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RFP - 2012-16 - Barr and Clark, Inc.BARR & CLARK Independent Environmental Testing ASBESTOS• LEAD• PHASE Proposalfor Lead -Based Paint & Asbestos Testing Consulting Services (RFP # 2012 -16) Prepared For: City of Rosemead City Clerk's Office Attn: Gloria Molleda, City Clerk 8838 E. Valley Boulevard Rosemead, CA 91770 Proposing Firm: Barr & Clark, Inc. 12684 Hoover Street Garden Grove, CA 92841 Phone: (714) 894 -5700 Fax. (714) 894 -5702 Contact Person: Matt Crochet November 26, 2012 12684 Hoover Street • Garden Grove, California 92841 • (714) 894 -5700 • Fax (714) 894 -5702 Environmental Consulting Services — 11126112 Proposal for Services — City of Rosemead Page 2 of 14 Table of Contents Cover Page Statement of Qualifications Statement of Training Certifications of Principals and %y Personnel Copies of Valid California Lead & Asbestos Inspector Certifications References Insurance Coverage Statement of Understanding the Scope of Work Standard Operating Procedures Statement of Litigation/Settlement Request Form Standard Fee Structure Schedule of Standard Hourly Rates Additional Information Insurance Binder Sample of LBP Inspection/Risk Assessment Report Sample ofACHInspection Report Environmental Inspection Request Form Page 3 4 S 6 8 10 11 11 12 12 13 14 APPENDIX A APPENDIX B APPENDIX C APPENDIX,D t 12684 Hoover Street • Garden Grove, California 92841 • (714) 894 -5700 • Fax (714) 894 -5702 Environmental Consulting Services — I M6 Proposal for Services -City of Rosemead Page 3 of 14 1. Cover Page City of Rosemead 8838 E. Valley Boulevard Rosemead, CA 91770 f l Re: Lead Based Paint (LBP) and Asbestos (ACM) Testing Consulting Services (RFP Number 2012 -16) Dear Sir/Madam: As the impact of the recent changes to the HUD requirements are becoming apparent to municipalities and community based organizations all across the country, we have carefully studied the relevant sections of 24 CFR, section 35 (Title X) and California DHS' Title 17 in regards to lead based paint inspections to better serve our clients. Additionally, we are very familiar with all applicable asbestos related rules and regulations (local, state, and federal) including EPA, ARP, HUD, DHS, NESHAP, CAL -OSHA, South CoastAQMD, Clear Air Act, TSCA, and OSHA. It is important to be in compliance with the regulations and to reduce complications to an already burdened project. Our knowledge and experience can help to minimize the impact of lead and asbestos - related considerations affecting your programs. Ban & Clark is pleased to bid on your ongoing Lead - Based Paint (LBP) and Asbestos (ACM) consulting work. Ban & Clark is proud of our past accomplishments and we are confident that we can continue to provide the City of Rosemead with timely and cost efficient services. The list of inspectors authorized to conduct the surveys and their certifications may be found on page 5. The following Ban & Clark principal is authorized to make all representations for this proposal: November 26, 2012 Matt Crochet — Presiden Barr & Clark, Inc 12684 Hoover Street Garden Grove, CA 92841 Phone: (714) 894 -5700 Cell: (310) 760 -2112 Fax: (714) 894-5702 Email: matt(a�barrandclark.com 12684 Hoover Street • Garden Grove, California 92841 • (714) 894 -5700 • Fax (714) 894 -5702 Environmental Consulting Services —1 M6 Proposal for Services — City of Rosemead Page 4 of 14 2. Statement of Oualifications Barr & Clark Environmental is a Southern California firm that was founded in 1992 on one basic premise: provide quality environmental consulting services at a fair and reasonable price. Today's property owners and managers are impacted with an ever - increasing number of environmental regulatory requirements in the day -to -day management of their assets. Barr & Clark offers affordable and practical alternatives to comply with these regulations and requirements. Barr & Clark is recognized by its peers as a leader in performing Lead -Based Paint Inspections, Asbestos Containing Materials Surveys, and Phase I Reports. If your project requires an abatement specification, project design, monitoring, clearance testing, or overall project management, our qualified staff is prepared to meet any of your environmental needs. Clients from over 45,000 projects have included airport facilities, military bases, financial institutions, health departments, housing authorities, correctional facilities, manufacturing plants, renovation/abatement contractors, large apartment complexes, property management companies, and private homeowners. Ban & Clark offers its clients comprehensive and integrated environmental consulting services. Ban & Clark specializes in providing these services in an integrated manner when construction or other events are in progress. It is recognized that the environmental project is often just one of many priorities for the building owner. Whether the other priorities are construction, a loan, or government - assisted funding, the environmental project will always be catered to meet the needs of the client. Over the past twenty years, Barr & Clark has gained extensive experience in working with numerous governmental agencies and their respective