1-ITB 2026-036GD.pdf

INVITATION T0 BID

Cut along the outer border and affix this label to your sealed bid envelope to identify it as a "Sealed Bid".

Be sure to include the name of the company submitting the bid. Sealed bids may be delivered to the Community Development front desk assistant, placed in the Community Development drop box or mailed to the address below.

SHALHD BID . D0 NOT OPEN

COMMUNITY DEVELOPMENT

Lead Based Paint Inspection and Risk Assessment

Bentancourt, ITB Bid No. 2026-036GD

Bid Due: March 9, 2026 by 4:00 PM CST

Bid Opening: March 10, 2026 at 8:30 AM CST For Information contact:

Greg Daniel - Construction Inspection Specialist (806)775-2291 gregdaniel@mylubbock.us

Company Name :

Contact Name :

Bids must be addressed to:

David Robertson, Assistant Director, Programming and Operations City of Lubbock, Community Development 1708 Crickets Ave Lubbock, TX 79401

VENDORS ARH STRONGLY ENCOURAGED

TO CAREFULLY READ THE HNTIRE BID

These General Conditions apply to all bids and become a part of the terms and conditions of any bid submitted. The City shall mean the City of Lubbock.

1. The right is reserved by the City, Community Development and said owner to reject any and all bids. All qualified bidders will receive consideration for award of contract without regard to: Race, Color, Religion, Sex, Familial Status, Handicap or national origin.

2. The City reserves the right to reject any or all bids, reject any particular item on a bid and to waive immaterial formalities and to accept the offer most advantageous to the City in its sole discretion. Unless otherwise specified herein, the City may award the bid either item-by-itemoranall-or-nonebasisforanyitemorgroupofitemsshownontheBidForm.

3. All bids are evaluated for compliance with specifications before the bid price is considered.

Failure to comply with the listed General Conditions may result in the disqualification of bid.

4. The City hereby notifies all Bidders that in regard to any contract entered into pursuant to the ITB, Historically Underutilized Businesses (HUBs) are afforded equal opportunities to submit proposals and shall not be discriminated against on the grounds of race, color, sex, disability, or national origin in consideration of an award.

5. A HUB is defined as a small business concern which is at least 51°/o owned and controlled by one or more socially and economically disadvantaged individuals, or in the case of any publicly owned business, at least 51% of the stock of which is owned by one or more socially and economically disadvantaged individuals. Socially and economically disadvantaged include Women, Black Americans, Hispanic Americans, Native Americans, Asian-Pacific Americans, and Asian-Indian Americans.

6. The Bidders shall not offer or accept gifts or anything of value nor enter into any business arrangement with any employee, official or agent of the City.

7. All contractors will be checked with HUD's federally debarred list of contractors. No award will be granted to a contractor on this list.

8. Contractors must agree to comply with these progran guidelines as well as all CDBG federal and state regulations, which are found in 24 CFR 570. In addition, 24 CFR 35 and 40 CFR 745 contain information on lead-based paint requirements with which contractors must be in compliance.

9. Change Order means a written order to a Contractor, executed by the City, in accordance with the Contract authorizing an addition to, deletion from, or adjustment or revision of the requirements of the Contract documents, or an adjustment to the compensation payable to the Contractor, or to the time for performance of the Contract and completion of the project, or a combination thereof, which does not alter the nature of project and is an integral part of the project objective. If a change order involves a decrease or an increase of $25,000 or less, the Director of Purchasing & Contract Management may approve the change order.

The following documents are required for submittal as part of this Sealed Bid:

• Comply with conflict of Interest Questionnaire chapter 176, if applicable

• Completed and signed Non-Collusion Affidavit

• Completed and signed suspension and Debarment certification

• Completed and signed Bid submission Form

• Completed and signed Bid Detailed specification

• Completed and signed vendor Acknowledgement

FAILURE TO COMPLETE AND PROVIDE ANY OF THE ABOVE MAY RESULT IN YOUR

SUBMITTAL BEING DEEMED NON-RESPONSIVE.

