Transmittal of Oniaha Lead Site 

Paint Stabilization File Folder 

Said# .g/^^ ^ Date: ^-^^7-/ 0 

Address: /^/ V <>-^ ^ 37 ^ 

Contractor: CityofOmaha Year: p- ^ J ^ 

Paint Stabilization 

Property File Folder Documents 

;x^or k Write Up 

f—^Signed Access Agreement for subject property 

Pre-Renovation form signed by Property Owner 

Pre-Renovation Form for Occupant/Tenant, ifapplicable 

/>f^inting Agreement/City of Omaha Purchase Order 

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

Renovation Recordkeeping Checklist signed by Certified Renovator 

L/Property information from Douglas County Assessor's Office 

_j/Othe r (describe): ^oM j 

J ^ ChahUJi^ r Ownn orJi 

Tip ^ 7*i— 3-7C5^/g 

City of Omaha Representative Signature Date 

I Jcy ^ I )CLI(MJI^ ^ 3/W^^/^ 

EPA Representative Signature . Date 

30262469 

11111111111 

Superfund 
EPA Paint Stabilization Program 

City of Omaha Planning Department 

Housing and Community Development Division 

Change Order Purchase Order U64740 

Group No. 77 

Project: David E. Anderson Change Order No. 1 

1014 S. 26th St. Date: 4/26/2010 

Contractor: G- & M. Painting Co., Inc. 

13707 Cuming St 

Omaha, NE 68154 

The Confract is changed as follows: 

No Electricity at Property. Generator needed to complete project. 

The original confract amount was:

 $1,480.00 

Net change by previosuly authorized Change Orders: ~ $0.00 

The confract amount prior to this Change Order was: $i ,480.00 

The Confract will be increased by this Change Order in the amount of: $250.00 

The new contract amount including this Change Order will be: $ 1,730.00 

The Contract time will be changed by 0 days. 

The date of substantial completion as ofthe date of this Change Order therefore is: 4/12/2010 

CONXJWTOR: ^ /''^y^ ' ^-^IT Y OF OMAHA: 

J I Signatur Signature e > 

4Tgi/g )::>"z/oi'i 

^ By 

¥/^/70 

Date Dat

:/ 

cc: Edward Dantzler 

Marian Todd 
CITY OF OMAHA 

PURCHASING - ROOM 1003 Purchase Order 

1819 FARNAM STREET 

PURCHASE PAGE ORDER NO. REVISION 

OMAHA, NE 68183-1003 

3 1164740 • 1 FAX# 402-444-5423 

SHIP TO: 

CITY OF OMAHA 

HOUSING & COMM DEV RM #1111 

1819 FARNAM STREET 

OMAHA.NE 68183 

VENDOR: G& M PAINTING CO INC > 

BILL TO: 7

13707 CUMING ST CITY OF OMAHA FINANCE OMAHA, NE 68154 DISBURSEMENTS ROOM #1007 

1819 FARNAM STREET 

OMAHA.NE 68183 

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

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

91298 05-APR-10 H HURT 04-OCT-10 H HURT 

PAYMENT TERMS SHIP VIA F.O.B. 

NET 30 DAYS DESTINATION 

FREIGHT TERMS REQUESTOR/DELIVER TO CONFIRM TO / TELEPHONE 

Many 

> < ITEM PART NUMBER / DESCRIPTION DELIVERY DATE QUANTITY UNIT UNITPRICE EXTENSION 

All prices and amounts on this order are express 5d in. :, US Doi: ar 


NEEDED: 1,730.00 N 


03-APR-lO 


C/0 # 1 DATED 4/26/10 


APPLIED ON 4/26/10 TO 


INCREASE SOW BY $250i0jD 


EPA PAINT STABILIZATIok 


PROGRAM GROUP 77 1014 S 


26TH ST 


C SHIP TO: 
 • Address at top of pabe 


DELIVER TO: ZIVNY, STEVEN D (1,730.00) 


NEEDED: •1,870.00 N 

03-APR-lO 


EPA PAINT STABILIZATION 


PROGRAM GROUP 77 116 Si 


36TH ST. 
 o SHIP' TO: 


Address at top of page 


DELIVER TO: ZIVNY, STEVEN D (1,870.00) 


NEEDED: 1,930.0 0 N 

03-APR-lO 

EPA PAINT STABILIZATION 


PROGRAM GROUP 77 4755 


SHIPTO: Address shown above. If shipment is delayed or any items not available, advise at once. Pur­

chase order number must appear on all invoices, packages, packing lists, bill of lading, and correspondence. Total ( Continued ) 

SHIPPING CHARGES TO BE PREPAID. IF APPLICABLE AND ADDED TO INVOICED, copy to be fur­

nished with invoice. 

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-Lie. 91-0316768. 

