Transmittal of Oniaha Lead Site 

Paint Stabilization File Folder 

Said # iSiTrf^ Date: ^^d-f-l O 

Address: ^3CI3L ^ 3 - / ^ S / -

Contractor: City of Omaha Year: S^-O/O 

Paint Stabilization 

Property File Folder Documents 

_^1 Work Write Up 

j/Signe d Access Agreement for subject property 

Pre-Renovation form signed by Property Owner 

Pre-Renovation Form for Occupant/Tenant, ifapplicable 

j,/Painting Agreement/City of Omaha Purchase Order 

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

Renovation Recordkeeping Checklist signed by Certified Renovator 

^ Property information from Douglas County Assessor's Office 

L^^ther (describe): FnOfoJ . 

7>^ / ^ 

City of Omaha Representative Signature Date 

D » . 3> Xo XolX. EPA Representative Signature 

30262458 

IH 

Superfund 
CITY OF OIVIAHA 

PURCHASING - ROOM 1003 Purchase Order 

1819 FARNAM STREET 

OMAHA, NE 68183-1003 

FAX# 402-444-5423 

PURCHASE ORDER NO. 

1167419 

REVISION 

0 

PAGE

1 

) 

J 

SHIPTO: 

CITYOFOMAHA 

HOUSING & COMM DEV RM #1111 

1819 FARNAM STREET 

OMAHA,NE 68183 

J

PRUDENT TECHNOLOGY INC VENDOR: kBILL TO: 2505 NO 24 ST CITY OF OMAHA FINANCE SUITE 308 DISBURSEMENTS ROOM #1007 

OMAHA, NE 68110 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 

94079 21-JUL-10 HHURT 

PAYMENTTERMS SHIP VIA F.O.B. . 

IMMEDIATE DESTINATION 

FREIGHT TERMS 

REQUESTOR/DELIVER ,T0 CONFIRM TO / TELEPHONE 

MARUCA, T MARIE WW 

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

All prices and amounts on this order are express 2d in : US Dollar 


NEEDED: 	 1,437.35 N 


22-JUL-lO 


EPA PAINT STABILIZATIORI 


PROGRAM GROUP 151 103 5: 


ATLAS ST	 • 
 O SHIP TO: i 


Address at top of page 


NEEDED: 	 1,014.90 N 


22-JUL-lO 


EPA PAINT STABILIZATION 


PROGRAM GROUP 151 2761i 


S 13TH ST •;• 
 o SHIP	 TO:• ! 


Address at top of pa^e 


NEEDED: 	 1,.3 87. 88 N 


-22-JUL-lO 


EPA PAINT STABILIZATION 


PROGRAM GROUP 151 4302! 


S-12TH ST i 


O SHIP TO:. I 


Address at top of page 


NEEDED: 	 1,437.35 N 


SHIPTO: Address sttown 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 ( Conlinued } 

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

nished with invoice. 

TAX EXEMPTION: The City of Omaha is exempt from Federal Excise Taxes and the Nebraska and City of 

Omaha Sales Taxes. Federal I.D. 476006304; STATE I.D. 01-0316768; Fuel Dealers Lie. 91-0316768. 

Clly Purohasiim^genl / Buyer 
CITY OF OMAHA 

PURCHASING - ROOM 1003 • Purchase Order 

1819 FARNAM STREET .REVISION PAGE 

OMAHA, NE 68183-1.003 

1167419 0 2 

PURCHASE ORDER NO. 

FAX# 402-444-5423 

SHIP TO: 

CITY OF OMAHA 

HOUSING & COMM DEV RM #1111 

1819 FARNAM STREET 

OMAHA,NE 68183 

PRUDENT TECHNOLOGY INC VENDOR: h -< 

BILL TO: 

CITY OF OMAHA FINANCE 

2505 NO 24 ST 

SUITE 308 DISBURSEMENTS ROOM #1007 

OMAHA, NE 68110 1819 FARNAM STREET • 

OMAHA.NE 68183 

ORIGINAL PURCHASE ORDER - VENDOR'S COPY (SEE INSTRUCTIONS BELOW) 

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

94079 21-JUL-10 H HURT 

PAYMENTTERMS SHIP VIA F.O.B. 

IMMEDIATE . DESTINATION 

FREIGHT TERMS REQUESTOR/DELIVER TO CONFIRM TO / TELEPHONE 

MARUCA, T MARIE 

> ITEM PART NUMBER / DESCRIPTION DELIVERY DATE QUANTITY UNIT UNIT PRICE EXTENSION 7

22-JUL-lO 


EPA PAINT' STABILIZATION 


PROGRAM GROUP 151 5609: 


S 22ND ST i 


O SHIP TO: . , .: 


Address at top of pape 


NEEDED: 1,184.90 N 


22-JUL-lO 


EPA PAINT STABILIZATION 


PROGRAM GROUP 151 5825! 


