TRANSMITTAL OF OMAHA LEAD SITE 

PAINT STABILIZATION FILE FOLDER 

SAID#: U0\^'O Date: 

Address: Ll^ h HI^^\Q ^ IU^ ^ ^ ^ 

LBP Stabilization Contractor: PRUDENT TECHNOLOGIES, INC. Year: 2009 

PAINT STABILIZATION 

PROPERTY FILE FOLDER DOCUMENTS 

« Video ofproperty (DVD): Pre-Stabilization & Post-Stabilization Videos 

y Executive Summary 

K Signed Access Agreement Form 

H Advance Notice Form 

M Pre-Stabilization Video Agreement Form 

^ Access Tracking Form 

IZ Property Access Assessment Form 

i£ Neighbor Access Agreement Form 

^ Paint Match Form 

V Pre-Stabilization Property Safety Assessment Form 

M Work-Site Hazards Analysis Checklist 

K Photographs: Pre-Stabilization Propertv Hazard Assessment Photographs 

'i& Douglas County Assessor Property information 

0 Property Completion Agreement Form Signed by Property Owner 

D Property Close-Out Check List Signed By EPA 

y-jP ' y^r^y^^^>^}^fcy _^ 

Prudent Technologies, Inc. Signature ~ Date 

EPA Signature

^//s//o ' Date 

30055112 

nw 

Superfund 
TECHNOLOGIBSk INC 

Property Summary 

Date: 11/~/2009 LBP STABILIZATION EPA CONTRACT EF-R7-08-07 Month of: Nov 

Property Address: 6703 Minne Lusa Bd. SAID #: 40145 

A. Executive Summary; 

a. Issues Encountered: NONE 

b. Issues Resolved: NONE 

c. Unique Findings: NONE 

d. Other Relevant Information: 

i. Access Date: 9/29/2009 

ii. Work Began: 10/08/2009 

iii. Close-Out Date: 10/09/2009 

B. Enclosures: 

1. Pre-Stabilization Video 

2. Post-Stabilization Video 

3. Signed Access Agreement Form 

4. Advance-Notice Form 

5. Pre-Stabilization Video Agreement Form 

6. Access Tracking Form 

7. Property Access Assessment Form 

8. Neighbor Access Agreement Form 

9. Property Paint Match Form 

10. Pre-Stabilization Property Safety Assessment Form 

11. Work-Site Hazards Analysis Checklist 

12. Pre- Stabilization Property Hazard Assessment Photographs 

13. Douglas County Assessor Property Information 

14. Signed Property Completion Agreement Form 

15. Property Close-Out Check List Signed By EPA 
TECHNOLOGIBS INC ' 

Prudent Technologies, Inc. (Prudent) is under contract (Contract # EP-R7-08-07) with the U. S. Environmental Protection 

Agency (EPA) to stabilize Lead Based Paint (LBP) at a number of properties located in Omaha, Nebraska, including the 

properly located at 4?7Q 3 fY)) f)/^^ . j^U^O . B ll/ ^ 

The EPA requests your permission to allow Prudent to perfonm LBP Stabilization at this property. By signing this form, the 

property owner grants permission to Prudent to perform activities related to LBP Stabilization including scraping paint and 

painting ofthe referenced property. Further, the owner/tenant verifies that they have received the LBP pamphlet "Renovate 

Right." 

By signing this document I agree to allow an EPA contractor to conduct a soil cleanup at my property following completion of 

lead-based paint stabilization, if the soil cleanup has not already been performed. I understand that the stabilization contractor 

cannot provide assurances of which contractor will be bound to the soil cleanup. I further understand that the soil cleanup 

contractor will make all reasonable efforts to address concerns that I, as the property owner, may have regarding soil 

cleanup at^ my property. 

ve read and understand the paragraph above. 

Signature of Proper^ Owner 

Date 

Ifyou have any questions about the LBP stabilization plarmed for your property, please contact Prudent's Customer 

Relations/Office Manager for the Lead Based Paint Stabilization, Mrs. Shannon Holt, at (402) 504-1004 or (402)812-0223. 

