## Transmitta l o f

Omah aLeadSite Pain t Stabilizatio n Fil e Folde r Said #;25V7 ^ Date : 6p-fd-7 0 Address : 2>C> 7 / J 2 > <& /VC / Contractor : Cit v o f

Omah aYear : tP-( > .7 0 

## Pain t Stabilizatio n Propert y Fil e Folde r Document s ^MVor k Writ e U p ^

< Signe dAcces s Agreemen t fo r

subjec t propert y Pre-Renovation for msignedby 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 or t

o replac e plants , etc. ) Renovation Recordkeeping Checklis t signedb y Certifie dRenovato r ^^Propert y informatio n fromDougla s Count y Assessor' s Offic e ^•^Othe r (describe) : V\\(Mi S 

## ~Tl7y ^ ^2 ^ 3'-JS'-j . Cit y o f Omah aRepresentativ e Signatur e Dat e 

# Sb^jjoix. . EP A Representativ e Signatur e / Dat e 3026247 6 

# illlil i Superfun d

## C h Y O F OMAH A PURCHASIN G - ROO M 100 3 • 

### Purchas e Orde r

181 9 FARNAM . STREE T ' r PURCHAS E ORDE R NO . PAG E REVISIO N OMAHA , N E 68183-100 3 116495 6 0 2

FAX * 402-444-542 3 7 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 CHEREK' S HOM E REPAI R VENDOR : 

## k BIL L TO : 1022 4 VVEI R S T CITY O F OMAH A FINANC E OMAHA . N E 6812 7 • DISBURSEMENT S ROO M #100 7 181 9 FARNA M STREE T OMAHA,NE6818 3 

### y ORIGINA L PURCHAS E ORDE R -VENDOR' S COP Y (SE E INSTRUCTION S BELOW ) CUSTOME R ACCOUN T NO . VENDORNO . 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 QUANTIT Y UNI T UNITPRIC E EXTENSIO N 11-APR-l O EP APAIN T STABILIZATIO N PROGRA M GROU P 8 2 302 2 LAFAYETT E AV E O SHI P TO : Addres s a t to p o f pafi e SDE D 3,580.0 0 N 

### Lll^P l JP A PAIN T STABILIZATIO N PROGRA M GROU P 8 2 3 0 7 N ^ 3 6T H AV E o SHI P T O Addres s a t to p o f pag e NEEDED : 1,980.0 0 N 11-APR-l O EP APAIN T STABILIZATIO N PROGRA M GROU P 8 2 351 0 SEWAR D S T O SHI P TO : Addres s a t to p o f pa^ e NEEDED : 2,074.0 0 N . 11-APR-l O EP APAIN T STABILIZATIO N

SHIPTO : Address shoWn.above . I f shipmen t i s delaye d o ran y item s no t available , advis e at once . Pur ctias c orde rnumbe rmus t appea ro n al l invoices , packages , packin g lists,.bil l o f lading , and . correspondence . Continue d) 

## Tota l C SHIPPIN G CHARGE S TOB 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 City o f Omah a i s exemp t fro m Federa l Excis e Taxe s an d tfi e Nebrask a an d City o f Oniah a Sale s Taxes . Federa l I.D . 476006304 ; STAT E I.D . 01-0316768 : Fue l Dealer s Lie . 91-0316768 . Cil y Purchasin g Agen l / Buye r

### Oracle iProcurement : Receiving Pag e I o f

1

Shoppin g Car t Hom e LQ9.Qll t Preference s Hgl p Diagnostic s ORACLG " iProcurement g H/Confirmatio n Receip t 5775 6 has bee n create d fo ryou . Receiv e Items : Confirmatio n Detail s Receip t Informatio n

Receip t Dat e 18^un-201 0 11:16:32 Receive d ite m Detail s Receip t Pacldn g Ite m Receip t Receip t Requisitio n Descriptio n Quantity:Uni t WaybillSli p Comment s Comments.Supplie r i 5775 6 CHANG E ORDE R 500iDOLLA R CHEREK' S # 2 DATE D HOM E 6/17/1 0 , REPAI R • INCREASE S THI S

. SO W BY $5100.0 0 '

