## Transmitta l o f

Omah aLea dSite Pain t Stabilizatio n Fil e Folde r Said #6i^S' H Date : ^-<^^-/e > Address : ^ Td^ ^ l^{/^n S s A Contractor : Cit v o f

Omah a Year : ^ & / ^ 

## Pain t Stabilizatio n Propert y Fil e Folde r Document s < X Wor k

Writ e U p gne dAcces s Agreemen t for-sub j ect propert y Pre-Renovation for msignedb y Propert y Owne r Pre-Renovation For mfo r

Occupant/Tenant , ifapplicabl e ^ Painting Agreement/Cit y o f

Omah aPurchas e Orde r Settlemen t documents (i.e. , fo r

damage o r

to replac e plants , etc. ) Renovatio n Recordkeepin g Checklis t signe db y Certifie dRenovato r 

# y Propert y informatio n fi-omDougla s Count y Assessor' s Offic e Othe r

(describe) : [ OOH S "

"T^vo ^ /^—

­ 

## 3-/^"'-'/ * Cit y of Omah aRepresentativ e Signatur e Dat e 

# J EP A Representativ e Signatur e I Dat e 3026248 3 

### Superfun d

## C . ( Y O F OMAH A PURCHASIN G - ROO M 100 3 

### Purchas e Order '

181 9 FARNA M STREE T r V.-. u REVISIO N PAG E ) PURCHAS E ORDE R NO . OMAHA , N E 68183-100 3 116435 6 0 1

FAX # 402-444-542 3 SHI P TO ; CITYOFOMAH A HOUSIN G & COM M DE V R M #111 1 181 9 FARNA M STREE T OMAHA,N E 6818 3

^ • • . _• • _ 

## .- J CHEREK' S HOM E REPAI R VENDOR : > BIL L TO : 1022 4 WEI R S T CIT Y O F OMAH A FINANC E OMAHA , N E 6812 7 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 DATE//BUYE R 7298 9 13-APR-1 0 HHUR T PAYMEN T TERM S SHI P VI A F.O.B . DESTINATIO N FREIGHTTERM S REQUESTOR/DELIVE R T O CONFIR M T O / TELEPHON E MARUCA , T MARI E (402 ) 659-200 4 > < ITE M PAR T NUMBE R / DESCRIPTIO N DELIVER Y DAT E QUANTITY UNI T UNI T PRIC E EXTENSIO N Al l price s an d amount s o n thi s orde r ar e expresse d in . : U S DOIJa r NEEDED : 3,970.0 0 N 11-APR-l O EP APAIN T STABILIZATIO N PROGEIA M GROU P 8 2 12 2 N : 34T H ST . O SHI P TO : Addres s a t to p o f pag e NEEDED : 2,584.0 0 N 11-APR-l O EP APAIN T STABILIZATIO N PROGRA M GROU P 8 2 190 4 EL M S T O SHI P TO : Addres s a t to p o f paQ e NEEDED' : 2,280..0 0 N 11-APR-l O EP APAIN T STABILIZATIO N PROGRA M GROU P 8 2 256 9 EVAN S S T O SHI P TO : Addres s a t to p o f pag e NEEDED : 2,358.0 0 N

SHIPTO : Addres s show n above . I f shipmen t i s delaye d o ran y item s not available , advis e at 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 C Continue d 

# 3 SHIPPIN G CHARGE S T O B E PREPAID , I F APPLICABL E AN D ADDE D T O INVOICED , cop y to b e fur­ nishe d wit h invoice . TA

X EXEMPTION : Th e Cily.o f Omah a i s exemp t fro m Federa l Excis e Taxe s an d th e Nebraska an d Cil y of 

# 'J-^-tUV' " iUv f Oniah a Sale s Taxes . Federa l I.O . 476006304 ; STAT E I.D . 01-0316768 ; Fue l Dealers Lie . 91-0316768 . Cil y Purchasin g Ageh l / Buye r V : :Plannin g Departmen t Omaha/Dougla s Civi c Cente r Inspector : To mRoz a181 9 Fama mStreet , Suit e 1003 r^Qt-o