Ciiy Purchasing Agent.' Buyer 
Planning Department 

Inspector: Steve Zivny Omaha/Douglas civic Center 

Date: 1/29/10 ^^^'^A""^^v,"u'^l!''!.l?2^ 

Omaha, Nebraska 68183 

(402)444-5150 

Name: David E. Anderson Telefax(402)546-07i4 

cityofo„..h. Address : 101 4 S 26*'^ Stree t R-E.cunni„ghar..RA.F.sAJviE 

Jim Suttle, Mayor 

OMAHA EXTERIOR PAINT STABILIZATION PROGRAM 

FOR THE EPA OMAHA LEAD SITE 

The Contract bid documents consist ofthe following sections: 

• Genera! P.esponsibilitiss for the Contractor and Occupant. 

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

The Contractor Shall: 

• Comply with HUD's "Guidelines for the Evaluation and Control of Lead-Based 

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

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

Specifications, Housing and Community Development Division, City of Omaha, 

Nebraska." (Copies are available.at the Planning Department.) 

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

Licensure, Titie 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 stabilizatioii 

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 vvith 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 Occuparit/Owner Shall 

• Remove and store away any personal property within twenty (20) feet ofthe area 

to be remediated. 

• Provide access to elecfricity and water throughout the paint stabilization process. 

• Ensure that all household 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 the work has be^n 

completed and the area has passed a visual inspection. 

Initials 
1014 S.26'*'Sfreet (Continued) 

Lead Hazard Control Plan 

Interim Control of Lead based Paint Hazards 

Paint Stabilization 

• Stabilize all previously painted exterior wood, brick or concrete surfaces 

ofthe dwelling to include but not limited to the siding, fascia, eaves, trim, 

window trim, gutters, downspouts, door trim and foundation. DO NOT 

INCLUDE DOORS OR WINDOWS. 

• Prepare and paint all previously painted surfaces by following the Safe 

Work Practices protocol for EPA exterior lead based paint stabilization. 

• All paint colors to match existing paint pattern. Prime and apply two 

coats of approved finish coat. (Refer to Plamiing Dept. approved paint 

list). 

• IF SPRAYED, ONE COAT SHALL BE BACK-BRUSHED OR 

BACK-ROLLED. 

Lead Based Paint Waste 

Lead-based paint waste must be handled as follows 

o All paint chips and component debris must be double bagged for disposal. 

• Clean paint chips from ground around perimeter pf dwelling before 

starting, during and after the project. 

• All lead painted components and debris must be removed from the site 

daily unless otherwise approved by the consfruction specialist. 

• All lead-based paint debris (chips and components) must be disposed of in 

a municipal solid waste landfill. 

Date 

'roperty. Owner 

Witness Date 

Occupant (if applicable) Date 

Occupant (ifapplicable) Date 
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 andflaking lead-based paint will be removed safely from fascia, eaves, 

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 vvill not be treated. 

• Windows or doors will not be included. 

• Rotten wood will not be replaced. 

• No housing repair will be done. 

Who will perform the work? 

o EPA contractors will test paint on exterior house siu-faces and give the results to 

the City of Omaha Paint Stabilization Program. 

• City Construction Specialists will prepare a work plan and contact the property 

ov/ner for permission to proceed. 

• Work will be competitively bid by approved, trained confractors. 

When will the work be done? 

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

• The City staff will prioritize homes based on die presence of children under age 

six if known and the severity of the problem. 

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

Initials /yj^-T ^ 
Consent for Access to Property 

RIGHT OF ENTRY TO PREMISES 

Grantor (the property owner) consents to and authorizes the United States Environmental Protection 

Agency (USEPA) or its authorized representatives, collectively the Grantee, to enter and perform 

certain environmental response activities upon the following described premises: 

Owner's Name: 

Davtime Phone: 

Owner Name(s): David E. Anderson 

553-1565 

Addresses of Properties Covered by this Agreement 

Property Address . 

City/State/Zip Code 

1014 S. 26th St. 

Omaha, NE 

. . • 

Grantor understands that this grant does not limit EPA's right of access under the Comprehensive 

Environmental Response and Liabilitv Act fCERCLA'). 42 USC. & 9601-9675. or anv other law. 

PURPOSE OF ACCESS 

The purpose of the response action is to stabilize loose or flaking exterior lead-based paint on 

residential properties, including day-care facilities, where remediation of lead contaminated soil has 

or will take place. Sampling of soil may be conducted. This consent shall allow Grantee onto. 

Grantor's property and fijrther, provides the Grantee the right to perform any and all envirorunental 

response actions and activities it deems appropriate. 

ENVIRONMENTAL RESPONSE ACTIONS 

The environmental response actions to be performed on subject property may include the following 

activities: 

1. Locating equipment and/or machinery on subject property in preparation for and in the course of 

the response activities. 

2. Obtaining samples from Grantor's property. 

(1) 2/12/2007 
Address: 1014 S. 26th St. 

