HomeMy WebLinkAboutRIVER SONG WALDORF SCHOOL - CONTRACT - RFP - P1026 NONPROFIT LEASE 906 E STUARTLEASE AGREEMENT
THIS LEASE AGREEMENT, made and entered into this Iq day of ,
2006, by and between THE CITY OF FORT COLLINS, COLORADO, a unicipal
Corporation, hereinafter referred to as the ("City"), and FORT COLLINS WALDORF
EDUCATION ASSOCIATION, INC. a Colorado nonprofit corporation, hereinafter referred
to as ("Tenant").
WITNESSETH:
WHEREAS, the City is the owner of certain Premises in the City of Fort Collins located
at 906 E. Stuart Street, Fort Collins, Colorado 80524 ("Premises"); and
WHEREAS, the Tenant desires to lease said Premises for the purpose of early
childhood programming and other associated uses;
WHEREAS, the use by Tenant of the Premises for its early childhood programming
and other associated uses would further an important public purpose of the City of Fort
Collins.
NOW, THEREFORE, for and in consideration of the mutual covenants and obligations
herein expressed, the monetary payment hereinbelow recited and the public benefit to be
derived from the service provided by the Tenant, the receipt and adequacy of which is hereby
acknowledged, it is hereby mutually covenanted and agreed by and between the parties as
follows:
1. Premises. The City hereby leases to the Tenant and the Tenant hereby leases
from the City, the Premises located at 906 E. Stuart Street in the City of Fort Collins,
Colorado, said property more fully described as follows:
A tract of land situate in the Northeast 1 /4 of the Northeast 1 /4 of Section 24,
Township 7 North, Range 69 West of the 6th P.M., and being a part of Tract 7,
of the East Acres Subdivision, a subdivision of record in the County of Larimer,
State of Colorado, and being more particularly described as follows:
Considering the South line of said Tract 7 as bearing S 89156' 00" West and
with all bearings contained herein relative thereto: Commencing at the
Southeast corner of said Tract 7, thence S 89156'00" West along the said South
line a distance of 846.15 feet to the point of beginning; thence along the East
line of the Spring Meadows on Spring Creek Subdivision N 00042' East, a
distance of 140.77 feet; thence along a South line of said subdivision N 89050'
West, a distance of 99.97 feet; thence S 00003'39" West, a distance of 141.16
feet more or less to the South line of said Tract 7; thence N 89056'00" East, a
distance of 98.40 feet to the true point of beginning.
1
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EXHIBIT "A"
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Environmental Scientists and Engineers, LLC
LEAD MANAGEMENT PLAN
RESIDENTIAL STRUCTURE
906 EAST STUART STREET
FORT COLLINS, COLORADO
1.0 Introduction
Walsh Environmental Scientists and Engineers, LLC (WALSH) conducted a lead -based
paint (LBP) inspection for the City of Fort Collins at a residential structure located at 906
East Stuart Street in Fort Collins, Colorado on July 28, 2006. The inspection identified
one door frame, one door trim, one window frame, and seven window sills to contain
LBP greater than 1.0 mg/cm? using XRF analysis. In addition, the inspection identified
and one component (ceramic floor tile) which contained lead. At the time of the
inspection, the paint on all of these components was in good condition with no visible
signs of deterioration, flaking, peeling, or abrasion. Lead -containing materials that are
intact do not pose a health risk provided it is maintained intact and not disturbed.
The objective of the Lead Management Plan is to prevent human exposure to lead
hazards through proactive policies and procedures, which comply with all applicable
federal, state, and local laws and regulations.
A table summarizing all LBP and lead -containing components identified during the
inspection is presented below. A figure depicting the location of and lead -containing
materials is attached.