- O/'N/r n Omaha , Nebrask a6818 3 L>ate . 2/J/I U (402)444-515 0 Telefa-t (402 ) 546.071 4 

### Name : Rub y Fernande z R.E . 

### Cunningham , RA,F.SAM E 

### jim'su^MVo r

.Addrcss : 256 9 Evan s S 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 . •LeadHazardContro l Pl.«n , Interi mContro l o f LeadBiise dPain t Kazaids . Th e Contracto r Shall : •Compl y with HUD' s "Guideline s fo r th e Evaluatio n andContro l o f Lead-Base d Pain t Hazard s i n Housing. " (Copie s are availabl e a t th e Plannin g Department. ) •Compl y wit h Standard s calle dfo r i n th e "CoastruCtio n an dRehabilitatio n Specifications , Housin g an dCornmunit y Developmen t Division , Cit y o f Omaha , Nebraska. " (Copie s ar e availabl e at tJie Planjiin g Department. ) •Complywit h th e Stat e ofNebrask aHealt h an dHuma n Service s Regulatio n and Licensure . Titl e 17 8 Chapte r 2 3 LeadBas e Paint Regulations . . •Coordinate dail y constructipr i schedul e wit h th e occupant •Subrni t informatio n cu t sheet s fo r al l substitution s o r approve dequals , prio r t o writte n approval o f th e Constructio n Specialist . : . • . Repai r o

r rejMac e alUtcm s daniage do r disturbe dduringpain t stabilK^ ^ activities . • • • Kee p wor k

sit e andsurroundin g are afree froi h accumulation s o f waste material s or

rubbi.'s h cause db y th e wor k

at al l times.. • • LJpo n dail y completio n o f work : clean up al l rubbish , exces s material , equipment , aii detc. , thi t i s coimecte dwit h th e work , an dleav e al l part s ofth e wor k

area s in a neat , sahitary , leadsaf e an dpresen!;ab.le . condition . •Complete thi s projec t withi n 3 0 calenda r days . Th e Occupfmt/Owiie r Shall •Remov e an dstore away any persona l property withi n twent y (20 ) fee t o f th e are a t o b e remediated . • Provid e acces s t o electricity an dwate r throughou t the paint stabilizatio n process . • Ensur e tha t al l hoiisehol dmember 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 feet away at all,time s unti l th e wor k

has-been cornplete dandth e are aha s passe davisual inspection:.. . ;•

•. . Initial s256 9 Evan s St (Continued ) 

## LeadHazar dGontro l Plan Interi mContro l of Lea dbase dPain t Hazard s Pain t Stabilizatio n •Prepar e an dpain t al l previousl y painte dexterio r surface s of th e dwellin g to include-bu t no t liinited.t o th e fascia , .eaVes , tiim, windo w trim , doo r tri m an dfoundation . Do no t includ e door s or windows . •Prepar e an dpain t al l previousl y painte dsurface sby followin g th e Saf e Wor k

Practice s protoco l fo r EP A exterio r lea dbase dpain t stabilization . •.Al l pain t color s to matc h existin g pain t pattern . Prim e andappl y tw o coat s of

approve dfinis h coat . (Refe r to Plarmin g Dept . approve dpain t list ) 

### • IF SPRAYED , ON E COA T SHAL L

BE BACK-BRUSHE D

OR BACK-ROLLED . Lead-Base dPain t Wast e Lead-base dpain t wast e mus t be handle d as follow s •Al l pain t chip s an dcomponen t debri s mus t be doubl e bagge dfo r disposal . •Clean pain t chip s fromgroun daroun dperimeter of dwellin g befor e starting , durin g an dafte r th e project . •Al l leadpainte dcomponent s an ddebri s mus t be remove dfro mth e sit e dail y imles s otherwis e approve d by th e constructio n specialist . • Al l lead-base dpain t debri s (chip s an dcomponents ) mus t be dispose d of in amunicipa l soli dwast e landfill . Property Owne r r opertyOwi(e ^ ^ Dat e Property Owner Dat e Witnes sDat e Occupan t (ifapplicable) .Dat e Occupan t (ifapplicable )Dat e Witnes s Dat e