5 21ST ST i 


6 SHIP TO: 


Address at top of page 


SHIP TO: 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 con'espondence. Total ( 6.462.36 )

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

nished with invoice. 

TAX EXEMPTION: The City of Omaha is exempt from Federal Excise Taxes and the Nebraska and City of 

Omaha Sales Taxes. Federal I.D. 476006304; STATE I.D. 01-0316768; Fuel Dealers Lie. 91-0316768. 

Clly Purchaiing Agenl / Buyer 
\ CITY OF OIVIAHA 

PURCHASING-ROOM 1003 Purchase Order ^.XV S 1819 FARNAM STREET 

PURCHASE ORDER NO. REVISION PAGE 

OMAHA, NE 68183-1003 

FAX# 402-444-5423 1167420 0 1 

SHIP TO: 

CITY OF OMAHA 

HOUSING & COMM DEV RM #1111 

1819 FARNAM STREET 

OMAHA,NE 68183 

BRAD BATES PAINTING VENDOR: < 

BILL TO: ' 3141 SO 52 ST 

CITY OF OMAHA FINANCE ' OMAHA, NE 68106 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 

72990 21-JUL-10 H HURT 

PAYMENT TERMS SHIP VIA F.O.B. 

IMMEDIATE DESTINATION 

FREIGHT TERMS REQUESTOR/DELIVER TO ^. \\ . CONFIRM TO / TELEPHONE 

MARUCA, T MARIE \;^\[ (402) 551-0927 

X: -< 

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

All prices and amountis on this order are expressjd in : US Dollar 


NEEDED: 1,200.0 0 N 

22-JUL-lO 

EPA PAINT STABILIZATION 


PROGRAM GROtJP 151 1522! 


1/2 B ST i 


O SHIP TO: • 
 Address at top of page 


SHIP TO: 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. Tota l C ^-^oooo ;

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

nished with invoice. 

TAX EXEMPTION: The City of Omaha is exempt fi-om Federal Excise Taxes and the Nebraska and City of iJk/> IVi' Omaha Sales Taxes. Federal I.D. 476006304; STATE I.D. 01-0316768; Fuel Dealers Lie. 91-0316768. city Purchasing Agent|/yBuyer 
Planning Depairtment 

^ _, Omahsi/Douglas Civic Center 

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

Date : 6/3/10 Omaha, Nebraska 68183 

(402) 444-5150 

Telefax (402) 546-0714 

Name: Mario Zuniga ^E . Cunningham, RA,RSAME 

r^T[.°r*" Address: 4302 S12 St Director 

Jim Suttle, Mayor 

OMAHA EXTERIOR PAINT STABILIZATION PROGRAM 

FOR THE EPA OMAHA LEAD SITE 

The Contract bid documents consist ofthe following sections: 

• General Responsibilities for tiie Contractor and Occupant. 

• r.eaci .Hazard Control Plan, Tnterim, Control of Lead Based Paint Hazaids. 

The Contractor Shall: 

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

Paint Hazaids in Housing." (Copies are available at the Planning Departoient.) 

• Comply with Standards called for in the "Construction and Rehabilitation' 

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

Nebraska." (Copies are available at the Plarming Department.) 

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

Licensure, Title 178 Chapter 23 Lead Base Paint Regulations. 

• Coordinate daily construction 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 all items damaged or disturbed during paint stabilization 

activities. 

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

or rubbish caused by the work at all times. 

• Upon daily completion of work: clean, up all rubbish, excess material, 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. 

• Complele 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 throughout the paint stabilization process. 

• Ensure that all household 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 

completed arid the area has passed a visual inspection. • 

Initials 
4302 S 12 St (Continued) 

Lead Hazard Control Plan 

Interim Control of Lead based Paint Hazards 

Paint Stabilization 

• Prepare and paint all previously painted exterior surfaces ofthe dwelling 

and garage to include but not limited to the fascia, eaVes, trim, 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. 

• Colors: Olympic/Lowes, Body - A28-4 "Smoked Salmon", Trim ­

B28-4 "Firecracker". (Refer to Planning Dept. approved paint list) 

• IF SPRAYED, ONE COAT SHALL BE BACK-BRUSHED OR 

BACK^RQLLED. 

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 chipsfrom 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 unless otherwise approved by the construction specialist. 

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

a municipal solid waste landfill. 

A -r-y ^ 

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 

hot 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 will 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 permissiori to proceed. 

• Work will be coinpetitively bid by approved, trained coritractors. 

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 of children imder age 

six if known and the severity of the problem. 

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

Initials 
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 authorized representatives, collectively the Grantee, to enter and perfonn 

certain environmental response activities upon the following described premises: 

Owner's Name: Davtime Phone:. 