Table 1 - Lead -containing Materials
Location
Component
Visible Color
Paint
XRF -
Result
Description
Condition
m /cm2
North Restroom (Room 113)
Glazing on Ceramic
; White
Good
18.9
Floor Tile
Classroom West of Kitchen
East Door Frame at
(Room 101)
Entrance to entrance
White
Good
2.02
Porch
Classroom West of Kitchen
East Door Trim at
White
Good
1.72
Room 101
Entrance to Kitchen
Classroom West of Kitchen
West Window Frame
White
Good
1.85
Room 101
and Sill
Classroom West of Kitchen
West Window Frame
White
Good
1.41
Room 101
and Sill
Classroom West of Kitchen
East Window Frame
White
Good
3.15
Room 101
and Sill
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Environmental Scientists and Engineers, LLC
I
Location
Component
Visible Color
Paint
XRF
Result
Description
Condition
(MCl/cm)
I
Classroom West of Kitchen
South Window Frame
White
Good
1.79
Room 101
and Sill
Classroom Directly East of
East Window Frame
White
Good
3.07
Restroom Room 111
and Sill
Hallway South of Kitchen (Room
Window Frame and
105)
Sill Directly South of
White
Good
1.94
Kitchen
Hallway South of Kitchen (Room
Window Frame and
105)
Sill Directly South of
White
Good
1.46
Restroom
North Restroom (Room 113)
North Window Frame
White
Good
1.34
and Sill
Note: mg/cm2 = Milligrams per square centimeter
2.0 General Description of Hazard Control Measures
A lead hazard is any condition that causes exposure to lead from lead -contaminated dust,
lead -contaminated soil, lead -contaminated paint that is deteriorated or present in
accessible surfaces, friction surfaces, or impact surfaces that would result in adverse
human health effects. Hazard control measures are procedures designed to prevent or
reduce exposure to lead -based paint hazards. The two types of hazard control measures
are interim control measures and abatement.
2.1 Interim Controls
Interim controls are designed to temporarily reduce human exposure or possible exposure
to LBP hazards. These measures include specialized cleaning, repairs, maintenance,
painting, and educational programs for management and residents. Examples of interim
controls include:
• Paint film stabilization (Painting over existing LBP)
• Friction and impact reduction treatments
• Dust removal
2.2 Abatement
Abatement is a measure or measures designed to permanently eliminate a lead -based
paint hazard. These measures include the replacement, removal, enclosure or
encapsulation of a lead -containing building component. Certified abatement workers and
supervisors must perform these activities, Examples of abatement include:
• Building component replacement
• Enclosure (Permanently covering)
• Paint removal by heat gun, chemical, or abrasive techniques
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Environmental Scientists and Engineers, LLC
• Encapsulation (Permanent measures with at least 20-year warranty)
2.3 Lead Hazard Control Practices Prohibited and not Recommended by
HUD
Specific work practices involving lead -containing materials are prohibited or not
recommended in the "Guidelines for the Evaluation and Control of Lead -Based Paint
Hazards in Housing," 1997 Revision, published by the U.S. Department of Housing and
Urban Development due to excessive dust generation. Lead -containing building
components identified during the inspection should never be subjected to the following
practices:
Prohibited Work Practices:
Open flame burning or torching. Open torches, infrared scorches electric irons, and
heat guns operating above 1,100 °F all may cause the release of lead fumes.
Machine sanding or grinding without high efficiency particulate air (HEPA)
vacuum exhaust. Circular, reciprocating, belt, and palm sanding of leaded surfaces can
generate large amounts of lead dust.
Abrasive blasting or sandblasting. Like sanders, abrasive blasters will release a large
amount of lead dust into the environment unless HEPA vacuum exhaust is used.
Uncontained hydrobalsting. Power washing often leads to paint chips and dust on the
surface. Hydrobalsting should not be used unless all runoff water is contained and
filtered.
Not Recommended Work Practices:
Dry scraping and sanding (except for limited areas). Extensive use of dry scraping or
sanding generates a significant amount of lead dust which is hard to contain. Surfaces
should be wetted prior to scraping/sanding so that the dispersal of dust is limited.
Methylene chloride paint stripers. Methylene chloride can cause liver and kidney
damage and carbon monoxide poisoning, and it is suspected to cause cancer. If chemical
paint removers are utilized, they should not contain methylene chloride.
2.4 Recommended Practices to Control LBP Hazards
The following practices are recommended to control the lead hazards associated with
identified lead -containing building components within the structure.
1. Appoint a designated person. This person should be responsible for conducting
periodic inspection of areas identified to contain lead and informing occupants
and contractors of the location and extent of lead within the structure.
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Environmental Scientists and Engineers, LLC
2. Monitor and periodically inspect the condition of identified lead -containing
materials. Inspections should include the following:
• Indications for paint failure (i.e., blistering, flaking, peeling, and
chalking).
• Indications of teeth marks on accessible surfaces (i.e., window sills).
3. Implement operations and maintenance program, including an ongoing paint over
coating program in areas where lead -containing materials are identified as long as
the paint is not blistering, flaking, peeling or chalking.
