Exhibit C Lead-Based Paint Certification and Checklist.docx
DOCX document 2 MB Posted
- Attached to
- AZ|CTR079165
- Contract number
- CTR079165
- Issued by
- Arizona
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Summary
This document is an Exhibit C certification and checklist issued by the Arizona Department of Economic Security (DES) regarding compliance with federal lead-based paint regulations under Title X and the Lead Safe Housing Rule. The certification applies to DES-funded projects, including emergency shelters and security deposit assistance programs, and requires project owners to confirm adherence to 24 CFR Part 35 and Arizona Revised Statutes Section 36-1673.
The document establishes three certification pathways for project owners: (1) certification that the property is free of lead-based paint and hazards based on inspection by a certified inspector; (2) completion of risk assessments for projects receiving over $5,000 in average annual DES assistance per unit or visual assessments for projects receiving less assistance, in compliance with 24 CFR Parts 5 and 35; or (3) certification that all identified lead-based paint hazards have been or will be corrected per federal and state codes. The certification exempts zero-bedroom dwellings and emergency shelters receiving assistance for 100 days or fewer, though DES recommends lead-safe policies for child-occupied spaces. Project owners must complete Attachment 1, a detailed self-certification form documenting evaluation methods, findings, identification of children under six years old, hazard reduction timelines, clearance examination results, and supporting documentation for all lead-based paint activities.
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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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