### Exterio r Lead-base dPain t Stabilizatio n ProgramManage dby th e Cit y o f Omah afo r

EPA Regio n 7 Omah aLeadSit e Th e purpos e o f thi s progra mi s t o prevent yard s wher e lead-contaminate dsoi l i s cleane d up frombecomin g re-Contaminate dby deterioratin g exterio r lead-base dpaint . Thi s i s no t ahom e repai r program . Whic h Home s Ar e Eligible ? •Home s wher e soi l clean-u p ha s been or 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 are eligibl e onl y b y referra l fromth e EPA . What wor k

wil l b e done ? •Loos e an dflakin g 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 dto 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 performth e work ? •EP A contractor s \vil l tes t pain t on exterio r hous e surface s andgiv e th e result s to th e Cit y o f Omah aPain t Stabilizatio n Program . •Cit y Constructio n Specialist s wil l prepar e awor k

pla n an dcontac t th e propert y owne r for permissio n t o proceed . •Wor k

wil l b e competitivel y bi dby approved , traine dcontractors . Whe n wil l th e wor k

b e done ? •Thi s progra mbegan i n 200 7 andwil l continu e fo r severa l years . •Th e City staf f wil l prioritiz e home s base do n th e presenc e ofchildre n under ag e si x if know n andth e severity o f th 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 fv . f .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 autiiorize drepresentatives , collectivel y th e Grantee , to ente r an dperfor m certai n environmental respons e activitie s upo n th e followin g describe dpremises : Owner' s Name : Davtime Phone : Owne r Name(s) : Rub y Fernande z 402-453-915 5

Addresse s o f Propertie s Covere db y thi s Agreemen t Propert y Addres s City/State/Zi p Code 256 9 Evan s St . Omaha , N E 6811 1

Granto r understand s tha t thi s grant doe s riot limi t EPA' s right o f acces s under th e Comprehensiv e Environmenta l Respons e andLiabilitv Ac t CCERCLA y 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 or 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 or

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 dfurther , provide s th e Grante e th e righ t t o perfor man y an dal l envirorunenta l 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 to 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 in preparatio n fo r an din th e cours e of. th e respons e activities . 2 .

Obtainin g sample s fro mGrantor' s property .

(1 ) 2/12/200 7Address : 256 9 Evan s St . Consen t fo r Acces s to Propert v (Tag 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 include 1.

) removal o f loos e or flaking pain t identifie db y EP A usin g lead-saf e method s i n complianc e wit h HUD/EPA regulation s an d2 ) repaintin g accordin g to th e attache dspecifications . TER M Thi s acces s agreement shal l b e operabl e fo r th e perio do f time i t take s t o complet e the envirorunental respons e activities . Upo n completio n o f th e respons e actions , al l right s an d privilege s give n by th e Granto r shal l ceas e o n tha t date , unles s extende dby asubsequen t agreement . AGREEMEN T NO T T O INTERFER E Granto r agree s no t t o interfer e 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 take an y action s regardin g th e us e o f th e Propert y which wil l endange r huma n healt h or welfar e or th e environment , or 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 to prospectiv e purchasers , lessees , assigns , o r grantee s o f th e propert y o r an y portio n of it . Granto r agree s t o provid e 30-da y notic e t o EPA prio r t o an y transfe r o f ownershi p right s to the property . SAMPLIN G RESULT S Grante e agree s t o provid e Granto r wit h th e result s o f an y andal l samplin g and/o r analysi s resultin g froni Grantee' s respons e activitie s o n tiie property . PRIO RCONDITION S AGREEMENT Th e granto r agree s t o th e conditio n o f th e propert y prio r t o remediatio n an dindicate s on Pag e 3 an y item s t o b e remove db y th e Granto r befor e activitie s commence . RESTORATIO N OF PROPERT Y Excep t for th e abov e state dpain t stabilization , th e Grarite 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 an dconditio n a s foun dimmediatel y precedin g th e beginnin g o f activitie s authorize db y thi s Agreement , following completio n o f th e respons e activities .