4. Implement response actions, if any (i.e., if deterioration or teeth marks are noted
during periodic inspections).
5. Notify outside contractors of the presence of all lead -containing materials within
the building prior to beginning work.
6. Records of the physical condition of all lead -containing material inspections
should be kept that include the following:
A record of all actions taken on lead -containing materials.
A record of the physical condition and location of lead -containing
materials.
• Persons involved with conducting inspections.
7. Recordkeeping for each preventative measure and/or response action should
include the following:
• Detailed description of the measures taken.
• Methods used.
• Location.
• Justification for why a specific measure or action was selected.
• Start and completion dates of all work.
• Names and addresses of all parties involved.
• If lead -containing material was removed, the disposal location should be
included.
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WINDOW SILLS
AND FRAMES I�WINDOW SILL AND FRAME
108
NOT TO SCALE
WINDOW SILLS
AND FRAMES 1
I
I
109 DOOR FRAME
1D2 f� I 2ND FLOOR
110 1 101 j
t05 I
I
� I
DOOR TRIM I 201
I
11t 104
103
I
106 I
10o I
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4
WINDOW SILL AND FRAME 113-
I
I 200
1ST FLOOR
112
I
CERAMIC TILE GLAZING {
I
WINDOW SILL AND FRAME I
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LEGEND:
AREAS OF IDENTIFIED LEAD -CONTAINING MATERIALS: AREAS OF LEAD -CONTAINING MATERIALS
CEP
AMC TILE GLAZING
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------- - PAINT CITY OF FORT COLLINS
RESIDENTIAL STRUCTURE - 905 E. STUART ST.
FORT COLLINS, COLORADO
Job: 7302-010 Doia: 08/06 Figure; 1
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2. Term.
A. Base Term. The base term of this Lease shall be for a two (2) year period
commencing on August 1, 2006, unless sooner terminated by either party pursuant to
paragraph 14 hereof.
B. Extensions. Unless the City determines, at its sole discretion, that such
renewal is not in the City's interest, the Tenant shall have the right and option to
extend the base term of this lease for one additional one-year term. However, such
extension is expressly contingent upon the Tenant not being in default hereunder.
Tenant shall provide sixty (60) day's notice prior to the end of any given lease term of
its intent to extend or to terminate the lease.
3. Rent. Tenant shall pay to the City, in advance, the sum of Five Dollars ($5.00)
per year as and for rent for the above described Premises, such payment to be made at
City's Right -of -Way Office, 117 North Mason Street, Fort Collins, Colorado, or at such other
place as the City may from time to time designate.
4. Security Deposit. The Tenant shall pay to the City the amount of Five Hundred
Dollars ($500.00) to be held as a security deposit on which the City is not required to pay
interest to the Tenant. The City shall have the right to apply all or part of said deposit to any
delinquent rent or utility charges to the Premises, but is not obligated to do so. Said deposit
or balance thereof, after deduction for damages or past due rent or utility charges, shall be
refunded only on termination of this Lease Agreement after inspection by the City and after all
personal property of Tenant has been removed. If Tenant is not found to be in default of the
performance of the covenants or conditions herein at the sole discretion of the Landlord, the
deposit will be returned within 60 days of vacancy, provided Tenant has provided the City
with a forwarding address to which the deposit can be mailed. This deposit shall be not
applied to the last rental payment.
5. Permissible Uses of Premises. Tenant agrees to use and occupy the Premises
only for the purpose of early childhood programming and associated uses and for no other
purpose whatsoever without the prior written consent of the City.
6. Condition of Premises. Maintenance and Damage. Tenant accepts the
Premises in their present condition "as is". Tenant acknowledges that the Premises, in their
present condition, comply fully with the City's covenants and obligations hereunder. Tenant
stipulates that the Premises have been examined, including the grounds, buildings and all
improvements, and that they are, at the time of this lease, in good order and repair, safe,
clean and in tenantable condition. Tenant acknowledges the presence of lead -based paint
on the Premises, and the receipt of the report titled, "Lead -Based Paint Inspection —
Residential Structure" prepared by Walsh Environmental Scientists and Engineers, LLC,
dated August 4, 2006 and revised August 6, 2006 (the "Report") Tenant shall be responsible
for all routine maintenance associated with the use of the Premises.
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7. Alterations, Improvements and Signs.