EP A PAIN T STABILIZATIO N PROGRA M

. GROU P 8 2 431 0 S 2 1 S T S T 5775 6 4850 9 EP A PAIN T 358 0 DOLLA R CHEREK' S STABILIZATIO N HOM E jPROfiRA M ..^ ^ REPAI R ^^--fGROU P 8 2 30 7 N ^ N / ^ 36T H AV E ) - Retur n to Receivin g Shop . I Requisition s | Receivin g | Contractor s | g ^^'" ^ | Hom e | Logou t | Preferences | Hel p | Diagnostic s Copyrigh t (c ) 2006 , Oracle . Al l right s resen/ed . • Privac y Statemen t Abou t thi s Pag e '^ ^



### http://pllusll3.corio.com:8000/OA_HTML/OA.jsp?page=/oracle/apps/icx/por/rcv/webui/I.. . 6/18/201 0Plannin g Departmen t

• Omaha/Dougla s Civi c Cente r Inspector : To mRoz a181 9 Farna mStreet . Suit e 1003 Dfltp

- 1/'>/i n Omaha , Nebrask a6818 3 i^aic . .vj.i v (402)444-515 0 Tclcfa. x (402 ) 546-071 4 

### Name : Kevi n Smit h E L E . Cunningham,RA,F.SAM E j£L°!i°M'^yo r

Address : 30 7 N 3 6 S^VeKue . °'""° ' 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 o f th e followin g sections : •Genera l Responsibilitie s for th e Contracto r an dOccupant . •LeadHazar dContro l Plan , Interi mContro l o f LeadBase dPaint Hazards . Th e Contracto r Shall : •Compl y with HUD' s "Guideline s fo r th e Evaluatio n an dContro l o f Lead-Base d Pain t Hazard s i n Housing: " (Copie s ar e availabl e a t th e Plannin g Department ) •Compl y wit h Standard s calle dfor i n th e "Constructio n an dRehabilitatio n Specifications , Housin g an dCommunity Developmen t Division , City o f Omaha , Nebraska. " (Copie s are availabl e a t th e Plaimin g Department. ) •Compl y wit h th e State ofNebrask aHealt h an dHuma n Service s Regulatio n and Licensure , Titl e 178.Chapter 2 3 Lea dBas e Pain t Regulations . •Coordinat e dail y constructio n schedul e wit h th e occupant •Submi t informatio n cu t sheet s fo r al l substitution s o f approve dequal s prio r t

o writte n approval ofth e Constructio n Specialist . •Repai r o r replac e al l item s damaged.o r disturbe ddurin g paint stabilizatio n activities . •Kee p wor k

sit e an dsurroundin g are afree fro maccumulation s o f wast e material s o r

rubbis h cause db y th e wor k

a

t al l times . •Upondail y completio n o f work : clean up all rubbish , exces s material , equipment , an detc. , that i s connecte dwith th e work , an dleav e al l part s ofth e wor k

area s i n a neat , sanitary , leadsaf e an dpresentabl e condition . •Complet e thi s projec t withi n 3 0 calenda r days . Th e Occupant/'Owner Shal l •Remov e an d.stor e awa y an y 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 dwate r throughou t the pain t stabilizatio n process . •Ensur e tha t al l househol dmember s sta y a t leas t te n fee t awa y fro mall wor k

area s an dals o kee p al l pet s a t 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 paissedavisua l inspection . _^ ' Initials' ^30 7 N 3 6 S t (Continued ) 

## Lea dHazar dContro l Plan InterimControl o f

Lea dbase dPain t Hazard s Pain t Stabilizatio n •Prepare an dpain t al l previousl y painte dexterio r surface s ofth e dwellin g an dgarag e t o includ e but not limite dt o the fascia , eaves , trim , windo w trim , doo r tri man dfoundation . D o no t includ e doors , window s o r gutters/downspouts . •Includ e al l stucc o an dfoundatio n surfaces . •Prepare an dpairi t al l previousl y painte dsurface s b y 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 t o matc h existin g pain t pattern . Prim e an dappl y tw o coat s o f

approve dfinish coat . (Refer t o Plannin g Dept . approve dpain t list ) •I F SPRAYED , ON E COA T SHAL L B E BACK-BRUSHE D O R BACK-ROLLED . Lea dBase dPain t Wast e Lead-base dpain t wast e mus t b e handle da s follow s Al l pain t chip s an dcomponen t debri s mus t b e doubl e bagge dfo r disposal . Clea n pain t chip s fro mgroun daroun dperimeter o f dwellin g befor e starting , durin g an dafte r th e project . Al l lea dpainte dcomponent s em ddebri s mus t b e removed , fromth e site dail y unles s otherwis e approve db y th e constructio n specialist . Al l lead-base dpain t debri s (chip s an dcomponents ) mus t b e dispose do f i n amunicipal soli dwaste landfill . 