regulations. These agencies include (but are not limited to) CAL/OSHA (ROSH), EPA, CAL/EPA, HUD, DTSC, NESHAP, TSCA, OSHA, SCAQMD, and DRS. These regulatory agencies each have their own perspective, priorities, and requirements (in some cases, several agencies' requirements may be in conflict with each other). Every environmentally impacted project will involve at least one or more of these agencies. Ban & Clark is known by the key personnel in these agencies and has maintained a positive relationship based on past experiences and mutual cooperation. Knowing the regulations and the regulators can avoid unanticipated delays and expenses on a project. Ban & Clark's consulting services are designed to facilitate decision - making. Our client's time factors, budget constraints, and overall plan for the property will be considered. Ban & Clark is proud of its "on time and no surprises" completion of projects. Strict quality control procedures and responsive customer service have earned the devotion of a broad base of clients. When the need for environmental testing or consulting arises, property owners know that Barr & Clark will provide them with a quality, integrated, and cost effective strategy. Ban & Clark utilizes state -of -the- art- practices, equipment, and techniques in accordance with all regulatory standards while performing Lead -Based Paint (LBP) and Asbestos (ACM) inspections. For LBP Inspections, the method employed is X -ray fluorescence (XRF) using a Radiation Monitoring Device Lead Paint Analyzer (RMD LPA -1). It is a non - destructive, non - evasive means of testing. Soil and dust samples collected are analyzed for lead content by an approved laboratory which is accredited 12684 Hoover Street • Garden Grove, California 92841 • (714) 894 -5700 • Fax (714) 894 -5702 Environmental Consulting Services — IM6112 Proposal for Services — City of Rosemead Page 5 of 14 by the American Industrial Association (AIHA), the National Institute for Standards and Technology ( NVLAP) and the California Department of Health Services (ELAP). Barr & Clark's ACMlnspections are conducted by fully qualified technicians to perform all tasks described in the scope of work in accordance with Federal, State, and Local regulations. The collected suspect building materials are analyzed by using Polarized Light Microscopy to determine the presence, type, and percentage of asbestos containing material in a NVLAP accredited laboratory facility. I Statement of Training Certifications of Principals and Key Personnel Matthew Crochet — President/CEO & Project Manager, Lead Operations Twenty years experience in lead -based paint field inspections, project designs, operations and maintenance plans, and clearance testing. Range of properties dealt with include single family residences, multi- family dwellings (apartments), commercial, industrial, and government owned facilities (military bases, post offices, prisons). Mr. Crochet is a member of the National Lead Abatement Council and the California Association of Certified Lead Professionals (Board Member). Certifications include: State of California Certified Lead Inspector/Risk Assessor (112) — I in California! State of California Certfed Lead Abatement Project Monitor (M 12) —12` in California! Keith Piner — Senior Project Director, Lead & Asbestos Operations Twelve years experience in lead and asbestos- related consulting, field inspections, and project monitoring for single family residences, apartment complexes, commercial structures, industrial sites, and school facilities. Certifications include: State of California Certified Lead Inspector/Risk Assessor (114441) DOSH Certified Asbestos Consultant (CAC #01 -4021) Robert Pitzer — Project Director, Lead & Asbestos Operations Ten years experience in lead and asbestos- related consulting, field inspections, and project monitoring for single family residences, apartment complexes, commercial structures, industrial sites, and school facilities. Certifications include: State of California Cerdf:ed Lead Inspector/Risk Assessor (116091) DOSH Certified Asbestos Site Surveillance Technician (SST# 07 -4235) Dave Wallach — Project Director, Asbestos Operations Eighteen years experience in asbestos - related consulting, field inspections, and project monitoring for single family residences, apartment complexes, commercial structures, industrial sites, and school facilities. Also Phase I and II Environmental Site Assessments, mold testing, and indoor air quality testing. Certifications include: DOSH Certified Asbestos Consultant (CAC# 01 -3008) State of California Certified Lead Supervisor (S 48 71) California Registered Environmental Assessor ( #03759) 12684 Hoover Street • Garden Grove, California 92841 • (714) 894 -5700 • Fax (714) 894 -5702 Environmental Consulting Services — 11126112 Proposal for Services — City of Rosemead Page 6 of 14 Diane Dahlen — Office Manager, Lead Sampling Technician Eleven years experience in lead and asbestos - related consulting for single family residences, apartment complexes, commercial structures, industrial sites and school facilities. Responsible for project scheduling, data entry, accounts receivable, marketing, customer