## Transmitta l o f

Omah aLea d Site Pain t Stabilizatio n Fil e Folde r Said#__3^AS3

_Date:_^r^3jl^ ^ Address : 3^7( r A ^ ^' ^ S-f

Contractor : Cit v o f

Omah aYear : ^~ ^ * 7 

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

Writ e U p / 

### Sighe d Acces s Agreemen t fo r

subjec t propert y Pre-Renovation for msigne db y Propert y Owne r Pre-Renovation For mfo r

Occupant/Tenant , ifapplicabl e J^Paintin 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 signe db y Certifie dRenovato r ^Propert y informatio n fro mDougla s Count y Assessor' s Offic e ^ Othe r

(describe) : / /lofO S

Cit y of Omah aRepresentativ e Signatur e Dat e EP A Representativ e Signatur e _ Dat e 3026244 5 

# iHRM I Superfun d

## CITY O F OMAH A PURCHASIN G - ROO M 100 3 ' 

### Purchas e Orde r

181 9 FARNA M STREE T .aURCriAS E ORDE R NO , REVISIO N P.AG E OMAHA , N E 68183-100 3 1 , 0 115S85 1 • FAX # 402-444-542 3 SHI P TO : CIT Y C F OMAH A HOUSIN G A COM M OE V R M #111 1 131 9 FARNA M STREE T OMAHA.N E 6818 3 US A CONS.TRUCTIO N SERVICE S IN C VENDOR : 

## k - < BIL L TO : 813 0 3 9 2 AV E CIT Y O F OMAH A FINANC E LAVISTA , N E 6812 8 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 ) CUSTOM ; I T ACCOUN T NO . VENDO R NO . DAT E O F ORDER/ BUYE R REVISE D DATE//BUYE R 605 7 25-AUG-0 9 P BURK E PAYMEN T TERM S SHI P VI A F.O.B . DESTINATIO N FREIGH T "ERM S REQUESTOR/DELIVE R T O CONFIR M T O / TELEPHON E MARUCA , T MARI E 0 214-570 0 < > • ITE M PAR T NUMBE R / DESCRIPTIO N DELIVER Y DAT E QUANTIT Y UNI T UNI T PRIC E EXTENSIO N IMPORTAN T D O NO T START WOR K

UNTI L PROCEE D ORDEf l I S ISSUE D B Y TH E PLANNIN G DEPARTMEN T - PE RGROU P 5 7 BI D DATE D 8/19/0' 9 A l l price s an d amount s o n thi s orde r ar e expres s =d i n U S DoHa r NEEDED : 650.0 0 N 23-AUG-0 9 EP APAIN T STABILIZATIO N PROGRA M GROU P 5 7 - 2 4 0 EMME T S T O SHI P TO : Addres s ab to p o f pag e NEEDED : 1 , 190.00 ' N 23-AUG-0 9 EP APAIN T STABILIZATION ! PROGRA M GROU P 5 7 - 361 5 N2 9T H ST . O SHI P TO : Addres s a t to p o f pag e

SHI P TO : Addres s show n above . I f shipmen t i s delaye d o ran y item s no l available , advis e a t once . Pur chas e orde: ' numbe r.mus 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 t o b e fur nishe d will-invoice . 

### Tota l ( ^•8^°° ° )
TAX EXErpTION : Th e Cit y of.Omah a I s exemp t fro m Federa l Excis e Taxe s an d th e Nebrask a and.Cit y of Omah a S a :i s Taxes . Federa l I.D . 476006304 ; STAT E I.D . 01-0316768 ; Fue l Dealer s Lie . 91-03,16768 . Cll y Purciiasin g Agen l / Buye rPlannin g Departmen t Inspector : To mRoz aOmaha/Dougla s civi c Cente r Date : 7/14/0 9 • '^'^^^"^^T^^f'iZ i Omahi , Nebrask a6818 3

