Exhibit C Lead-Based Paint Certification and Checklist.docx
DOCX document 2 MB Posted
- Attached to
- AZ|CTR079167
- Contract number
- CTR079167
- Issued by
- Arizona
About this file
This document is a Lead-Based Paint Certification and Checklist form issued by the Arizona Department of Economic Security (DES). It serves as a compliance certification tool for project owners receiving DES funding to ensure adherence to federal lead-based paint regulations under 24 CFR Part 35 and Arizona Revised Statutes 36-1673. The form provides guidance on lead-based paint requirements specific to emergency shelters and security deposit assistance programs funded by DES, distinguishing between zero-bedroom dwellings (which are generally exempt) and units with one or more bedrooms that may be subject to lead-safe housing standards.
The certification requires project owners to document their compliance status through three primary pathways: confirmation that the property is free of lead-based paint hazards, completion of risk assessments (for projects averaging over $5,000 per unit annually) or visual assessments (for projects receiving less assistance), and verification that all identified lead-based paint hazards have been corrected in accordance with federal and state codes. The accompanying Attachment 1 requires detailed self-certification information including the project number, year built, DES assistance amounts, presence of children under six years of age, results of inspections or risk assessments, identification of contractors performing hazard reduction activities, clearance examination results, and documentation of all lead-based paint compliance activities. No pricing, contract amounts, or renewal terms are specified in this document, as it functions as a regulatory compliance checklist rather than a procurement or service agreement.
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Exhibit C Arizona Department of Economic Security
Lead-Based Paint Certification and Checklist
EMERGENCY SHELTERS: If DES funds are being used to operate an emergency shelter, is the shelter subject to the lead-based paint regulation?
The answer to this question depends on the shelter's configuration. Most emergency shelters are exempt, because they fall under the definition of zero-bedroom dwellings, which are exempt under the Title X statute. If the shelter does not qualify for the zero-bedroom exemption, it is covered by regulation.
A zero-bedroom dwelling is defined in section 35.110 as "any residential dwelling in which the living areas are not separated from the sleeping area. The term includes efficiencies, studio apartments, dormitory or single room occupancy housing, military barracks, and rentals of individual rooms in residential dwellings.” The term “single room occupancy housing” is defined as “housing consisting of zero-bedroom dwelling units that may contain food preparation or sanitary facilities or both.” Group homes are exempt if they consist of “rentals of individual rooms in residential dwellings.”
If you provide funds for a shelter with units having one or more bedrooms, and that receive assistance for more than 100 days, it is required that you adopt and implement a policy that assures that the child-occupied spaces will be lead safe. If you provide funds for a shelter with zero-bedroom units, or a shelter receiving assistance for up to, but not more than, 100 days, the units are exempt from the regulation, but DES recommends that you adopt and implement a policy that assures that the child-occupied spaces will be lead safe, when the units are occupied by children of less than 6 years of age.
SECURITY DEPOSIT ASSISTANCE: If DES funds are used to provide security deposits to homeless persons to assist them in obtaining housing, what lead-based paint requirements apply to the unit?
The requirements of 24 CFR Part 35 Subpart K and A.R.S. §36-1673 apply to this unit. (If the activity involves the placement of a person in a unit that will be used for housing purposes for more than 100 days, the exemption for emergency rental assistance does not apply.)
PROJECT OWNER'S CERTIFICATION THAT THE PROJECT IS IN COMPLIANCE
WITH THE LEAD SAFE HOUSING RULE
[Name of Project Owner]:
(the “Project Owner”), the Owner of [Project Name:]
[City:]
[State:]
[Project Number:]
(the “Project”), by and through its duly authorized representative (the "Signer”) identified below hereby certifies that: (check boxes that apply)
| ☐ |
| 1. A certified lead-based paint inspector has determined that this property is free of lead-based paint and/or lead-based paint hazards, as defined in 24 CFR Part 35 and A.R.S. §36-1673. If the property has been determined to be free of lead-based paint and/or lead-based paint hazards, no further action is required under HUD and A.R.S. regulations, but local regulation may still apply. You may skip number 2 and 3, but sign and indicate who conducted the inspection and date of performance on Attachment 1. |
| ☐ |
| 2. A risk assessment (where the project receives assistance averaging over $5,000 per unit per year) or a visual assessment (where the project receives less assistance) was performed in compliance with contracts and the Physical Condition Standards, and Inspection requirements of 24 C.F.R Part 5, Subpart G, and 24 C.F.R. Part 35, Subpart H, as identified in Attachment 1, and A.R.S. §36-1675. The project includes the subsidized units, common areas, buildings, grounds, and systems. |
| ☐ |
| 3. All identified lead-based paint hazards at the Project have been, or will be, corrected in compliance within all Federal, State and local codes including the requirements at 24 C.F.R. Part 35, Subpart H, as identified in Attachment 1, and A.R.S. §36-1673 |
This certification is made by the Project Owner and is signed by a duly authorized representative of the Project Owner, who is authorized by reason of his/her position as the [State Fully Relationship Between the Signer of Certification and the Project Owner:]
All of the foregoing statements, including the completed Attachment 1 as well as the date, signature and identifying information of the Signer and the Project Owner that follows, are HEREBY CERTIFIED as true and accurate this day of
Project Owner:
By Signature:
Print Name:
Title:
Please complete ATTACHMENT 1
ATTACHMENT 1
DETAILED PROJECT OWNER’S SELF-CERTIFICATION
FOR LEAD-BASED PAINT HAZARDS
IN PROJECT-BASED RENTAL ASSISTANCE UNITS
Project Number:
Year Built:
| Is the average annual DES assistance per unit over $5,000?........................................... |
| Yes☐ |
| No☐ |
| Are there children under 6 years of age living in any of the units?............................................ |
| Yes☐ |
| No☐ |
| Have you been informed of any cases of children residing at the project who have elevated blood lead levels?............................................................................................ |
| Yes☐ |
| No☐ |
| Has a visual assessment been performed? (up to $5,000 per unit only)................................... |
| Yes☐ |
| No☐ |
Which of the following evaluations has been done?
| Lead-based paint inspection…………………………………………………………………. |
| Yes☐ |
| No☐ |
| Risk Assessment (required if over $5,000 per unit)....................................................... |
| Yes☐ |
| No☐ |
| Was any lead-based paint found?.............................................................................................. |
| Yes☐ |
| No☐ |
| Were any lead-based paint hazards found?............................................................................... |
| Yes☐ |
| No☐ |
Who conducted the visual assessment or evaluation and when?
| If up to $5,000 per unit, when will paint stabilization be done? |
| __/__/__ |
OR
If over $5,000 per unit, when will all identified lead-based hazards
| where children under 6 years of age reside be controlled; and |
| __/__/__ |
| when will all other identified lead-based hazards be controlled? |
| __/__/__ |
Who has performed or will perform the above-mentioned hazard reduction activities?
| Have you had clearance examinations performed?................................................................... |
| Yes☐ |
| No☐ |
| Did the examination pass?......................................................................................................... |
| Yes☐ |
| No☐ |
Who did the clearance examinations?
| Do you have documentation for all lead-based paint activities above (reports, invoices, etc.)? |
| Yes☐ |
| No☐ |
Completed By:
| Name |
| Signature |
| Date |
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