Transmittal of Omaha Lead Site 

Paint Stabilization File Folder 

Said# 6i^S'H 

Date: ^-<^^-/e > 

Address: ^ Td^ ^ l^{/^nS s A 

Contractor: Citv of Omaha 

Year: ^ & / ^ 

Paint Stabilization 

Property File Folder Documents 

<X Work Write Up 

gned Access Agreement for-subj ect property 

Pre-Renovation form signed by Property Owner 

Pre-Renovation Form for Occupant/Tenant, ifapplicable 

^ Painting Agreement/City of Omaha Purchase Order 

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

Renovation Recordkeeping Checklist signed by Certified Renovator 

y 

Property informationfi-om Douglas County Assessor's Office 

Other (describe): [ OOHS " 

"T^vo^ /^— ­ 3-/^"'-'/* 

City of Omaha Representative Signature Date 

J 

EPA Representative Signature 

I Date 

30262483 

Superfund 
C. (Y OF OMAHA 

PURCHASING - ROOM 1003 Purchase Order' 

1819 FARNAM STREET r 

V.-. u PURCHASE REVISION PAGE ) ORDER NO. 

OMAHA, NE 68183-1003 

1164356 0 1 FAX# 402-444-5423 

SHIP TO; 

CITYOFOMAHA 

HOUSING & COMM DEV RM #1111 

1819 FARNAM STREET 

OMAHA,NE 68183 

^ • • . _ • • _ .-J 

VENDOR CHEREK'S HOME REPAIR : > 

BILL TO: 10224 WEIR ST 

CITY OF OMAHA FINANCE OMAHA, NE 68127 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 DATE//BUYER 

72989 13-APR-10 HHURT 

PAYMENT TERMS SHIP VIA F.O.B. 

DESTINATION 

FREIGHTTERMS REQUESTOR/DELIVER TO CONFIRM TO / TELEPHONE 

MARUCA, T MARIE (402) 659-2004 

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

All prices and amounts on this order are expressed in. : US DOIJar 


NEEDED: 3,970.0 0 N 

11-APR-lO 


EPA PAINT STABILIZATION 


PROGEIAM GROUP 82 122 N: 


34TH ST. 
 O SHIP TO: 


Address at top of page 


NEEDED: 2,584.0 0 N 

11-APR-lO 

EPA PAINT STABILIZATION 


PROGRAM GROUP 82 1904 


ELM ST 


O SHIP TO: 


Address at top of paQe 


NEEDED': 2,280..00 N 

11-APR-lO 

EPA PAINT STABILIZATION 


PROGRAM GROUP 82 2569 


EVANS ST 


O SHIP TO: 


Address at top of page 


NEEDED: 2,358.0 0 N 

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 C SHIPPING

Continued 3

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

nished with invoice. 

TAX EXEMPTION: The Cily.of Omaha is exempt from Federal Excise Taxes and the Nebraska and Cily of 'J-^-tUV'" iUvf Oniaha Sales Taxes. Federal I.O. 476006304; STATE I.D. 01-0316768; Fuel Dealers Lie. 91-0316768. Cily Purchasing Agehl / Buyer V : : 
Planning Department 

Omaha/Douglas Civic Center 

Inspector: To m Roz a 1819 Famam Street, Suite 1003 

r^Qt-o- O/'N/rn Omaha, Nebraska 68183 

L>ate. 2/J/IU (402)444-5150 

Telefa-t (402) 546.0714 

Name: Ruby Fernandez R.E. Cunningham, RA,F.SAME 

jim'su^MVor .Addrcss: 2569 Evans St "'""^ 

OMAHA EXTERIOR PAINT STABILIZATION PROGRAM 

FOR THE EPA OMAHA LEAD SITE 

The Contract bid documents consist ofthe following sections: 

• General Responsibilities for the Contractor and Occupant. 

• Lead Hazard Control Pl.«n, Interim Control of Lead Biised Paint Kazaids. 

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 Planning Department.) 

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

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

Nebraska." (Copies are available at tJie Planjiing Department.) 

• Complywith the State ofNebraska Health and Human Services Regulation and 

Licensure. Title 178 Chapter 23 Lead Base Paint Regulations. . 

• Coordinate daily constructipri schedule with the occupant 

• Subrnit information cut sheets for all substitutions or approved equals, prior to 

written approval of the Construction Specialist. 

:. •. Repair or rejMace alUtcms daniaged or disturbed duringpaint stabilK^^ 

activities. • 

• • Keep work site and surrounding area free froih accumulations of waste materials 

or rubbi.'sh caused by the work at all times.. 

• • LJpon daily completion of work: clean up all rubbish, excess material, equipment, 

aiid etc., thit is coimected with the work, and leave all parts ofthe work areas in a 

neat, sahitary, lead safe and presen!;ab.le. condition. 

• Complete this project within 30 calendar days. 

The Occupfmt/Owiier Shall 

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

to be remediated. 

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

• Ensure that all hoiisehold 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-been 

cornpleted and the area has passed a visual inspection:... 

;•• .. Initials 
2569 Evans St (Continued) 

Lead Hazard Gontrol Plan 

Interim Control of Lead based Paint Hazards 

Paint Stabilization 

• Prepare and paint all previously painted exterior surfaces of the dwelling 

to include-but not liinited.to the fascia, .eaVes, tiim, window trim, 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 Plarming 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 

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

• Clean paint chips from ground around perimeter of dwelling before 

starting, during and after the project. 

