Transmittal of Oinaha Lead Site 

Paint Stabilization File Folder 

Said# 3^S'7^— Date: 1-^-/7 ) 

Address 0:2 P^i ^ ^'VWOVX B)»M ^ Aty : 

Contractor: CityofOmaha Year: <P-C 7 O 

Paint Stabilization 

Property File Folder Documents 

^^^or k Write Up 

_^,^j«f Signed Access Agreement for subject property 

Pre-Renovation form signed by Property Owner 

Pre-Renovation Form for Occupant/Tenant, ifapplicable 

/•'fainting Agreement/City of Omaha Purchase Order 

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

Renovation Recordkeeping Checklist signed by Certified Renovator 

Property informationfi-om Douglas Counly Assessor's Office 

^^^ther (describe): Tn(yh(XS 

"T'a^vt— /^M- ^ 3-7S'-7'3L^ 

City of Omaha Represeptatiye Signature Date 

mdMy EPA Representative Signature Date 

30262490 

P 

Superfund 
CITY OF OMAHA 

PURCHASING - ROOM 1003 Purchase Order 

1819 FARNAM STREET 

PURCHASE OROEA NO. 

OMAHA, NE 68183-1003 

1166624 FAX# 402-444-5423 

SHIP TO: 

CITYOFOMAHA 

HOUSING & COMM DEV RM #1111 

1819 FARNAM STREET 

0MAHA,NE 68183 

G 4 M PAINTING CO INC VENDOR: >. - < 

BILL TO: 13707 CUMINGST CITY OF OMAHA FINANCE OMAHA. NE 68154 DISBURSEMENTS ROOM #1007 

1819 FARNAM STREET 

OMAHA,NE 68183 

ORIGINAL PURCHASE ORDER • VEND0R: S COPY (SEE INSTRUCTIONS BELOW) 

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

91298 17-JUN-10 H HURT 

PAYMENTTERMS SHIP VIA F.O.B. • 

DESTINATION IMMEDIATE 

FREIGHTTERMS REQUESTOR/DELIVER TO CONFIRM TO / TELEPHONE 

MARUCA, T MARIE 

> < 

ITEM PART NUMBER / DESCRIPTION DELIVERYDATE QUANTITY UNIT UNITPRICE EXTENSION 

All prices and amounts on this order are express ;d in : US Doi; ar 


NEEDED: 1,395.00 N 


16-JUN-10 


EPA PAINT • STABILIZATIOtJ 


PROGRAM GROUP .13.4 2508! 


AMES AV 


O SHIP TO: 


Address at top of page 


NEEDED: 1,840.00 N 


16--mjN-10 


EPA PAINT^^TABILIZATION 


PROGRAM GROUP 13-4 2895 


CROWN POINT AV 


O SHIP TO: ' 


Address, at top of page 


NEEDED: i,960.00 N 


16-JUN-lO 


EPA PAINT STABILIZATION 


PROGRAM GROUP 134 3150! 


LARIMORE AV 


O SHIP TO: 


Address at top of page 


NEEDED: 1,860.00 N 


SHIP TO: Acidress shown above. If shipment is delayed or any items not available, advise at once. Purchase order number must appear on all invoices, packages, packing lists, bill of lading, and conespondence. Total C__E^^-) SHIPPING CHARGES TO BE PREPAID, >F APPLICABLE AND ADDED TO INVOICED, copy lobe furnished with invoice. 

TAX EXEMPTION: The City of Omaha Is exempt from Federal Excise Taxesand the Nebraska and City of 

Omaha Sales Taxes. Federal I.O: 476006304; STATE I.D. 01-0316768; Fuel Dealei-s Lie. 91-0316768. 

Cily Purchas'ingAgpnl / Buyer ^'

: L_: '. 
>:;• 'i-' . 

Planning Department 

Omaha/Douglas Civic Center inspector: Io m Roz a 1819 Famam Street,Suite 1003 

Dale : 5/11/10 Omaha, Nebraska 68183 

(402)444-5150 

Telefax (402) 546-0714 

Name: Riva Investments LL^ E. Cunningham, RA,F.SAME 

jiSsmuXy'l.r Address: 2895 Crown Point Av ^^--' 

OMAHA EXTERIOR PAINT STABILIZATION PROGRAM 

FOR THE EPA OMAHA LEAD SITE 

The Contract bid documents consist ofthe following sections: 

• General Responsibilities for the Contiactor and Occupani. 

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

The Contractor Shall: 

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

. Painl Hazards in Housing." (Copies are available al the Planning Department.) 

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

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

Nebraska." (Copies are available at Ihe'Planning Department.) 