General questions about the Omaha Lead Site cleanup can be directed to the EPA Public Information Centers at (402) 731­

3045 (South Omaha office) or (402) 991 -9583 (North Omaha office). 

Property Access Granted B 

Hrncia^ I,CLf>4^ ML. (Please Print Name) 

Property Owner Signature: 

(Signature) 

'^l^'l/o'} 

(Date) 

8080 Ward Parkway, Suite 405 2505 N. 24'" Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 
TECHNOIOCIBS. IN C 

PROPERTY INFORMATION 

(To be completed by resident and/or property owner — please print) 

RESIDENT NAME: Renter 

RESIDENT ADDRESS: 

IF RENTAL, PROPERTY OWNED BY: 

OWNER'S MAILING ADDRESS; 

OWNER'S TELEPHONE NUMBER - HOME: (^/O^ ^Sy-Qh^ l WORK: ( V^^) ^ j C ''O^O S 

NUMBER OF OCCUPANTS UNDER 7 YEARS OLD::-^ /g9
 NUMBE l R OF OCCUPANTS 7 YEARS OLD AND OLDER: 


NUMBE lUMBI R OF CHILDREN UNDER 7 YEARS OLD WHOM PLAY IN THE YARD FOR 5 HOURS OR MORE PER WEEK: 


COMMENTS OR SPECIAL INSTRUCTIONS: (I.E. DOGS, ENTRY GATES, ETC.) 

/ nystuJJi (JGa - iTUyo A^- ^ iKuyuMuy ^ Volify^y^^sh(ypLf>JUyd 

AU rHORirV FOR ENVIRONMENTAL RESPONSE AC! IONS: The activities to be implemented by EPA under this agreement are 

pursuant to Section 104 ofCERCLA, 42 U.S.C. 9604. EPA's rigjit of access to the property is provided for in Section 104{e) ofCERCLA, 

42 U.S. C 9605(e), which provides entry for "determining the need for response, or choosing or taking any response action under this title, or 

otherwise enforcing the provisions ofthe title." 

8080 Ward Parkway, Suite 405 2505 N. 24'" Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 

Fax; (816) 363-3707 

Phone: (402)504-1004 

Fax: (402)504-1005 

Phone: (210)822-9588 

Fax: (210) 579-6577 
TECHNOLOGIES^] 

Advanced notice needed. 

After signing the access you allow Prudent to begin Lead Based 

Paint Stabilization. All Plants, weeds and any vehicles or itenis on 

open porch (enclosed porches will NOT be stabilized) must be 

renioved prior to stabilization. All Pets must be out of yard during 

stabilization. How much notice do you need to have above 

mentioned tasks completed? If you are a landlord you will need to 

contact the tenant as Prudent Technologies will only inform you. 

Do you have any pets that reside in yard? y / Mo 

Notice needed: ^</^s 

Number to call to give notice: 

Whom we are giving notice to 

Home Owner's Signature 

8080 Ward Parkway, Suite 405 2505 N. 24'" Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402)504-1005 Fax:(210)579-6577 
TBCHNOLOGIESt ] 

PRE-STABILIZATION VIDEO FORM 

I UNDERSTAND THAT PRUDENT TECHNOLOGIES WILL BE COMING 

OUT TO SHOOT A PRE-STABILIZATION VIDEO AT MY PROPERTY. 

THE VIDEO IS JUST A TOOL USED TO DOCUMENT THE CURRENT 

PROPERTY STATUS/CONDITION. A POST VIDEO WILL ALSO BE 

SHOT PRIOR TO COMPLETION OF STABILIZATION. 