CITY OF LUBBOCK, TEXAS

CONTRACT INSURANCE

SECTION A. Prior to the approval of this contract by the City, the Contractor shall furnish a completed Insurance Certificate to the City, which shall be completed by an agent authorized to bind the named underwriter(s) to the coverages, limits, and termination provisions shown thereon, and which shall furnish and contain all required information referenced or indicated thereon. THE CITY SHALL HAVE NO DUTY TO PAY OR PERFORM UNDER TIIIS CONTRACT UNTIL SUCH CERTIFICATE SIIALL HAVE BEEN DELIVERED TO TIE CITY.

INSURANCE COVERAGE REQUIRED

SECTION 8. The City reserves the right to review the insurance requirements of this section during the effective period of the contract and to require adjustment of insurance coverages and their limits when deemed necessary and prudent by the City based upon changes in statutory law, court decisions, or the claims history of the industry as well as the Contractor.

SECTION C. The Contractor shall obtain and maintain in full force and effect for the duration of this contract, and any extension hereof, at Contractor's sole expense, insurance coverage written by companies approved by the State of Texas and acceptable to the City, in the following type(s) and anount(s):

TYPE OF INSURANCE

GENERAL LIABILITY

-Cormercial General Liability I Claims Made I WAleavy Equipment

EOther Occurrence o Include Products of Complete Operation Endorsements

PROFESSIONAL LIABILITY

AUTOMOTIVE LIABILITY

Ichy Auto I Scheduled Autos I Non-Owned Autos

EXCESS LIABILITY

I Umbrella Form

GARAGE LIABILITY

Echy AutoI

I BUILDER' S RISK

I INSTALLATION FLOATER

EPOLLUTION

HCARGOI

EAll Ouned Autos I Hired Autos

COMBINED SINGLE LIMIT

General Aggregate Products-Comp/Op AGG Personal & Adv. Injury Contractual Liability Fire Damage (any one fire) Med Exp. (any one person)

General Aggregate

Combined Single Limit

Each Occurrence

Each Occurrence

Auto Only - Each Accident Each Accident Aggregate I 1000/o of the Total Contract Price I 100% of the Total Material Costs

WORKERS COMPENSATION-STATUTORY AMOUNTS OR OCCUPATIONAL MEDICAL AND DISABILITY

EE ENILOYERS ' LIABILITY

OTHER: COPIES OF ENDORSEMENTS ARE REQUIRED

|/City of Lubbock named as additional insured on Auto/General Liability on a primary and non-contributory basis.

I;To include products Of completed operations endorsement.

|Waiver of subrogation in flavor of the city of Lubbock on all coverages, except

S

The City of Lubbock shall be named as an additional insured on a primary and non-contributory basis and shall include a waiver of subrogation in favor of the City on all liability coverage's except professional liability. A waiver of subrogation will be required on workers comp coverages. All Copies of the Certificates of Insurance and all applicable endorsements are required.

SECTION D. Approval, disapproval, or failure to act by the City regarding any insurance supplied by the Contractor shall not relieve the Contractor of full responsibility or liability for damages and accidents as set forth in the contract documents. Neither shall the bankruptcy, insolvency, or denial of liability by the insurance company exonerate the Contractor from liability.

INSURANCE REQUIREMENTS

I, the undersigned Bidder certify that the insurance requirements contained in this bid document have been reviewed by me and my Insurance Agent/Broker. If I an awarded this contract by the City of Lubbock, I will be able to, within ten (10) business days after being notified of such award by the City of Lubbock, furnish a valid insurance certificate to the City meeting all of the requirements defined in this bid.

If the time requirement specified above is not met, the City has the right to reject this proposal and award the contract to another contractor. If you have any questions concerning these requirements, please contact the Director of Purchasing & Contract Management for the City of Lubbock at (806) 775-2572.