Owner Name(s): Mario Zimiga 402-502-5113 

Addresses of Properties Covered by this Agreement 

Property Address 

City/State/Zip Code 

4302 S. 12th St. 

Omaha, NE 68107 

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

Environmental Response and Liabilitv Act fCERCLA). 42 USC. & 9601-9675. or ariv other law. 

PURPOSE OF ACCESS 

The purpose of the response action is to stabilize loose or flaking exterior lead-based piaiht 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 perforin any and all envirormiental 

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. 

2/12y7007 (1) 
Address: 4302 S. 12th St. 

Consent for Access to Propertv (Page 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 

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

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

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

such manner 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 vn\h the results of any and all sampling and/or analysis resulting 

from Grantee's response activities on the 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 Grantee 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 Agreerrient, following completion of the response 

activities. 

(2) 2/12/2007 
Address: 4302 S. 12th St., Omaha, NE, 68107 

CURRENT CONDITION / PROPOSED RESPONSE ACTIVITIES 

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

contractor activities. This will also serve as documentation for the piupose of assuring that 

restoration activities are completed to the satisfaction of the property owner and the United States 

Environmental Protection Agency (EPA). 

Items to be removed bv propertv 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 grariting 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: ^fj ^ '^^^-'^^s'Z^^ZT^ ^^^^ (^—^^7^''^^^(7^ 

(3) 2/12/2007 
Douglas County Account Information Page 1 of3 

Douglas County, Nebraska Property Record - R1741240000 

Print Reoort 

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

New Feature -> -» i * Subdivision Sales Search 

Owner 

ZUNIGA MARIO R 

ETAL 

4302 S 12 ST 

OMAHA NE 68107-0000 

Property Informatio n 

Key Number: 4124 0000 17 

Account Type: Residential 

Parcel Number: 1741240000 

Parcel Address: 4302 S 12 ST 

OM/\HANE 68107-0000 

Legal Description: MID CITY ADD LOT 54 BLOCK 0 45 X 110 

Value Informatio n 

Land Improvement Total 

2011 $5,700.00 $58,000.00 $63,700.00 • 

2010 $5,700.00 • $58,000.00 $63,700.00 

2009 $5,700.00 $60,500.00 $66,200.00 

2008 $5,700.00 $60,500.00 $66,200.00 

2007 $5,700.00 $60,500.00 $66,200.00 

2006 $5,700.00 $64,200.00 $69,900.00 

Sales Informatio n 

Sales Date: 2007-03-16 

Deed Type: WD Book: 2007 Psge: 030110 

Price: $85,000.00 

Grantor Pedersen Thomas etal 

Grantee: Zuniga Mario etal 

Valid/Invalid: Valid 

Exclusion Reason: 

Land Informatio n 

Acres SF Units Depth WIddi Vacant 

0.11 4950.0 1.0 110.0 45.0 No 

Improvemen t Informatio n 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountoo=Rl 7... 3/13/2012 
Douglas County Account Information 

Building 1 

MimimwiiiMtmjim.v-w.)ii,'b.xM.Hg;Tini 

CLICK TO ENLARGE IMAGE 

Square Footage: 1004.0 

Perimeter 0.0 

Unit Type: 

Built As: 1 1/2 Story Unfin 

HVAC: Central Air to Air 

Exterior: Masonry Common Brick 

Interior: Drywall 

Roof Cover: Composition Shingle 

Roof Type: Gable 

Floorcover: Allowance 

Year Percent 

year Su/7t Remodeled Remodeled 

1921 0% 

Detail Type Detail Description 

Add On Fence Chain Link 

Add On Unfinished Attic W/floor 

Appliance Allowance 

Basement Bsmnt Block 8 ft 

Fixture Base Fixtures 

Fixture Bath Full 

Garage Detached 

Porch EncI Screen 

Porch EncI Solid Wall 

Page 2 of 3 

4302 S 12 ST 

"*. » 

leir ii» 1 

OMacliMl 3(r nn«FI»Of 308 OSq 1004 0 Sq. n . 

14 » 

1 M» 

Mff 

»o EnclSoMWii: 1 1/2 Slory Unfinlshe-d ;.UM,aS(».B,-; 

Bsmrt eiock 9 ft 

1004 OS Q PI. 

CLICK TO ENLARGE IMAGE 

Percent Complete: 100.0% 

Quality: Average 

Condition: Fair 

Condo Square Footage: 0.0 

Rooms: 6.0 

Units: 1.0 

Battis: 1.0 

Bedrooms: 3.0 

Stories: 1.5 

Foundation: Block 

Sprinkler Square Footage: 0.0 

Adjusted Year Physical Age Built 

1921 90 

Units 

1.0 

864.0 

1.0 

1004.0 

1.0 

1.0 

434.0 

24.0 

189.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=R17... 3/13/2012