OWNER ?a\:>rNCa C^SV^ ^ S NAME 

ftd G-7 0?> ^A^r^^e. Uv^^^ PROPERTY ADDRESS ,

BVID/SAID: Uo\^ S 

HOMEOWNERS SIGNATURE: <^-- \ 

PRUDENT REPRESENTATIVE SIGNATUREV_^^|^^^^ ^ J^^CUlZ ^ 

ANY CONDITIONS NEED TO BE AWARE OF BEFORE SHOOTING 

VIDEO: (LE. PETS, NOTICE NEEDED): 

{/^yJ tuidU 

8080 Ward Parkway, Suite 405 2505 N. 24"" Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska S8110 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)504-1004 Phona: (210)822-9588 

Fax: (816) 363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 
TBCHNOLOGIBS^] 

ACCESS INFORMATION TRACKING SHEET 

 ^^^^^ ^ \\3S.CAQCJ BVID: h6]L{ ^ PROPERTY ADDRESS: GlO' b

Property Owned By: 

(If new property owner) 

Owners Phone No's: Home: Work: 

Cell: ~ Fax: -

Access Contractor: ASW PDA MES PE Other (Prudent) 

DATE TIME ACCESSOR CONRACT DETAIL 

^l-v^l^ ^ £"'2»o ^an^e V «5ireir>-V-«-J 

f o O 

Comments: 

8080 Ward Parkway, Suite 405 2505 N. 24*" Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax:(816)363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 
TECHNOLOGIBS;] 

Access Assessment Form: (Must be completed for every property. 

Information must be obtained from a property walk thru, not given 

by owner) 

Is the property stucco or asbestos? 

If yes, is any of the^tucc^or asbestos damaged or cracked? 

If yes, stop as we can't stabilize this property. It requires special preparation 

techniques. It will be returned to EPA and they will assign at a later date. 

Does this property require lots of scrapping? 

NX) 

Does this property require a lift or scaffolding to reach upper levels? 

NO 

Does this property have lots of plants or items in areas where painting is 

required? 

tJO 

Does this property have any significant structural damage? 

If yes, EXPLAIN? 

8080 Ward Parkway, Suite 405 2505 N. 24'" Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 
TBCHNOLOGIBS*] 

Does this property have a garage? 

If yes, describe location of garage. 

VxxcV: iU<S^ 

Does this property have aluminum siding? 

/ vO 

If yes, is it original factory finish or has it been painted over? 

y>J{) 

Does this property have any other type of structural components? (l.e. roof 

shingles as siding)? 

If yes, EXPLAIN? 

Is this property vacant or 

Are there any pets at this property? 

Are there any low hanging power lines? 

8080 Ward Parkway, Suite 405 2505 N. 24'" Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax:(816)363-3707 Fax: (402)504-1005 Fax: (210) 579-6577 
OOLOGIES. IN C 

2. TO BE FILLED OUT ONLY IF CHANGING COLOR 

PROPERTY ADDRESS:

BVID: MONMC, 

 iGlO' ^ ^^\Y^^vg_ V>>JS OV B GI 

Location 

Siding 

Paint Description 

SWaoiTAA/^gL-^j 

Paint 

Yes 

. y 

Paint 

No 

Soffit 

Fascia 

Comer Trim 

I0ect|(l4)t}^(

^^Jo^\[XY]

 \

 [

 '>\

 ,,

 1 

| 

y 

vy 

Window Trims 

Door Trims 

Front Porch Ceiling 

Front Porch Ceiling Beams.ir 

Front Porch Floor 

txjc4(^W 

k)d {fLi\ 

iK)CCc\[(^Sl^^)

(oood^Vi^^UVj 

'

r

M 

y

 ''

 •'

 I 

J 

J 

L ^ 

L ^ 

<-y 

L-^ 

Front Porch Railings 

Front Porch Steps 

Siding Baseboards - -

Foundation —­

0^^ . AU ^Utx^lp^V) \ jf 1 

h/d-ejA ^ 'orv./ft^>^ •^ l^0£> ^ V ' ' -* 

I AGREE TO THE COLORS INDICATED ABOVE. I UNDERSTANT THAT I 

CANNOT CHANGE THE SELECTED COLORS LATER ON AS PRUDENT 

WOULD HAVE PURCHASED THE PAINT SPECIFICALLY FOR THE 

REFERENCED PROPERTY. ALSO I UNDERSTAND THAT COLORS SELECTED 

MAY NOT LOOK EXACTLY AS IT IS^HOWN ON SWATCHES AFTER 

PAINTING ON MY PROPERTY!) 