. (402)444-515 0 

## Name : Alic e Wallac eTelefax (402) 546-07i 4 CityofOmaha

- AddreSS" . 361 5 N 2 9 S t StcvcnN.Jensen.AICP . L A Ji mSuttle , Mayo r 

## OMAHA EXTERIO RPAIN T STABILIZATIO N PROGRA M FO RTH £EP A OMAH A LEAD SIT E Th e Contrac t bi ddocument s consis t ofth e followin g sections : •Genera l Responsibilitie s for th e Contracto r an d Occupant . •Lea dHazar dContro l Plan , Interi mContro l o f Lea d Base d Pain t Hazards . Th e Contracto r Shall : •Compl y with 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 a t 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 availabl e a t th e Plarmin g Department. ) •Compl y wit h th e Stat e ofNebrask aHealt h an d Huma n Service s Regulatio n an d Licensure , Titl e 17 8 Chapte r2 3 Lea d 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 or approve d equal s prio r t o vvritten approva l o f th e Constructio n Specialist . •Repai r o r replac e al l item s damage d o r distiorbe d durin g pain t stabilizatio n

. activities . •Kee p wor k

sit e an dsurroundin g are afre e fromaccurtiulatipn s o f wast e material s o r

rubbis h cause db y th e wor k

a

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

area s i n a neat , sanitary , lea dsaf e an d presentabl e condition . •Comptete thi s projec t withi n 3 0 calehda'-days . Th e Occupant/Owne r Shal l •Remov e ari dstor e away any persona l propert y withi n twent y (20 ) feet o f th e are a t o b e remediated . •Provid e acces s t o electricity an d wate r throughou t tfie pairi t stabilizatio n process : •Ensur e tha t all househol dmember s stay a t leas t te n fee t away fro mal l wor k

area s an dals o kee p al l pet s at leas t te n feet away a t al l time s unti l th e wor k

ha s bee n complete dan dth e are aha s passe d avisua l inspection

Initial s G b 1^ 7

### Exterior Lead-base d Pain t Stabilizatio n Progra mManagedb y th e Cit y of Omahafo 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 mbecoming re-contaminate db y deterioratin g exterio r

lead-basedpaint . Thi s i s no t ahom e 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 contractor ha s identified deterioratin g 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-basedpain t will b e removedsafel y frorr i fascia , eaves , siding , trim , windo w trim , doo r

tri man dfoundation . •Surface s will be primed an dpainte dt o matc h existing pain t colo r

a s closel y a s possible . Wha t will no t b e done ? •Surface s which hav e no pain t will no t b e treated . •Window s o r

door s wil l no t be included . •Rotten woo d wil l not b e replaced . •.N o housing repai r

v/il l b e done ; Wh o will perfor mth e work ? •EP A contractor s will tes t pain t o

n exterior hous e surface s an dgive the result s t o th e Cit y of OmahaPain t Stabilizatio n Program . •Cit y Constructio n Specialist s vnll prepar e awor k

pla n an dcontac t th e propert y owne r

fo r

permissiont o proceed . •Wor k

will b e competitivel y bidb y approved , traine dcontractors . Whe n will th e wor k

b e done ? •Thi s progra mbega n in 200 7 an dwil l continu e fo r

severa l years . •Th e Cit y staf f

will prioritiz e home s basedo n th e presenc e o f

children unde r

age six i f

known an d th e severit y o f

th e problem . Pain t Stabilizatio n i s voluntary an dwil l b e don e onl y wit h permissio n ofth e owner . Initial s (X-U j

### 361 5 N 2 9 S t (Continued ) 

## Lea dHazar d Contro l Plan InterimContro l o f

Lea d base dPaint Hazard s Pain t Stabilizatio n 1 .

Stabiliz e all previousl y painte dexterior surface s o f

th e house . Includ e window s @ fron t porc h an duppe r rear o

f

house . D o no t includ e doors . 2 .

Prepar e an d paint al l previously painte dsurface s b y followin g th e Saf e Wor k

Practice s protocol fo r

EP A exterio r

lea dbasedpain t stabilization . 3 .