A. All alterations, additions, improvements or changes to the Premises by
Tenant subsequent to the commencement of the Lease term shall be subject to the
written approval of the City and shall be done in a good and workmanlike manner
without impairing the structural soundness of the building and in compliance with the
building and zoning laws and with all other laws, ordinances, orders, rules, regulations
and requirements of all federal state or municipal governments and the appropriate
departments, commissions, boards and officers thereof; and the Tenant shall procure
certificates of occupancy, if required by law. Furthermore, such alterations, additions
and improvements shall not be commenced until any contractor or subcontractor
engaged for such purpose shall deliver to the Tenant (with a copy to the City) a
certificate evidencing that proper workmen's compensation insurance is in full force
and effect, covering any persons performing such work, and that the same may not be
canceled without at least ten (10) days prior written notice to the City. Furthermore, no
such alterations, additions or improvements shall be commenced until the Tenant shall
have procured and paid for all required municipal and other governmental permits and
authorizations of the various municipal departments and governmental subdivisions
having jurisdiction over the matter. Alterations or modifications to areas identified in
the Report as having lead -based paint must be completed in cooperation with a
certified lead -based paint abatement company approved by the City.
B. All alterations, changes and improvements built, constructed, or placed on
the Premises by Tenant, with the exception of the fixtures removable without damage
to the Premises and movable personal property shall, unless otherwise provided by
written agreement between the parties hereto, be the property of the City and remain
on the Premises at the termination of this Lease.
C. The Tenant shall not affix, erect or maintain on the Premises any sign or
advertisement without first obtaining the City's approval as to the sign or
advertisement to be erected on the Premises. All such signs must comply with all
applicable laws. The cost of erection and maintenance of such sign or advertisement
shall be the responsibility of the Tenant.
8. Assignment and Subletting. The Tenant shall not assign, sublet or grant any
concession or license for use of the Premises or any part thereof without the prior written
consent of the City. The City's consent to any given assignment, subletting, concession or
license shall not be deemed to be a consent to any future assignment, subletting, concession
or license. An assignment, subletting, concession or license obtained without the prior
written consent of the City, or an assignment or subletting by operation of law, shall be void
and shall, at the City's option, terminate this Lease.
9. Dangerous Materials. Tenant shall not keep or have on the Premises any
article, item or thing of a dangerous, inflammable or explosive character that might
3
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unreasonably increase the danger of fire to the Premises or that might be considered
hazardous or extra hazardous by any responsible insurance company.
10. Utilities. Tenant shall be responsible for arranging for and paying for all utility
services required on the Premises.
11. Maintenance and Repair. Tenant shall keep and maintain the Premises,
grounds, appurtenances, improvements and fixtures in a safe and sanitary condition and in
good repair during the term of this Lease and any renewal thereof at the sole expense of the
Tenant. Such maintenance shall include, but not be limited to, all required repairs to the
plumbing, heating apparatus, electric and gas fixtures, snow removal and grounds
maintenance. In addition, major maintenance and repair of the Premises, whether or not due
to the Tenant's misuse, waste or neglect or that of its employees, agents, or visitors, shall be
the sole responsibility of the Tenant at Tenant's expense. In maintaining and repairing the
Premises, Tenant shall comply with the Lead Management Plan contained in the Report,
which Lead Management Plan is attached hereto as Exhibit "A" and incorporated herein by
reference. The City may inspect the Premises as described in paragraph 13, below, to
ensure Tenant's compliance with the Lead Management Plan.
12. Mechanic's Liens. The Tenant agrees to pay or cause to be paid promptly all
bills and charges for material, labor or otherwise in connection with or arising out of any
alterations, additions or changes made by the Tenant or its agents or subtenants to the
Premises; and the Tenant agrees to hold the City free and harmless against all liens and
claims of liens for such labor and materials, or either of them, filed against the Premises or
any part thereof and from and against any expense and liability in connection therewith. The
Tenant further agrees to discharge (either by payment or by filing the necessary bond or
otherwise) any mechanic's, material man's or other liens against the Premises arising out of
any payment due or alleged to be due for any work, labor, services, materials or supplies
claimed to have been furnished at the Tenant's request in, on or about the Premises and to
indemnify the City against any lien or claim of lien attached to or upon the Premises or any
part thereof by reason of any act or omission on the Tenant's part. The Tenant shall,
however, have the right to contest any mechanic's liens or claims filed against the Premises,
provided the Tenant shall diligently prosecute any such contest and at all times effectively
stay or prevent any sale of the Premises under execution or otherwise and pay or otherwise
satisfy any final judgment adjudging or enforcing such contested lien and thereafter procure
record satisfaction or release thereof. The Tenant also agrees in any such contest, at the
Tenant's cost and expense, to defend the same on behalf of the City.