ADDITIONAL POLICY ENDORSEMENTS

The City shall be entitled, upon request, and without expense, to receive copies of the policies and all endorsements thereto and may make any reasonable request for deletion, revision, or modification of particular policy terms, conditions, limitations, or exclusions (except where policy provisions are established by law or regulation binding upon either of the parties hereto or the underwhter of any of such policies). Upon such request by the City, the Contractor shall exercise reasonable efforts to accomplish such changes in policy coverages, and shall pay the cost thereof.

REQUIRED PROVISIONS

The Contractor agrees that with respect to the above required insurance, all insurance contracts and certificate(s) of insurance will contain and state, in whting, on the certificate or its attachment, the following required provisions :

a. Name the City of Lubbock and its officers, employees, and elected representatives as additional insureds, (as the interest of each insured may appear) as to all applicable coverage;

b. Provide for 30 days notice to the City for cancellation, nonrenewal, or material change;

c. Provide for notice to the City at the address shown below by registered mail;

d. The Contractor agrees to waive subrogation against the City of Lubbock, its officers, employees, and elected representatives for injuries, including death, property damage, or any other loss to the extent same may be covered by the proceeds of insurance;

e. Provide that all provisions of this contract concerning liability, duty, and standard of care together with the indemnification provision, shall be underwitten by contractual liability coverage sufficient to include such obligations within applicable policies.

NOTICES

The Contractor shall notify the City in the event of any change in coverage and shall give such notices not less than 30 days prior the change, which notice must be accompanied by a replacement Certificate of Insurance.

All notices shall be given to the City at the following address:

Marta Alvarez, Director of Purchasing and Contract Management City of Lubbock 13 14 Ave K, 9th Floor Lubbock, Texas 79401

TEXAS GOVERNMENT CODF SECTION 2252.152

The undersigned representative of the undersigned company or business, being an adult over the age of eighteen (18) years of age, pursuant to Texas Government Code, Chapter 2252, Section 2252.152, certify that the company named above is not listed on the website of the Comptroller of the State of Texas concerning the listing of companies that are identified under Section 806.051, Section 807.051 or Section

2253.153. I fiuther certify that should the above-named company enter into a contract that is on said listing of companies on the website of the Comptroller of the State of Texas, which do business with Iran, Sudan or any Foreign Terrorist Organization, I will irrmediately notify the City of Lubbock Purchasing and Contract Department.

TEXAS GOVHRNMENT CODE SECTION 2271.002

Company hereby certifies the following:

1. Company does not boycott Israel; and

2. Company will not boycott Israel during the term of the contract.

The following definitions apply to this state statute:

(1 ) "Boycott Israel" means refusing to deal with, terminating business activities with, or otherwise taking any action that is intended to penalize, inflict economic harm on, or limit commercial relations specifically with Israel, or with a person or entity doing business in Israel or in an Israeli-controlled territory, but does not include an action made for ordinary business purposes; and

(2) "Company" means an organization, association, corporation, partnership, joint venture, limited partnership, limited liability partnership, or limited liability company, including a wholly owned subsidiary, majority-owned subsidiary, parent company, or affiliate of those entities or business associations that exists to make a profit.

This Certification is required from a Company if the Company has 10 or more full-time employees and the contract for goods or services (which includes contracts formed through purchase orders) has a value of $100,000 or more that is to be paid wholly or partly from public funds of the governmental entity.

TEXAS GOVERNMENT CODE 2274

By entering into this Agreement, Contractor verifies that:

(1) it does not, and will not for the duration of the contract, have a practice, policy, guidance, or directive that discriminates against a firearm entity or firearm trade association or

(2) the verification required by Section 2274.002 of the Texas Government Code does not apply to the contract.

If Contractor is a company with 10 or more full-time employees and if this Agreement has a value of at least $ 100,000 or more, Contractor verifies that, pursuant to Texas Government Code Chapter 2274, it does not have a practice, policy, guidance, or directive that discriminates against a firearm entity or firearm trade association; and will not discriminate during the term of the contract against a firearm entity or firearm trade association.

Contractor represents and warrants that:

(1) it does not, and will not for the duration of the contract, boycott energy companies or

(2) the verification required by Section 2274.002 of the Texas Government Code does not apply to the contract.