Homeowner signatu ^kAAJLjIput^ Date: 

8080 Ward Parkway, Suite 405 2505 N. 24*" Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone:(816)363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402)504-1005 Fax: (210) 579-6S77 
TECHNOLOGIBS; ] 

NEIGHBORHOOD PROPERTY ACCESS FORM 

IS THERE A NEIGHBORING PROPERTY THAT NEEDS TO BE ACCESSED ALONG 

WITH ASSIGNED PROPERTY TO COMPLETE STABILIZATION PROCESS? 

IF IT IS, GET ACCESS FROM ALL REQUIRED NEIGHBORHOOD PROPERTIES. 

8080 Ward Parkway, Suite 405 2505 N. 24*" Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax: (816) 363-3707 Fax: (402)504-1005 Fax: (210) 579-8577 
TECHNOLOGIES. 1 

PRE-STABILIZATION PROPERTY SAFETY ASSESSMENT FORM 

PROPERTY ^IC b lnn%noe LoS^o tjxj ADDRESS 

BVID/SAID: ^O^M S 

PRUDENT ASSESSMENT REPERSENTATIVE: 

-Son, .a- Aal^l^ " 

REPERSENTATIVE REMARKS/FINDINGS: 

(POWER-LINE PROXIMITY TO PROPERTY, SCAFFOLDING/ LADDERS/ LIFTS 

NEEDED, UNSAFE AREAS, UNSAFE NEIGHBORHOOD...ETC.) 

8080 Ward Parkway, Suite 405 2505 N. 24*" Street, Suite 308 4242 Medical Drive, Suite 4250 

Kansas City, MO 64114 Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (816) 363-3703 Phone: (402)504-1004 Phone: (210)822-9588 

Fax; (816) 363-3707 Fax: (402) 504-1005 Fax: (210) 579-6577 
TECHNOLOGIBS.] 

Checklist for the Worksite Hazard Analysis \^^.- . 

Crew: Date: 

Item OK? Hazard Corrective Action 

Overhead Lines /as/Jj ^ JMl­ In-transit Yehicle Clearance 

Levels around high wires 

Vehicle Clearance around 

high wires when working 

Phone lines 

Cable lines 

Gas Line 

Water Line 

Sewer Line 

Septic Tank 

Propane/Butane 

Access to/on Property 

M ^ 

Neighbor Access Required - 4 ^ 

High Traffic Area y)u^ 

Garage ^ ^ ^"i-uuiyc^ 

Structures |n^ r^cKg ^ ^ 

^AiC^x: ^ LdncM 

Driveway oi y 

Sidewalk 

Foundation £jTi c/ — 

Retaining Walls n^ 

Fences 

Trees 

-6^^=^ 

Foliage OuTOiatJl^Ki^T . ^ 

General Condition of yard M_ 

h^^^ft^^ ^ i^iy^J^cd Damaged Areas: sink 

holes/rotted wood 

Sprinkler System 

Pets 

3 n ^ 

Insects 

Weather Conditions 

Unsafe driving conditions 

Unsafe neighttorhood 

Crew Suli-Contractor Safi 

8080 Ward Beltway, Suite 405 2505 N. 24*" Street, Suite 308 edical l^rive, Suite 4250 

Kansas CitVvMO 64114 Omaha, Nebraska 68110 San Mitonio, TX 78229 

Phone:(816)363-3703 Phone: (402)504-1004 Phon4: (210)822-9588 

Fax: (816) 363-3707 Fax: (402)504-1005 F|IX: (210) 579-6577 
Glo3 (A*:«v^vuU^ Sp. 
Current Sample Pre-Renovation Form 

Effective until April 2010. 