13. Right of Inspection. The City shall have the right at all reasonable times, during
the term of this Lease and any renewal thereof, to enter the Premises for the purpose of
inspecting the Premises and all buildings, grounds and improvements thereof, provided the
City shall contact the Tenant at least twenty-four (24) hours prior to such visit. In the event of
an emergency, to protect or minimize the risk of harm to life or property when Tenant shall
not be personally present to open and permit an entry into the Premises, City or City's agents
may enter the same by a master key or may forcibly enter the same, without rendering the
4
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City or such agents liable therefore, and without in any manner affecting the obligations and
covenants of this Lease.
14. Surrender of Premises. At the expiration of this Lease term or any renewal
thereof, the Tenant agrees to quit and surrender the Premises in as good a state and
condition as they were at the time of commencement of this Lease, reasonable wear and tear
and damages by the elements excepted. The Tenant agrees to be responsible and to
reimburse the City for any repairs to the Premises required due to the Tenant's occupancy of
the Premises.
15. Default. If any default is made in the payment of rent, or any part thereof, at the
times hereinbefore specified, or if any default is made in the performance of or compliance
with any term, provision or condition hereof, or if the Tenant fails to meet the Community
Development Block Grant (CDBG) client service requirements, this Lease, at the option of the
City, shall be terminated and forfeited, and the City may reenter the Premises and remove all
persons therefrom. The Tenant shall be given written notice of any default or breach of the
provisions of this Agreement and termination or forfeiture of the Lease shall not result if,
within twenty (20) days after receipt of such notice, the Tenant has corrected the default or
breach or has taken action reasonably likely to affect such correction within a reasonable
time.
16, Insurance.
A. The Tenant, at its sole cost and expense, shall, during the term of this
Lease, procure, pay for and keep in full force and effect a comprehensive policy of
commercial general liability insurance covering the improvements and the Premises
insuring the Tenant in an amount not less than Five Hundred Thousand Dollars
($500,000.00) covering bodily injury, including death to persons, personal injury and
property damage liability arising out of a single occurrence. Such coverage shall
include, without limitation, legal liability of the insureds for property damage, bodily
injuries and deaths of persons in connection with the operation, maintenance or use
of the Premises (including acts or omissions of the Tenant), legal liability arising out of
lawsuits related to employment contracts of the Tenant and protection against the
liability for non -owned and hired automobiles. Such coverage shall also include, if
applicable, comprehensive automobile liability insurance, garage keepers' liability,
liability for property of others, host liquor liability, water damage liability, contractual
liability, workmen's compensation insurance for employees of the Tenant and such
other risks as shall customarily be required by private institutional mortgage investors
with respect to property similar in construction, location and use.
B. The Tenant, at its sole cost and expense, shall, during the term of this
Lease, procure, pay for and keep in full force and effect a policy of property insurance
covering all leasehold improvements to the Premises and all of the Tenant's
equipment, trade fixtures, appliances, furniture, furnishings and personal property
from time to time in, on or upon the Premises. This insurance shall be in an amount
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not less than the full replacement cost without deducting for depreciation. Such
insurance shall afford protection against at least the following: (i) loss or damage from
fire and perils normally covered by the standard extended coverage endorsement;
and (ii) such risk as shall customarily be covered with respect to property similar in
construction, location and use, including all perils normally covered by the standard
"all risk" endorsement when such is available.
C. If the Tenant employs any person in connection with the operation and
use of the Premises as contemplated under this Lease Agreement, the Tenant shall, at
its own sole cost and expense, during the term of this Lease, procure, pay and keep in
full force and effect workers' compensation insurance, in an amount not less than Six
Hundred Thousand Dollars ($600,000.00) for each occurrence, for all of its employees
to be engaged in work on the Premises under this Lease Agreement.
D. All policies of insurance carried by the Tenant shall name the Tenant as
insured and shall name the City as additional insureds and loss payees for the policy.