Al l paint color s t o match existin g paint pattern . Prim e an dappl y tw o coat s o

f

approve d finis h coat . (Refe r

to Planning Dept . approvedpain t list ) 4 .I F SPRAYED , ON E COA T SHALL B E BACK-BRUSHE D O R BACK-ROLLED . Lea d Base d Pain t Wast e Lead-base d pain t H'ast e mus t b e handle da s follow s •Al l pain t chip s andcomponen t debri s mus t b e double baggedfo r

disposal . •Clea n pain t chip s fro mgroundaroun dperimete r

o

f

dwelling befor e starting , during an dafte r

th e project . •All lea d painte d component s anddebri s must be remove dfro mth e sit e • dail y unles s otherwis e approvedb y th e construction specialist . •Al l lead-base d paint debri s (chip s an dcomponents ) mus t b e disposed o f

i

n amunicipa l soli dwast e landfill . Propert y Owne r

Dat e Propert y Owne r

Dat e Witnes sDat e Occupan t (ifapplicable )Dat e Occupan t (ifapplicable )Daf e t 

### Witnes sDat eConsen t fo r Acces s t o Propert y RIGH T O F ENTR Y T O PREMISE S Granto r (th e property owner ) consent s t o an d authorize s th e Unite d State s Envirorunental Protectio n Agenc y (USEPA ) o r it s authorize drepresentatives , collectivel y th e Grantee , t o ente r an d perfor m certai n environmenta l respons e activitie s upo n th e followin g describe dpremises : Owner' s Name : Davtim e Phone : • Owne r Name(s) : ALLIC E WALLAC E 402-933-557 7

Addresse s o f Propertie s Covere d b y thi s Agreemen t Property Addres s City/State/Zi p Cod e 361 5 N . 29th St . Omaha , N E

Granto r understand s tha t thi s gran t 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 dLiabilit v Ac t fCERCLAI . 4 2 USC . & 9601-9675 . o r an v othe r law . PURPOS E O F ACCESS . Th e purpos e o f th e response . 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-car e facilities , wher e remediatio n o f leadcontaminate 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 ont o Grantor' s property an dfUrther, provide s th e Grante e th e righ t t o perfor man y an d al l environmental respons e action s an dactivitie s i t deem s appropriate . FUTUR E ACTIO N B y signin g thi s document , th e granto r agree s t o allo w a n EP A contracto r t o conduc t asoi l cleanu p a t

thi s propert y followin g completio n o f lead-base d pain t stabilization . Th e granto r acknowledge s tha t th e pain t stabilizatio n contractor canno t provid e assurance s tha t bin d th e soi l cleanu p contractor . Th e granto r understand s tha t th e soi l cleanu p contracto r wil l make al l reasonabl e effort s t o addres s cohcerii s tha t th e granto r ma y hav e regardin g soi l cleanu p a t thi s property . ENVIRONMENTA L RESPONS E ACTION S • Th e envirorunenta l respons e action s t o b e performe d o n subjec t property ma y includ e tli e followin g activities : . . 1 .Locatin g equipmen t and/o r machinery 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 : 361 5 N . 29t h St . Consen t fo r Acces s t o Propert\ ' (Pag 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 ) remova l o f loos e or flaking pain t identifie d b y EP A usin g lead-saf e method s i n complianc e with HUD/EP A regulation s an d2 ) repaintin g accordin g t o th e attache d specifications . TER M Thi s acces s agreemen t shal l b e operabl e fo r th e perio d o f tim e i t 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 tha t date , unles s extende d b y asubsiequeii t agreement . AGREEMEN T NO T T O INTERFERE Grantor , agree s not t o interfere wit h an y ofth 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 tak e an y action s regardin g th e us e ofth e Property whic h 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 marmer durin g th e ter mo f thi s consent . Granto r agree s t o provid e notic e an d acop y o f thi s agreenien 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-day notic e t o EP A prio r t o any transfe r o f ownershi p right s t o 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 an y an d al l samplin g and/o r analysi s resultin g frohi Grantee' 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 o f th e propert y prio r t o remediatio n an d indicate 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 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 foun d immediatel y precedin g th e beginnin g o f activitie s authorize db y this ' Agreement , followin g completio n o f th e respons e activities .