Confirmation of Receipt of Lead Pamphlet 

5/Khave received a copy of the pamphlet, Renovate Right: Important Lead Hazard 

Infonmation for Families, Child Care Providers and Schools infoiming me of 

the potential risk of the lead hazard exposure from renovation activity to be 

performed in my dwelling unit. I received this pamphlet before the work began. 

^M^/o? 

of recipient / 7 Date 

\jlj.0y./L . yTeexiJljuJ 

Signature of recipient 

Self-Certification Option (for tenant-occupied dwellings only) — 

If the lead pamphlet was delivered but a tenant signature was not obtainable, 

you may check the appropriate box below. 

• Refusal to sign — I certify that I have made a good faith etfoil to deliver the 

pamphlet, Renovate Right: Important Lead Hazard Informatton for Families, 

Child Care Providers and Schools, to the rental dwelling unit listed below at the 

date and time indicated and that the occupant refused to sign the confirmation 

of receipt. I further certify that I have left a copy of the pamphlet at the unit with 

the occupant. 

^Unavailable for signature — I certify that I have made a good faith effort to 

deliver the pamphlet. Renovate Right: Important Lead Hazard Information for 

Families, Child Care providers and Schools, to the rental dwelling unit listed 

below and that the occupant was unavailable to sign the confirmation of receipt. 

I further certify that I have left a copy of the pamphlet at the unit by sliding it 

under the door. 

Printed name of person certifying Attempted delivery 

date and time 

lead pamphlet delivery C^M"^ 

Signature of person certifying lead pamphlet delivery 

Unit Address 

Note Regaiding Mailing Option — /Vs an alternative to delivery in person, you 

may mail the lead pamphlet to the owner and/or tenant. Pamphlet must be mailed 

at least 7 days before renovation (Document with a certificate of mailing from the 

post office). 
Douglas Coimty Account Infomiatio laion Page 1 of2

Douglas County, Nebraska Property Record - R1750540002 

Print Report 

NEW Feature - Parcel Dimensions available @ scale 0-50 ft west of 52nd St - VJOW O n Ma p Information is valid as of 2009-9-15 Treasurer's Tax Report 

New Feature " • r* • • Auto Sales Search 

Owner 

EASTER PATRICIA L ^^vji ^ Ifoi ^ 

6703 MINNE LUSA BLVD 

OMAHA NE 68112-0000 

Property Informatio n 

Key Number 5054 0002 17 

Account Type: Residential 

Parcel Number: 1750540002 

Parcel Address: 6703 MINNE LUSA BD 

OMAHA NE 68112-0000 

Legal Description: MINNE LUSA LOT 14 BLOCK 11 LOTS 13 & 14 MINNIE LUSA ADD BLK 11 

Value Informatio n 

Land Improvement Total 

2009 $8,900.00 $83,100.00 $92,000.00 

2008 $8,900.00 $83,100.00 $92,000.00 

2007 $8,900.00 $83,900.00 $92,800.00 

2006 $8,900.00 $83,900.00 $92,800.00 

2005 $8,900.00 $83,900.00 $92,800.00 

2004 $8,900.00 $67,800.00 $76,700.00 

Sales Informatio n 

Sales Date: 2004-07-24 

Deed Type: WD Book: 2004 Page: 129040 

Price: $100,000.00 

Grantor: Marto T White etal 

Grantee: Patricia L Easter 

Valid/Invalid: Valid 

Exclusion Reason: 

Land Informatio n 

Acres SF Units Depth Width Vacant 

0.0 0.0 1.0 120.0 106.0 No 

Improvemen t Informatio n 

http://douglasne.niapping-online.coni/DouglasCoNe/static/accountinfo.jsp?accountno=R1750540002 9/24/2009 
Douglas County Account Informadon Page 2 of2 lation 