If Contractor is a company with 10 or more full-time employees and if this Agreement has a value of at least $ 100,000 or more, Contractor verifies that, pursuant to Texas Government Code Chapter 2274, it does not boycott energy companies; and will not boycott energy companies during the term of the Agreement.

This verification is not required for an agreement where a governmental entity determines that these requirements are inconsistent with the governmental entity' s constitutional or statutory duties related to the issunnce, incurrence, or management of debt obligations or the deposit, custody, management, borrowing, or investment of funds.

CONFLICT OF INTEREST QUESTIONNAIRE CHAPTER 176

FOR VENDOR DOING BUSINESS WITH LOCAL GOVERNMENTAL ENTITY

This questiomaire reflects changes made to law by H.B. 23, 84th Leg., Regular Session

Businesses and individuals doing business with the City need to file conflict of interest questiomaires with the Office of the City Secretary's Office. Local government officers are also required to file when a conflict exists.

The questiomaire is to be filed in accordance with Chapter 176, Local Government Code, by a vendor who has a business relationship as defined by Section 176.001 (1 -a) with a local goverrmental entity and the vendor meets the requirements under Section 176.006(a).

By law this questiomaire must be filed with the City Secretary' s Office of the local governmental entity no later than the 7th business day after the date the vendor becomes aware of the facts that require the statement to be filled.

Chapter 176 of the Local Goverrment Code requires the City Manager and Council Members to file a Conflicts Disclosure Statement regarding their relationships with City vendors (including bidders and potential vendors).

The law also requires that any vendor who contracts, or seeks to contract, with the City for the sale or purchase of property, goods or services (including a bidder on a City contract) file a "Conflict of Interest Questiormaire" regarding the vendor's business relationships, if any, with Council Members or the City Manager.

Compliance is the responsibility of each individual, business or agent who is subject to the law's filing requirement. Questions about compliance should be directed to your legal counsel.

Questiormaire is available at http ://www. ci.1ubbock.tx.us/departments/purchasing/vendor-information

CITY 0F LUBB0CK, TX LIST 0F MUNICIPAL OFFICIALS

FOR CONFLICT 0F INTEREST DISCLOSURE

(Required by Local Government code Section 176)

NAME

Mark MCBrayer

Christy Martinez-Garcia

Gordon Harris

David Glasheen

Brayden Rose

Dr. Jennifer Wilson

Tim Collins

W. JaITett Atkinson

POSITION

Mayor

Council Member, District 1

Council Member, District 2

Council Member, District 3

Council Member, District 4

Council Member, District 5

Council Member, District 6

City Manager

NON-COLLUSION AFFIDAVIT

STATE OF TEXAS

LUBBOCK COUNTY

being first duly sworn, on histher oath, says that the bid above submitted is a genuine and not a sham or collusive bid, or made in the interest or on behalf of any person not therein named; and shethe further says that the said bidder has not directly induced or solicited any bidder on the above work or supplies to put in a sham bid, or any other person or coaporation to refrain from bidding; and that said bidder has not in any manner sought by collusion to secure to self an advantage over any other bidder orbidders.

Name of Fim

Signature of Bidder

SUSPENSION and DEBARMENT CERTIFICATION

Federal Law (A-102 Common Rule and OMB Circular A-110) prohibits non-Federal entities from contractingwithormakingsub-awardsundercoveredtransactionstopartiesthataresuspendedordebarredor whose principals are suspended or debarred. Covered transactions include procurement contracts for goods or services equal to or in excess of $25,000 and all non-procurement transactions (e.g., sub-awards to sub-recipients).

Contractors receiving individual awards of $25,000 or more and all sub-recipients must certify that their organization and its principals are not suspended or debarred by a Federal agency.

Before an award of $25,000 or more can be made to your firm, you must certify that your organization and its principals are not suspended or debarred by a Federal agency.

I, the undersigned agent for the firln naned below, certify that neither this firm nor its principals are suspended or debarred by a Federal agency.