Consent for Access to Propertv (Page 2) 

3. Planning and implementing the response action on the Grantor's property. 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. Upon completion of the response actions, all rights and 

privileges given by the Grantor shall cease on that dafe, 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 with any of Grantee's property, or take any actions regarding the 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 frarisfer of ownership rights to the 

property. 

SAMPLING RESULTS 

Grantee agrees to provide Grantor with the 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 said 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 response 

activities. 

(2) 2/12/2007 
Address: 1014 S. 26th St.^ Omaha, NE, 

CURRENT CONDITION / PROPOSED RESPONSE ACTIVITIES 

The purpose of this section is to provide a mutual agreernent as to conditions of property prior to 

contractor activities. This will also serve as documentation for the purpose of assuring that 

restoration activities are completed to the satisfaction of the property owner and the United States 

Environmental Protection Agency (EPA). 

Items to be removed bv propertv owner prior to the response activities: 

1. 

2. 

3 . • 

4. 

5. 

Items NOT to be removed bv contractor during removal activities: 

1­

2. 

3. 

4. . 

5. 

ADDITIONAL COMMENTS: 

CWv ^ C^Uv - \ D ' \lf>J<:^[Uv^ •#• ^^GD(n- 2f e p)vrJA\>^^^-WJLL (.Uwt'^ J 

Y<sA/^ <tu> SW ^ UJW-T C 

I have read the foregoing document and understand that it is an agreement granting permission to 

the Grantee to enter the above described premises for the purpose of conducting enviromnental 

response activities, and I agree to its terms and conditions. I acknowledge that I have received the 

pamphlet "Renovate Right" 

Grantor's Signature: ^ ^ 7^!^^^^^^'^:^''^^^''^ Date .Zr/'/O 

(3) mm^ian 
Douglas County Account Information Page 1 of2 

Douglas County, Nebraska Property Record - R1714250000 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of 52nd St - Vle W OH Ma p Information is valid as of 2009-12-31 Treasurer's Tax Report 

New Feature -+->- + Auto Sales Search 

Owner 

ANDERSON DAVID E ^ T t 

4805 N 107 ST 

OMAHA.NE 68134-0000 

Property Informatio n 

Key Number: 1425 0000 17 

Account Type: Multiple Res 

Parcel Number: 1714250000 

Parcel Address: 1014 S 26 ST 

OMAHA NE 68105-0000 

Legal Description: MARSHS ADD LOT 4 BLOCK 9 1/2 VAC ALLEY ADJ & LOT 4 BLK 9 50 X 132.5 

Value Informatio n 

2009 

2008 

2007 

2006 

2005 

2004 

Land 

$13,200.00 

$13,200.00 

$13,200.00 

$13,200.00 

$13,200.00 

$13,200.00 

Improvement 

$72,400.00 

$72,400.00 

$72,400.00 

$65,000.00 

$65,000.00 

$65,000.00 

Total 

$85,600.00 

$85,600.00 

$85,600.00 

$78,200.00 

$78,200.00 

$78,200.00 

Sales Informatio n 

Sales Date: 2004-04-16 

Deed Type: 

Price: 

QC 

$0.00 

Book: 2004 Page: 053839 

Grantor: MARGE A ANDERSON 

Grantee: DAVID E ANDERSON 

Valld/lnvalld: Invalid 

Exclusion Reason: Fannily Sale 

Land Informatio n 

Acres 

0.15 

SF 

6600.0 

Units 

1.0 

Depth 

132.0 

Width 

50.0 

Vacant 

No 

Improvemen t Informatio n 

http://douglasne.mapping-onUne.com/DouglasCoNe/static/accountinfo.jsp?accountno=R17... 1/25/2010 
Douglas County Account Information Page 2 of2 

Building 1 

•<r 

' « • 

M... 

S»S(fa!s Ft TWO STORY 

CLICK TO ENLARGE IIVIAGE 

Square Footage: 1639 0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: End Condition: Fair 

Built As: 2 Story Condo Square Footage: 0.0 

HVAC: Central Air to Air Rooms: 7.0 

Exterior: Frame Siding Units: 3.0 

Interior: Drywall Batlis: 2.0 

Roof Cover: \ Composition Shingle Bedrooms: 3.0 

Roof Type: i Gable Stories: 2.0 

Floorcover: : Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Percent Adjusted Year Year Built Physical Age Remodeled Remodeled Built 

1920 1997 0% 1920 90 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft _818.0 

Basement Finished 400.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 2.0 

Porch EncI Screen 112.0 

Porch Slab Roof Ceiling 54.0 

Porch Slab Roof Ceiling 112.0 

Porch Slab w/Steps 63.0 

Porch Wood Deck 54.0 

User 3 UNIT CONVERSION 1.0 

User New windows 1.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl 7... 1/25/2010