(2 )2/12/200 7Address : 256 9 Evan s St. , Omaha , NE , 6811 1 CURRENT CONDITIO N /PROPOSE D RESPONS E ACTIVITIE S Th e purpos e o f thi s sectio n i s t o provid e aniutual agreemen t as t o condition s o f propert y 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 propert y owner an dth e Unite dState s Environniental Protectio n Agenc y (EPA) . Item s t o b e remove dbv propert y owner prior t o th e respons e activities : 1 . • 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 :

I hav e readth e foregoin g documen t an dunderstan dthat i t i s a n agreement jgraritin g permissio n to th e Grante e to ente r th e abov e describe dpremise s fo r th e purpos e o f conductin g environmenta l respons e activities , an dI agre e to it s term s an dconditions . I acknowledg e tha t I hav e receive dthe pamphle t "Renovat e Right" . Grantor' s Signature : 

### H\idr^-^7iA^r,-^<^ ^ Dat e ^^l(f^^^ ^

(3 ) vimoQ i

### Dougla s Coimt y Accoun t Information Pag e 1 of 3 Dougla s County , Nebrask a Propert y Recor d - R210068000 0 Prin t Repor t Vie w Interactiv e GI S Ma p Informatio n i s vali d a s o f 2012-2-2 8 Treasurer' s Ta x Repor t Ne w Featur e -> ^

- > - » Subdivisio n Sale s Searc h Owne r FERNANDE Z RUB Y 256 9 EVAN S S T OMAH A N E 68111-000 0 Propert y Informatio n Ke y Numtie r 006 8 000 0 2 1 Accoun t Type : Residentia l Parce l Number : 210068000 0 Parce l Address : Lega l Description : 256 9 EVAN S S T OMAH A N E 68111-000 0 REDICKS-CLARK-ADOLO T 5 BLOC K3 46. 2 3 X 12 0 Valu e Informatio n 201 1 201 0 200 9 200 8 200 7 200 6 Lan d $2,500.0 0 $2,500.0 0 $2,500.0 0 $2,500.0 0 $2,500.0 0 $2,500.0 0 Improvemen t $38,800.0 0 $46,200.0 0 $46,200.0 0 $46,200.0 0 $42,400.0 0 $42,400.0 0 Tota l $41,300.0 0 $48,700.0 0 $48,700.0 0 $48,700.0 0 $44,900.0 0 $44,900.0 0 Lan d Informatio n Acre s 0.1 2 S F 5520. 0 Unit s 1. 0 Depti i 120. 0 Widti i 46. 0 Vacan t N o Improvemen t Informatio n Buildin g 1



### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R21.. . 3/14/201 2Dougla s County Accoun t Informatio n Pag e 2 o f 3

Tw o Story 256 9 Evan s S t

S4<oMF1»« r

EwnEHOisi t mo ^ f l CLIC KT O ENLARG E IMAG E Squar e Footage : 1520. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Goo d

Buil t As : 2 1/ 2 Stor y Unfi n Cond o Squar e Footage : 0. 0 HVAC : Force d Ai r Rooms : 8. 0 Exterior : Fram e Sidin g Units : 1. 0 Interior : Drywal l Baths : 1. 0 Roo f Cover : Compositio n Shingl e Bedrooms : 4. 0

Roo f Type : Hi p Stories : 2. 0 Floorcover : Allowanc e Foundation : Bloc k 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 191 5 0 0 % 191 5 9 6 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 752. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Porc h Sla b Roo f Ceilin g 192. 0

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R21. . . 3/14/201 2Dougla s County Accoun t Informatio n Pag e 3 o f 3

3 ­ '* SpauWir> g S t Spauldin g 8 1 z a . I T

" Manderso n S t Mander&o n S t Manderso n S t S Pratt S l Prat t S t z M M B > z " Evan s S t Evan s S t 2 r o 2 I7 > Pinkne y S l Pinkr>e y S t z I O 2 Pinkne y S l Emme l S l 5 £ 2 OT Bristo l S l Bristo l S t Lothro p S t ^ z • £kJt'>||l r S ^ 3 Ma p dat a ©201 2 Googl e Th e abov e ma p i s powere d b y Google , an d i s intende d t o provid e a genera l ide a o f a property' s location . I f yo u requir e a mor e exact propert y location , yo u ma y us e th e Interactiv e GI S Map s tha t ar e maintaine d b y ou r office .

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R21. . . 3/14/201 2