Company Nane :

DUNS Number:

Federal Tax ID or Social Security Number:

Signature of Company Official :

Printed Nanie of Company Official:

Date:

BID SUBMISSION FORM

Lead Based Paint Inspection and Risk Assessment

ITB No. 2026-036GD

In compliance with the Invitation to Bid, the undersigned Bidder having exanined the Invitation to Bid, instructions to bidders, General Conditions of the Agreement, Bid Detailed Specifications, and being familiar with the conditions to be met, hereby submits the following bid for furnishing the material, equipment, labor and everything necessary for providing the items listed and agrees to deliver said items at the locations and for the prices set forth on the bid form and/or the bid table associated with this bid.

A bid will be subject to being considered irregular and may be rejected if it shows omissions, alterations of form, conditional alternate bids, additions or alternates in lieu of the items specified, if the unit prices are obviously unbalanced (either in excess of or below reasonably expected values), or irregularities of any kind. The Invitation to Bid is by reference incorporated in this contract. Bid Detailed Specification should be tabulated, totaled and checked for accuracy. Unit price will prevail in case of errors. Alterations or modifications to the bid forin will not be accepted. Person making the correction must initial any corrections. Late submittals will not be accepted.

Unless otherwise specified herein, the City may award the bid either item-by-item or on an all-or-none basis for any item or group of items shown on the bid.

The City is seeking a contract for with one or more contractors. In order to assure adequate coverage, the City may make multiple awards, selecting multiple vendors to provide the products desired, if multiple awards are in the best interest of the City. A decision to make a multiple award of this bid, however, is an option reserved by the City, based on the needs of the City.

MOST FAVORED PRICING: The Bidder certifies that the price quoted is not in excess of the lowest price charged anyone else, including its most favored customer, for like quality and quantity of the products/services; does not include an element of profit on the sale in excess of that normally obtained by the Bidder on the sale of products/services of like quality and quantity; and does not include any provision for discounts to selling agents. If at any time during the contract period, the supplier should sell or offer for sale to any other customer, an equal or less quantity of similar contract products of like or better quality, at a lower net price(s) than provided herein, supplier agrees to notify the City and sell sane product(s) at the lower price(s) on all deliveries made during the period in which such lower price(s) is effective.

LUMP SUM TABLE

BID DESCRIPTION LUMP SUM

GENERAL ITEMS

The bidder proposal to furnish all materials

S and accomplish all work described herein in accordance with all provisions of the rehabilitation.

Bidder hereby agrees to commence the work on the above project on a date to be specified in a written "Notice to proceed" and complete the project within calendar days, not to exceed 4 weeks from the date of "Notice to Proceed".

Authorized Signature :

Printed Name and Title:

E-mail Address : Contact Number:

VENDOR ACKNolhrLEDGEMENT

In compliance with this solicitation, the undersigned bidder, having examined the bid documents, instructions to bidders, documents associated with the invitation to bid, and being familiar with the conditions to be met has reviewed the above information regarding:

• Required documents for submittal

• General conditions

• Insurance Requirements

• Texas Government code section 2252.152

• Texas Government code section 2271.002

• Texas Government code 2274

• Conflict of Interest Questionnaire

• Non-Collusion Affidavit

• Suspension and Debarment certification

• Bid submission Form

• Bid Detailed specification

Authorized Signature :

Printed Name and Title:

E-mail Address :

Date:

Contact Number:

LEAD BASED PAINT INSPECTION and RISK ASSESSMENT Address: 5430 35th st

City, State Zip: Lubbock, TX 79407

Homeowner: Erma Bentancourt

Phone#: (806)3324095

The undersigned hereinafter referred to as the "Contractor'' hereby declares and acknowledges that the only person or parties interested in this PROPOSAL / BID as principals are those named herein.

The Contractor acknowledges that he has received and carefully examined the "Work Write-up", herein titled Bid Detailed Specification Form.