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

Licensure, Titie 178 Chapter 23 Lead Base Paint Regulations. 

• Coordinate daily constiuction 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 ali ilems damaged or disturbed during paint stabilization 

activities. 

• Keep work site and surrounding area free from accumulations of waste maleriais 

or rubbish caused by the work at all times. 

• Upondaily completion of work: clean up all rubbish, excess niaterial, equipment, 

and etc., that is connected with 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 Occupant'Owner Shall 

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

to be remediated. 

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

• Ensure that all household members stay at least ten feet away from all work areas 

and also keep all pets al least ten feel away at all times until the work has been 

completed and the area has passed a visual inspection. 

Initials ^ ^ 
2895 Crown Point Av (Continued) 

Lead Hazard Control Plan 

Interim Control of Lead based Paint Hazards 

Paint Stabilization 

• Prepaire and painl all previously painted exterior surfaces ofthe dwelling 

and garage to include but not limited lo the fascia, eaves, trim, window 

trim, door trim and foundation.. Include flush window 6n west side of 

house and wood door (^ rear of house and garage^ 

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

Work Practices protocol for EPA exterior lead based paint stabilization. 

• All painl colors lo match existing painl pattern. Prime and apply two coals 

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 perimeier of 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 construction specialist. 

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

MU^ ^-n-fO 

Property C^wner 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 lo prevent yards where lead-contaminated soil is cleaned 

up from becoming re-conlaminaled by deteriorating exierior 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 conlractor has 

identified deteriorating exterior lead-based painl. 

• 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, tiim, window trirn, door trim and foundation. 

• Surfaces will be primed and painted td match existing paint color as closely as 

possible. 

What will nol be done? 

• Surfaces which have no paint will not be treated. 

• Windows or doors will nol be included. 

• Rotten wood will not be replaced. 

• No housing repair will be done. 

Who will perform the work? 

• EPA contractors will test paint on exterior house surfaces and give the results to . 

the City Of Omaha Painl 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 Cily staff will prioritize homes based on the presence ofchildren under age 

six ifknown and the severity ofthe problem. 

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

Initials S^i/ 
Consent for Access to Property 

RJGHT OF ENTRY TO PREMISES 

Grantor (the properly ov^ner) consents to and authorizes the United States Environmenlai Protection 

Agency (USEPA) or its authorized representatives, colleclively the Granteej lo enter and perform 

certain environmental response activities upon the following described premises: 

Owner's Name: Davtime Phone: 

Owner Name(s): Riva Investments 402-350-9442 

Addresses of Properties Covered by this Agreement 

Property Address 

City/Stale/Zip Code . 

2895 Crown Point Av. 

Omaha, NE 68111 

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

Environmenlai Response and Liabilitv Act fCERCLAV 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 properly and fiirther, provides the Grantee the right to perform any and all environmenlai 

response actions and activities it deems appropriate. 

ENVIRONMENTAL RESPONSE ACTIONS 

The environmenlai 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. 

2/12/2007 (1) 
Address: 2895 Crown Point Av. 

Consent for Access lo Propertv ("Page 2) 

3. Plarming and implementing the response action on tiie Grantor's properly. This will include 

1) removal of loose or flaking painl identified by EPA using lead-safe methods in compliance 

with HUD/EPA regulations and 2) repainting according lo the attached specifications. 

TERM , 

This access agreement shall be operable for the period of time it lakes to complete the 

environmenlai response activities. Upon completion oif 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 wilh any ofthe aclivities undertaken by Grantee at the Property, 

tamper wilh 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 lo use the Property in 

such manner during the term of this consent. Grantor agrees to provide notice arid a copy of this 

agreemenl to prospective purchasers, lessees, assigns, or grantees ofthe property or any portion of 

il. Grantor agrees to provide 30-day notice to EPA prior to any transfer of ownership rights lo 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 properly. 

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 stale 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: 2895 Crown Point Av. 

, Omiahai NE, 68111 

CURRENT CONDITION / PROPOSED RESPONSE ACTIVITIES 

The purpose of this section is to provide a mulual agreement as to conditions of property prior to 

conlraclor activities. This will also serve as documentation for the purpose of assuring tiiat 

restoration activities are completed lo the satisfaction of the properly owner and the United Slates 

Environmental Prolection Agency (EPA). 

Ilems to be removed bv propertv owner prior lo the response activities: 

1. 

4. 

5. 

Items NOT to be removed bv contiactor during removal activities: 

1 . • . 

2. 

3- . . . 

4. 

5 . • 

ADDITIONAL COMMENTS: 

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

the Grantee to enter tiie 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: '^SiUOJA— ^^^^ 'T''/? "fO 

(3) 2/12/2007