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

daily imless otherwise approved by the construction specialist. 

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

a municipal solid waste landfill. 

Propert opertyOwi(ey Ownerr ^ ^ Date 

Property Owner Date 

Witness Date 

Occupant (ifapplicable). Date 

Occupant (ifapplicable) Date 

Witness 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 and flaking 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 will 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? 

• EPA contractors \vill test paint on exterior house surfaces and give the results to 

the City of Omaha Paint Stabilization Program. 

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

owner for permission to proceed. 

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

When will the work be done? 

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

• The City staff will prioritize homes based on the presence ofchildren 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 fv. f. 
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 autiiorized 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): Ruby Fernandez 

402-453-9155 

Addresses of Properties Covered by this Agreement 

Property Address 

City/State/Zip Code 

2569 Evans St. Omaha, NE 68111 

Grantor understands that this grant does riot limit EPA's right of access under the Comprehensive 

Environmental Response and Liabilitv Act CCERCLAy 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 further, 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: 2569 Evans St. 

Consent for Access to Propertv (Tage 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 

envirorunental response activities. Upon completion of the response actions, all rights and 

privileges given by the Grantor shall cease on that date, 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 of the Property which 

will endanger human health or welfare or the environment, or allow others to use the Property in 

such marmer 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 transfer 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 

froni Grantee's response activities on tiie property. 

PRIOR CONDITIONS AGREEMENT 

The grantor agrees to the condition of the 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 Graritee 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: 2569 Evans St., Omaha, NE, 68111 

CURRENT CONDITION /PROPOSED RESPONSE ACTIVITIES 

The purpose of this section is to provide a niutual agreement 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 

Environniental Protection Agency (EPA). 

Items to be removed bv property 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: 

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

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

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

pamphlet "Renovate Right". 

Grantor's Signature: H\idr^-^7iA^r,-^<^^ Date ^^l(f^^^^ 

(3) vimoQi 
Douglas Coimty Account Information Page 1 of3 

Douglas County, Nebraska Property Record - R2100680000 

Print Report 

View Interactive GIS Map Information is valid as of 2012-2-28 Treasurer's Tax Report 

New Feature ->^ -> -» Subdivision Sales Search 

Owner 

FERNANDEZ RUBY 

2569 EVANS ST 

OMAHA NE 68111-0000 

Property Informatio n 

Key Numtier 0068 0000 21 

Account Type: Residential 

Parcel Number: 2100680000 

Parcel Address: 

Legal Description: 

2569 EVANS ST 

OMAHA NE 68111-0000 

REDICKS-CLARK-ADOLOT 5 BLOCK 3 46.23 X 120 

Value Informatio n 

2011 

2010 

2009 

2008 

2007 

2006 

Land 

$2,500.00 

$2,500.00 

$2,500.00 

$2,500.00 

$2,500.00 

$2,500.00 

Improvement 

$38,800.00 

$46,200.00 

$46,200.00 

$46,200.00 

$42,400.00 

$42,400.00 

Total 

$41,300.00 

$48,700.00 

$48,700.00 

$48,700.00 

$44,900.00 

$44,900.00 

Land Informatio n 

Acres 

0.12 

SF 

5520.0 

Units 

1.0 

Deptii 

120.0 

Widtii 

46.0 

Vacant 

No 

Improvemen t Informatio n 

Building 1 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R21... 3/14/2012 
Douglas County Account Information Page 2 of 3 

Two Story 2569 Evans St 

S4<oMF1»«r 

EwnEHOisit mo ^ fl 

CLICK TO ENLARGE IMAGE 

Square Footage: 1520.0 Percent Complete: 100.0% 

Perimeter 0.0 Quality: Average 

Unit Type: Condition: Good 

Built As: 2 1/2 Story Unfin Condo Square Footage: 0.0 

HVAC: Forced Air Rooms: 8.0 

Exterior: Frame Siding Units: 1.0 

Interior: Drywall Baths: 1.0 

Roof Cover: Composition Shingle Bedrooms: 4.0 

Roof Type: Hip Stories: 2.0 

Floorcover: Allowance Foundation: Block 

Sprinkler Square Footage: 0.0 

Year Built Year 

Remodeled 

Percent 

Remodeled 

Adjusted Year 

Built Physical Age 

1915 0 0% 1915 96 

Detail Type Detail Description Units 

Appliance Allowance 1.0 

Basement Bsmnt Block 8 ft 752.0 

Fixture Base Fixtures 1.0 

Fixture Bath Full 1.0 

Porch Slab Roof Ceiling 192.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R21... 3/14/2012 
Douglas County Account Information 

Page 3 of 3 

3­

'* SpauWir>g St 

Spaulding 81 

z 

a. IT 

" Manderson St Mander&on St 

Manderson St 

S 

Pratt Sl 

z Pratt St 

M 

MB > z " Evans St Evans St 2 

ro I7> 2

Pinkney Sl Pinkr>ey St 

z 

IO 

2 Pinkney Sl 

Emmel Sl 

5 

£2 OT 

Bristo Bristol Sl l St 

Lothrop St 

^ z 

•£kJt'>||lr S 

^ 3 

Map data ©2012 Google 

The above map is powered by Google, and is intended to provide a general idea of a property's location. If you 

require a more exact property location, you may use the Interactive GIS Maps that are maintained by our 

office. 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R21... 3/14/2012