The Contractor proposes to furnish all materials and accomplish all work described herein in accordance with all provisions of the rehabilitation for the sum of:

and further agrees to commence the work on the above project on a date to be specified in a written "Notice to Proceed" and complete the LEAD BASED PAINT INSPECTION and RISK ASSESSMENT

REPORT within calendar days, and refumed no later than 4 weeks from the date of the "Notice to Proceed".

The Cfty is exempt from Federal Excise, State Sales and Transportation taxes.

Tiex MusT NOT BE INCLUDED iN BID.

Tax exemption certificates will be executed by the Purohasing Director upon request.

Contractor Printed Name

Contractor Add ress

Contractor Signature

Contractor Phone #

LEAD BASED PAINT INSPECTION and R[SK ASSESSMENT ALL LEAD BASED PAINT INSPECTION and RISK ASSESSMENT TO BE CONDUCTED ACCORDING T0 THE

PROTOCOLS AS ISSUED BY THE TEXAS DEPARTMENT OF HEALTH -TEXAS ENVIRONMENTAL LEAD

REGULATION, and ALL OTHER REQUIREMENTS THAT ARE SET FORTH BY ANY OTHER FEDERAL and/or

STATE AGENCIES.

ALL WORK TO BE CONDUCTED BY STATE CERTIFIED FIRMS. INSPECTORS. and RISK ASSESSORS ONLY.

CERTIFICATION:

THE ATTACHED BID HAS BEEN REVIEWED and FOUND TO BE COMPLETE and COST REASONABLE.

Commetits.. ANY ADDITIONAL WORK ITEMS REQUESTED OUTSIDE OF THESE REQUIREIVIENTS WILL NOT BE COMPENSATED BY THE DEPARTMENT WITHOUT PRloR WRITTEN

APPROVAL.

Date out TO Bid / Issued: Februarv 27. 2026

Inspectors to contact in reference to this bid:

Bid written by: Grea Daniel 775-2291

INSPECTORS. CERTIFICATION OF BID ACCEPTANCE:

Date Built: 1964

Homeowner: Erma Bentahcourt Address: 5430 35th St

Lubbock. TX 79407

Phone #: /8061 3324095

BID DETAILED SPECIFICATION FORM

!!! CONTRACTOR IS TO VERIFY ALL QUANTITIES and MEASUREMENTS !!!

WORK - ITEMS

A. HOUSE and STORAGE SHEDS

NOTE: BEGIN LEAD BASED PAINT INSPECTION and RISK ASSESSMENT AT THE NORTHWEST CORNER OF THE HOUSE ON THE EXTERIOR and ON THE INTERIOR. PROCEED CLOCKWISE.

a.1 DRAWING and LAYOUT: INCLUDE ALL MEASUREMENTS OF ALL THE HOUSE and EACH ROOM Provide a drawing and layout of the house, showing each room with measurements/dimensions, labeling each. Provide a diagram of DUST sampling and SOIL sampling collection locations.

a.2 WINDOwsand DOORS On the drawing and layout provide the location of each and the size of each with measurements/dimensions.

a.3 INTERIOR: DUST WIPE SAMPLING *"MUST USE A NLLAP ACCREDITED LABORATORYH* Collect a 1-square foot sampling from the floor in each room. Collect dust wipe sampling from each window sill in each room. (and trough, if applicable)

EXTERIOR: SOIL SAMPLING

Collect a soil sample from each side of the house, IF BARE SOIL EXIST and from any play area. (follow protocol collection process) a.4 PROVIDE A "SUIVIIVIARY NOTICE OF LEAD BASED PAINT INSPECTION and RISK ASSESSMENT" a.5 PROVIDE ALL RESULTS FROM XRF and LAB RESULTS. INCLUDE PERFORMANCE

CHARACTERISTICS SHEETS (P.C.S.) FOR XRF DEVICE.

a.6 DELIVER A PAPER COPY OF THE INSPECTloN and RISK ASSESSIVIENT TO THE HOMEOWNER and HAVE THE HOMEOWNER SIGN THE ''NOTICE OF EVALUATION" FORM. THIS FORIvl ls TO BE

INCLUDED WITH THE REPORT.

a.7 ONCE THE REPORT IS COIVIPLETE. PROVIDE 1 (ONE) PRINTED COPY TO THE HOMEOWNER. SEND

AN EMAIL TO THE COMMUNITY DEVELOPIVIENT DEPARTMENT OF THE CITY OF LUBBOCK

ASSIGNED INSPECTOR A PDF COPY OF THE ENTIRE REPORT INCLUDING THE HOMEOWNER

SIGNED "NOTICE OF EVALUATION" FORM.

