200 7 200 6 200 5 200 4 Lan d $13,200.0 0 $13,200.0 0 $13,200.0 0 $13,200.0 0 $13,200.0 0 $13,200.0 0 Improvemen t $72,400.0 0 $72,400.0 0 $72,400.0 0 $65,000.0 0 $65,000.0 0 $65,000.0 0 Tota l $85,600.0 0 $85,600.0 0 $85,600.0 0 $78,200.0 0 $78,200.0 0 $78,200.0 0 Sale s Informatio n Sale s Date : 2004-04-1 6 Dee d Type : Price : Q C $0.0 0 Book : 200 4 P age : 05383 9 Grantor : MARG E A ANDERSO N Grantee : DAVI D E ANDERSO N Valld/lnvalld : Invali d Exclusio n Reason : Fannil y Sal e Lan d Informatio n Acre s 0.1 5 S F 6600. 0 Unit s 1. 0 Dept h 132. 0 Widt h 50. 0 Vacan t N o Improvemen t Informatio n http://douglasne.mapping-onUne.com/DouglasCoNe/static/accountinfo.jsp?accountno=R17. . . 1/25/201 0Dougla s Count y Accoun t Informatio n Pag e 2 of 2
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### TW O STOR Y CLIC KT O ENLARG E IIVIAG E Squar e Footage : 163 9 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : En d Condition : Fai r

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 : 3. 0 Interior : Drywal l Batlis : 2. 0 Roo f Cover : \ Compositio n Shingl e Bedrooms : 3. 0 Roo f Type : i Gabl e Stories : 2. 0 Floorcover : : Allowanc e Foundation : Bloc k Sprinkle rSquar e Footage : 0. 0 Yea r Percen t Adjuste d Yea r Yea rBuil t Physica l Ag e Remodele d Remodele d Buil t 192 0 199 7 0 % 192 0 9 0 Detai l Typ e Detai l Descriptio n Unit s Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f t _818. 0 Basemen t Finishe d 400. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 2. 0 Porc h Enc I Scree n 112. 0 Porc h Sla b Roo f Ceilin g 54. 0 Porc h Sla b Roo f Ceilin g 112. 0 Porc h Sla b w/Step s 63. 0 Porc h Woo d Dec k 54. 0 Use r 3 UNI T CONVERSIO N 1. 0 Use r Ne w window s 1. 0

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R l 7.. . 1/25/201 0