2/12/200 7 (2 )

### Address : 361 5 N . 29t 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 agreemen t a s t o condition s o f

propert y prio r

t

o contractor activities . Thi s will als o serve a s documentation fo r

the purpos e o f assurin g tha t restoratio n activitie s ar e completed to th e satisfaction ofth e propert y owne r

an dthe'Unite d State s Environmenta l Protectio n Agenc y (EPA) . Item s t o b e remove d b v propert v owne r

prio r

to the respons e activities : 1 . 2 . • 3 . ' 4 . 

### 5 . Item s NO T to be removed b y contractor during remova l activities : 1 . 2 . . 3 . • 

### 4 . 5 . • • • 

### ADDITIONA L COMMENTS :

I hav e read the foregoin g documen t an dunderstandtha t i

t i s a n agreemen t grantin g permission t o the Grante e t o ente r

th e above describedpremise s fo r

the purpos e o f

conductin g environmenta l respons e activities , an d I agree to it s term s an dconditions . I acknowledg e tha t I have received th e pamphlet "Renovat e Right" . Grantor' s Signature : fUL.", . ^^)^^Q^^c ^ Dat e %J^_j Q .

(3 ) iinmi^ iDougla s Count y Accoun t Informatio n htlp://douglasne.niapping-online.coin/DouglasCoNe/static/accoiintinfo. , Dougla s County , Nebrask a Propert y Recor d - R054457000 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 WALLAC E ALIC E ETA L 361 5 N 2 9 S T OMAH A N E 68111-000 0 Propert y Informatio n Ke y Number : 445 7 000 0 0 5 Accoun t Type : Residentia l Parce l Number : 054457000 0 Parce l Address : 361 5 N 2 9 S T OMAH A N E 68111-000 0 Lega l Description : BEDFOR D PLAC E LO T 2 BLOC K1 7 N 1/ 2 24. 5 X 12 5 Valu e Infbrmatio n Lan d Improvemen t Tota l 201 1 $1,800.0 0 $10,600.0 0 $12,400.0 0 201 0 $1,800.0 0 ' $21,200.0 0 $23,000.0 0 200 9 $1,800.0 0 $21,200.0 0 $23,000.0 0 200 8 $1,800.0 0 $21,200.0 0 $23,000.0 0 200 7 $1,800.0 0 $22,800.0 0 $24,600.0 0 200 6 $1,800.0 0 $22,800.0 0 $24,600.0 0 Sale s Inforniatio n Sale s Date : 2006-05-0 8 Dee d Type : Q C SooIr ; 200 6 Page : 05111 5 Price : $ 25,000.0 0 Grantor : JOH N TURNE R SR . Grantee : ALIC E WALLAC E ETA L Valld/lnvalld : Vali d Exclusio n Reason : No n Bon o wit h Do c Stamp s Sho w Al l Transaction s

Lan d Infbrmatio n Acre s S F Unit s Dept h Widt h Vacan t 0.0 7 3125. 0 125. 0 25. 0 N o 1-0 Improvemen t Informatio n Buildin g 1

1 o f 3 3/14/201 2 2:2 9 P MDougla s Counly Account Infonnalio n littp://douglasne.niapping-on i ine.coin/DouglasCoNe/static/accountinro .

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

Roo f Type : Gabl e Stories : 1. 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 % 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 612. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Porc h Enc I Soli d Wal l 126. 0 Porc h Sla b Roo f Ceilin g 28. 0

2 o f 3 3/14/201 2 2:2 9 P MDougla s Count y Account Infonnatio n liUp://douglasne.niapp i ng-on i ine.coin/DouglasCoNe/static/accountinlb ,

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p data ©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 may us e th e Interactiv e GI S Map s tha t ar e maintaine d b y ou roffice .

3 o f 3 3/14/201 2 2:2 9 P M