# 3-i>-/ ^ Propert y 0 Witnes s Dat e Occupan t (i f applicable ) Dat e Occupan t (ifapplicable ) Dat e Witnes s Dat e

### Exterior Lead-basedPain t Stabilization Progra mManage db y the Cit y o f Omah afo r

EP A Region 7 Omah aLea dSit e Th e purpos e o f thi s programi s to preven t yard s wher e lead-contaminate dsoi l i s cleane d up fro mbecomin g re-contaminate db y deterioratin g exterio r lead-base dpaint . Thi s i s no t ahom e repai r program . Whic h Home s Are Eligible ? •Home s wher e soi l clean-u p ha s bee n o r wil l b e don e an da n EPA contracto r ha s identifie ddeterioratin g exterio r lead-base dpaint . •Home s ar e eligibl e onl y by referral fromth e EPA . What wor k

wil l b e done ? •Loos e an dflaking 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 dt o 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 perfor mth e work ? •EP A contractor s wil l tes t pain t o n 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 Constmctio n Specialist s wil l prepar e awor k

pla n an dcontac t th e property owner fo r permissio n to 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 an dwil l continu e for severa l years . •Th e Cit y staf f wil l prioritiz e home s base don th e presenc e ofchildre n under ag e

. si x if know n and . th 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 sConsent.fp 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 to an dauthorize s th e Unite dState s Environmenta l Protectio n Agenc y (USEPA ) o r it s authorize drepresentatives , collectivel y th e Grantee , t o enter an dperfor m certai n environmenta l respons e activitie s upo n th e followin g describe dpremises : Owner' s Name : Daytime Phone : Owner Name(s) : Kevi n Smit h 402-344-395 3

Addresse s of Propertie s Covere db y thi s Agreement Propert y Addres s City/State/Zi p Cod e . 30 7 N . 36t h Ave . Omaha , N E 6813 1

. ' Granto r understand s tha t thi s grant doe s ho t limi t EPA' s right of acces s under th e Comprehensiv e Environmental Respons e an dLiabilitv Ac t (CERCLA') . 4 2 USC . «S : 9601-9675 . or an y 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 or flaking exterio r lead-base dpain t on residentia l properties , includin g day-care facilities , wher e remediatio n o f leadcontaminate dsoi 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 propert y an dfUrther , provide s th e Grante e th e righ t to perfor man y an dall 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 t o b e performe do n subjec t propert y ma y include the followin g activities : 1 .Locatin g equipmen t and/o r machiner y o n subjec t property in preparatio n fo r an di n th e cours e o f th e respons e activities . 2 . Obtainin g sample s fro mGrantor' s property .

2/12/200 7 (1 )Address : 30 7 N . 36t h Ave . Consent for Acces s t o Propert v fPae 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 ) removal o f loos e o r flaking pain t ideritifie db y EP A usin g lead-saf e method s i n complianc e wit h HUD/EP A regulation s an d2 ) repaintin g accordin g toth e attache dspecifications . TER M Thi s acces s agreement shal l b e operabl e fo r th e perio do f time it take s to complete the environmental 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 on tha t date , unles s extende dby asubsequen t agreement . AGREEMEN T NO T T O INTERFER E Granto r agree s no t to interfere wit h an y o f th e activitie s undertake n by Grante e a t th e Property , tamper wit h any o f Grantee' s property , o r take any action s regardin g th e us e o f the Propert y which wil l endange r huma n healt h o r welfar e o r th e envirormient , o r allow , other s to 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 andacop y o f thi s agreemen t t o prospectiv e purchasers , lessees , assigns , o r grantee s o f th e propert y or any portio n o f it . Granto r agree s to provid e 30-da y notic e t o EPA prio r to an y transfer o f ownership right s t o the property . SAMPLIN G RESULT S Grante e agree s t o provid e Granto r with th e result s o f an y an dall samplin g and/o r analysi s resultin g fror n Graiitee' s respons e activitie s o n th e property . PRIO RCONDITION S AGREEMEN T . . Th e granto r agree s to th e conditio n o f th e propert y prio r to remediatio n an dindicate s o n Pag e 3 an y item s t o b e remove dby th e Granto r befor e activitie s commence . RESTORATIO N OF PROPERT Y Excep t fo r th e abov e state dpain t stabilization , th e Grante e agree s that 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 dimmediately precedin g th e beginnin g o f activitie s authorize dby thi s Agreement , followin g completio n o f th e respons e activities .