Building 1 

5.£;,o:,. ^ '• ^' ''^^^^^^^§^S^ «703 Minn* Lisa Btvd. 2SI0fy •'^^^SsS^^^^M 

• BTR ^ A 

41 "^'^Bfe^' . 1 1 ^»^»-,..-^- . J .- ..'.'S^« - ••'• 

^ 1 • li —llii^ ^ K^:: : "'^'''^^^giB^Hl^^H^^H^^^^^^^ I 

W' ^ ^ 1 ^- ik 1 n_J j| | li 

1 

1 CLICK TO ENLARGE IMAGE 1 

Square Footage: 1711.0 

Perimeter 0.0 

Unit Type: 

BuiitAs: 2 Story 

HVAC: Central Air to Air 

Exterior: Masonry Common Brick 

Interior: Drywall 

Roof Cover: Composition Shingle 

Roof Type: Gable 

Floorcover Allowance 

Year Percent Year Built Remodeled Remodeled 

1925 0% 

Detail Type Detail Description 

Appliance Allowance 

Appliance Fireplace Masonry 

Basement Bsmnt Block 8 ft 

Fixture Additional Fixtures 

Fixture Base Fixtures 

Fixture Bath Full 

Garage Detached 

Porch Slab Roof Ceil 

EiiL 

•avjin^ M«< 

•rgVT' 

KMH n 

CLICK TO ENLARGE IMAGE 

Percent Complete: 100.0% 

Quality: Average 

Condition: Average 

Condo Square Footage: 0.0 

Rooms: 6.0 

Units: 1.0 

Baths: 1.0 

Bedrooms: 3.0 

Stories: 2.0 

Foundation: Block 

Sprinkler Square Footage: 0.0 

Adjusted Year Physical Age Built 

1925 84 

Units 

1.0 

1.0 

768.0 

1.0 

1.0 

1.0 

361.0 

70.0 

http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl 750540002 9/24/2009 
IES»INC. 

Prudent Property Close-Out Form (Lead-Based Paint Stabilization) 

SAID: if0t^9 ' 

.. Property Address: 470S f^'UA^lVS.^, ^1 ^ 

Owner's Name: Patr^Oioo ba^fvr 

i S.NO 

' 1 

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: 3 

4 

1 

5 

\ 6 

7 

8 

9 

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i 11 

! 12

Performance Standards/close-Out Criteria 

Was the entire 8tructure(s) painted with the exception of the stated, 

excluded areas? This would include painting of other associated 

features including fascia, eaves, siding, all trim, porches, box 

beams, columns, rails, and exterior surfaces of garages. 

Was all scraping and other preparation work completed 

satisfactorily? 

Were all required areas of the structure(s) primed as needed and 

painted with two top coats? 

Are ail of the areas where contaminated materials have been spilled 

thoroughly vacuumed/ cleaned? 

Did the contractor collect/vacuum all falling and scraped paint chips 

on the entire property, roadways, alleyways, public access areas 

and also remove any other generated debris? 

Is the grass area that surrounds the structure(s) in reasonably good 

condition? 

Was the paint products utilized equivalent to a 30 year 

product/quality? 

Are all items such as polyethylene sheeting, ladders, paint brushes, 

cones, barrier tape etc properiy removed? 

Is there any evidence of property damage that was done by the 

contractor? Any property damage needs to be completed prior to 

the EPA Close-Out. 

Are there any property items that were temporarily re-located by the 

contractor that need to be moved back? 

Are there any (known) lingering issues with the property owner(s) 

that have been left unresolved? 

 Other Considerations? Property Owner Discussions? Additional 

Work that is Required 

Prudent Representative Signature: 

Date 

Property Owner Signature\Jw/t6^..dyO J^^^^j^^X- ^ 

Date: 

8080 Ward Parkway, Suite 405 

Kansas City, MO 64114 

Phone:(816)363-3703 

Fax: (816) 363-3707 

Yes NO ! 1 

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2506 N. 24" Street, Suite 308 4242 Medical Drive, Suite 4250 

Omaha, Nebraska 68110 San Antonio, TX 78229 

Phone: (402)504-1004 Phone: (210)822-9588 

Fax: (402)504-1005 Fax: (210) 579-6577