The policy or policies shall contain a provision that the policy or policies cannot be
canceled or materially altered either by the insureds or the insurance company until
thirty (30) days prior written notice thereof is given to the Tenant and the City. Upon
issuance or renewal of any such insurance policy, the Tenant shall furnish a certified
copy or duplicate original of such policy or renewal thereof with proof of premium
payment to the City. Any such policies shall contain waivers of subrogation and
waivers of any defense based on invalidity arising from any act or neglect of any
assignees or sublessees of the Tenant.
17. Indemnification. Tenant agrees to indemnify and hold harmless the City
against all damages, claims, liabilities for injury or damage to person, property or whenever
and by whomever brought and causes of action arising from or in anyway relating to the
Tenant's possession or use of the Premises.
18. Americans with Disabilities Act. The Tenant shall comply with all Federal, State
and local laws, including the requirements of the Americans with Disabilities Act (ADA). The
City does not represent that the Premises meet the requirements of the ADA for the purposes
of Tenant's intended use of the Premises.
19. Conditions of the Agreement. It is further agreed by and between the City and
Tenant as follows:
A. That this Agreement may not be enlarged, modified, or altered, except as
in writing, signed by the parties as an amendment hereto.
B. That no waiver of any breach of this Agreement shall be held or
construed to be a waiver or any subsequent breach thereof.
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C. That it is expressly understood and agreed by the parties hereto that in
the performance of the obligations provided for in this Agreement, time is of the
essence.
D. The covenants and conditions herein contained shall apply to and bind
the heirs, legal representatives, and assigns of the parties hereto and all covenants
are to be construed as conditions of this Lease.
E. If either party must resort to legal action to enforce the terms of this
Agreement, the non -prevailing party shall reimburse the prevailing party for the
prevailing party's reasonable legal fees, including attorney's fees.
IN WITNESS WHEREOF, the parties hereto have signed this Agreement the day and
year first written above.
7
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CITY:
THE CITY OF FORT C(
Municipal Corporation
By: k
Darin Atteberry, City
A EST' '-ORT
l
City Plqk SEAL
APP 6ED AS TO if
istaht City
NS,
TENANT:
FORT COLLINS WALDORF EDUCATION
ASS CIATION, INC.
i
Beatrice Meye arsons
Board President
ATTEST:
Chic ine oll
Treasurer
ATTACHMENTS:
1. Lead -Based Paint Disclosure
2. Exhibit "A" — Lead Management Plan
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Disclosure of Information on Lead -Based Paint and/or Lead -Based Paint Hazards
Lead Warning Statement
Housing built before 1978 may contain lead -based paint. Lead from paint, paint chips, and dust can pose
health hazards if not managed properly. Lead exposure is especially harmful to young children and pregnant
women. Before renting pre-1978 housing, lessors must disclose the presence of known lead -based paint and/or
lead -based paint hazards in the dwelling. Lessees must also receive a federally approved pamphlet on lead
poisoning prevention.
Lessor's Disclosure
(a) Presence of lead -based paint and/or lead -based paint hazards (check (i) or (ii) below):
(i) X Known lead -based paint and/or lead -based paint hazards are present in the housing
(explain).
As per Lead -Based Paint Inspection Report (see below)
(ii) Lessor has no knowledge of lead -based paint and/or lead -based paint hazards in the
housing.
(b) Records and reports available to the lessor (check (i) or (ii) below):
(i) X Lessor has provided the lessee with all available records and reports pertaining to
lead -based paint and/or lead -based paint hazards in the housing (list documents
below).
Lead -Based Paint Inspection - Residential Structure - dated Aug- 9- 2006
prepared by Walsh Environmental Scientists b Engineers, LLC
(ii) Lessor has no reports or records pertaining to lead -based paint and/or lead -based
paint hazards in the housing.
Lessee's Acknowledgment (initial)
(c) Lessee has received copies of all information listed above.
(d) Lessee has received the pamphlet Protect Your Family from Lead in Your Home.
Agent's Acknowledgment (initial)
(e) Agent has informed the lessor of the lessor's obligations under 42 U.S.C. 4852d and
is aware of his/her responsibility to ensure compliance.
Certification of Accuracy
The following parties have reviewed the information above and certify, to the best of their knowledge, that
the information they have provided is true and accurate.
Q- rY� r1� r p.I G,s1'i a.
L sor DPI Lessor Date
L s at Lessee Date
Agent Date Agent Date