(2 )2/12/200 7

### Address : 30 7 N . 36t h Ave. , Omaha , NE , 6813 1 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 property prior t o contractor " 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 dt o th e satisfactio n o f th e propert y owne r an dth e Unite dState s Environmenta l Protectio n Agenc y (EPA) . Item s to b e remove db v propert v owne r prio r t o th e respons e activities : I . . . • ' ' 

### 2 . 3 - . 4 . 5 . • 

### Item s NO T to b e remove db v contracto r durin g remova l activities : 1 . . 2

­ 3 . . • ' • . ^ 

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

I hav e rea dth e foregoin g documen t an dunderstan dtha t i t i s a n agreemen t grantin g permissio n t o th e Grante e t o ente r th e abov e describe dpremise s for th e purpos e o f conductin g environmenta l respons e activities , an dI agre e t o it s term s an d conditions . I acknowledg e tha t I hav e receive dth e pamphle t "Renovat e Right" . Grantor' s Signature ; ^''!^^^^:. , <pStc<J ^ Dat e 3-Ci>-7 0

(•y

^ 1/17/7.00 7

### Dougla s Coimt y Accoun t Information Pag e 1 of 3 Dougla s County , Nebrask a Propert y Recor d - R091139000 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 -* -* r* . Subdivisio n Sale s Searc h Owne r SMIT H KEVI N C ETA L 30 7 N 3 6 AV E OMAH A N E 68131-000 0 Propert y Informatio n Ke y Number : 113 9 000 0 0 9 Accoun t Type : Residentia l Parce l Number : 091139000 0 Parce l Address : 30 7 N 3 6 A V OMAH A N E 68131-000 0 Lega l Description : CRESTO N ANNE X LO T 4 BLOC K0 -E X S 1 1 E 6 5 FT - LT 4 IRRE G Valu e Informatio n Lan d Improvemen t Tota l 201 1 $6,400.0 0 $82,900.0 0 $89,300.0 0 201 0 $6,400.0 0 $82,900.0 0 $89,300.0 0 200 9 $6,400.0 0 $76,200.0 0 $82,600.0 0 200 8 $6,400.0 0 $76,200.0 0 $82,600.0 0 200 7 $6,400.0 0 $83,700.0 0 $90,100.0 0 200 6 $6,400.0 0 $83,700.0 0 $90,100.0 0 Sale s Informatio n Sale s Date : 1998-04-2 9 Dee d Type : D Book : 209 3 Page : 05 7 Price : $ 64,000.0 0 Grantor : Grantee : Valid/Invalid : Vali d Exclusio n Reason : i.an d Informatio n Acre s S F Unit s Dept h Widti i Vacan t 0.1 4 6380. 0 1. 0 145. 0 44. 0 N o Improvemen t Informatio n 

### http://douglasne.mapping-online.com/DougIasCoNe/static/accountinfo.jsp?accountno=R09.. . 3/14/201 2Dougla s County Accoun t Informatio n Pag e 2 o f 3 Buildin g 1

ti l

man * ^

...a v t i a TW O STOR Y

CLIC KT O ENLARG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : 1386. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Averag e

Buil t As : 2 1/ 2 Stor y Unfi n Cond o Squar e Footage : 0. 0 HVAC : Centra l Ai rt o Ai r Rooms : 6. 0 Exterior : Fram e Stucc o Units : 1. 0 Interior : Drywal l Baths : 1. 0 Roo f Cover : Compositio n Shingl e Bedrooms : 3. 0

Roo f Type : Gabl e Stories : 2. 5 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 3 0 % 192 3 8 7 Detai l Typ e Detai l Descriptio n Unit s Ad d O n Unfinishe d Atti c W/floo r 598. 0 Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f t 598. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Garag e Detache d 520. 0 Garag e Detache d 200. 0 Porc h Cvr d Woo d Dec k 55. 0 Porc h Sla b Roo f Ceilin g 120. 0

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R09. . . 3/14/201 2

### Dougla s Count y Accoun t Information Pag e 3 o f 3

Th e abov e ma p i s powere d by 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 exac t propert y location , yo u ma y us e th e Interactiv e GI S Map s tha t ar e rhaintaine d by ou r office .



### http://douglasne.mapping-online.corn/DouglasCoNe/static/accountinfo.jsp?accountao=R09.. . 3/14/201 2