TOTAL BID:

LEAD BASED PAINT

DEPARTMENT RISK ASSESSMENT PROTOCOL

INSPECTION and RISK ASSESSMENT

For each structure (house, storage building, garage, and carports).

ONLY PAINTED COVERED SuRFACES ARE TO BE TESTED!

NORTH is ALWAYS (SIDE-A) EAST is ALWAYS (SIDE-B) SOUTH is ALWAYS (SIDE€) WEST is ALWAYS (SIDE-D)

ALWAYS BEGIN AT THE NORTHWEST CORNER OF THE STRUCTURE,

WORKING CLOCKWISE. THIS IS ALSO TRUE FOR EACH INTERIOR

ROOM OF THE STRUCTURE.

EXTERIOR: Includes all of the house, storage sheds (if being addressed through rehab.) garage, and/or carports.

Begin at the NORTHWEST CORNER of the structure where the RISK ASSESSMENT is to be conducted. Begin XRF testing WALL -lsIDE-A} (NORTH): NOTE: If different materials and/or paint history is determined, then each color and/or materials are to be tested.

TEST ALSO:

WINDOW: Window trim, Window sill, window frame (if painted).

BQQB: Exterior door, door trim, and door jamb.

FASCIA. SOFFIT. RAFTER TAILS: Fascia trim, sofflt (if present) and rafter tails (if expesed and painted).

PORCHES: Ceiling, trim, posts, beams and railings.

Continue testing EACH SIDE working clockwise. Next, SIDE-8 IEAST}, then, SIDE€ lsouTHl and SIDE-D (WESTl. (AIl that is listed above apply, if present).

* continued on the next page *

INTERIOR: Includes all bedrooms, bedroom closets, halls, hall closets, kitchen, living areas, bathrooms, utility room and garages.

Begin at the NORTHWEST room of the house. Begin XRF testing WALL -lsIDE-Al lNORTHl: Test each wall, basebeard trim, window (if present), window trim, window frame, entry door, closet dcor, door trim, shelving and ceiling.

Continue testing EACH SIDE working clockwise. Next, SIDE-8 (EASTl, then, SIDE{ (SOUTHl and SIDE-D (WESTl. (AIl that is listed above apply, if present).

WIPE SAMPLE COLLECTION

LEAD DUST WIPE SAMPLE COLLECTION:

Sample collection must be conducted according to the HUD and TELRR sample collection protocols.

Take 1-sample from the floor, interior window sill and trough (if present) for

EACH INTERIOR ROOM.

(Bedrooms, bathrooms, living rooms, halls, kitchen, and utility rooms).

NOTE: Include a map layout of the structure, with a # signifying the sample collection number where the sample was taken.

BARE SOIL SAMPLE COLLECTION

BARE SOIL SAMPLE COLLECTloN:

1-Usually on the exterior bare soil drip line near the structure on each side (SIDEA; NORTH), (SIDE-B; EAST), (SIDE€; SOUTH), (SIDE-D;

WEST). COMPOSITE SAMPLING 13rindividual test locations for 1-samDle).

2-PLAY AREA: Sample collection to be taken according to the HUD and TELRR sample collection protocols.

NOTICE 0F EVALUATION

Lead Based Paint Inspection and Risk Assessment have received a Notice of Evaluation in the form of a Lead Based Paint Inspection and Risk

Assessment report.

Received this

Signature:

Print Name:

Address:

(Street) ( C ity) ( State) (Z ip)