service, and general administrative duties. Certifications include: State of California Certified Lead Sampling Technician (20036) 4. Copies of Valid California Lead & Asbestos Inspector Certifications Matthew Crochet - President & Project Manager, Lead Operations State of California Department of Public Health Lead - Related Certificate Expiration Construction Type Date Certificate Inspector /Assessor 06/13/2013 Keith Piner — Senior Project Director, Lead & Asbestos Operations State of California Department of Public Health Lead - Related Certifica Expiration Construction Type Date Certificate Inppector /Assessor 05/0612013 State of California Division of Occupational Safety and Health Certified Asbestos Consultant Keith A Piner Name Certification No. 01 -4021 Expires on 11116113 This cotrealion was esued by the Division of 0mupa6snal Wear and Handle as aulhonned by It Sections 7160 at seq of the Businasss and Professions Code. -I 12684 Hoover Street • Garden Grove, California 92841 • (714) 894 -5700 • Fax (714) 894 -5702 Environmental Consulting Services — 11126172 Proposal for Services — City of Rosemead Page 7 of 14 Robert Pitzer — Project Director, Lead & Asbestos Operations State of California Department of Public Health Lead - Related Certificate Expiration State of California Construction Type Date Division of Occupational Safety and Health Certificate 1 Inspector /Assessor 1012812013 Certified Site Surveillance Technician �' Robert P Pfizer N..e Certification No. 074235 Expires on 07119113 This asMheahan Nas Mood by the Nam of Ouupdonal Safety and Haah as Whoneed by f l Fl +1 C ? 1 s n s r r a c - No f e sns 's C dl seq al the Business aM aL.aho� o.ax.._ '..::' a�hn� Rolessionsode. Dave Wallach Project Director, Asbestos Operations Diane Dahlen — Office Manager, Lead Sampling Technician State of California Department of Public Health Lead - Related Certificate Expiration Construction Type Date Certificate T piing Technician 01/23/2013 imam 04 I04 20036 12684 Hoover Street • Garden Grove, California 92841 • (714) 894 -5700 • Fax (714) 894 -5702 Environmental Consulting Services — 11/26 Proposal for Services — City of Rosemead Page 8 of 14 5. References Community Development Commission of the County of Los Angeles — Block Grant Division • Type of Projects: Lead Inspections, Asbestos Inspections, Design of Abatement Specifications, Risk Assessments, and Clearance Testing for single family residences, mutli - family, and commercial structures. • Project Name/Location: Thousands of projects throughout the greater Los Angeles area. • Contact: Bill Pro Housing Rehabilitation Loan Programs (323) 890 -7240 bnroL&Iacde.org • Address: 2 Coral Circle, Monterey Park, CA 91755 • Date started/completed: Have completed thousands of projects from 1998 to present. Currently under contract for lead and asbestos consulting services. • Name of Regulatory Oversight Agencies: HUD, SCAQMD, EPA, CDPH/DHS, CDC, and CAL -OSHA. • Description: Services include lead inspections, asbestos inspections, risk assessments, abatement specifications, monitoring, and clearance testing. All services comply with EPA and HUD guidelines. Barr & Clark is currently under contract to perform lead and asbestos- related services for CDC's Single Family Grant Program, Housing Rehabilitation Loan Programs, and Home Ownership/Home Buyer Program. City of Los Angeles — Housing Department (LAHD) • Type of Projects: Lead Inspections, Asbestos Inspections, Design of Abatement Specifications, Risk Assessments, and Clearance Testing for single family residences and multifamily housing properties. • Project Name/Location: Thousands of projects throughout the greater Los Angeles area. • Contact: Paul Meza (213) 808 -8994 PMeza(a�land.lacit�org • Address: 1200 W. 7 Street, 8 Floor Los Angeles, CA 90017 • Date started/completed: Have completed thousands of projects from 1994 to present. Currently under contract for lead and asbestos consulting services. • Name of Regulatory Oversight Agencies: LAHD, SCAQMD, Office of Historic Preservation, CDC, EPA, CDPH/DHS, HUD, and CAL -OSHA. • Description: Services include lead inspections, asbestos inspections, risk assessments, abatement specifications, monitoring, and clearance testing. All services comply with California, EPA, and HUD guidelines. Barr & Clark is currently under contract to perform lead and asbestos- related services for the Los Angeles Housing Department NPP Programs as well as the Handyworker Program. 12684 Hoover Street • Garden Grove, California 92841 • (714) 894 -5700 • Fax (714) 894 -5702 Environmental Consulting Services — 1I/26/l2 Proposal for Services — City of Rosemead Page 9 of 14 City of Huntington Park — Economic Development Department f ' • Type of Projects: Lead Inspections, Asbestos Inspections, Design of Abatement Specifications, Risk Assessments, and Clearance Testing for single family residences and multifamily housing. • Project Name/Location: Various projects throughout the City of Buena Park. • Contact: Fernanda Palacios (323) 584 -6266 tpalacios(c)huntint,tonpark.org • Date started/completed: Have completed numerous projects from 2001 to present. Currently under contract for lead -based paint and asbestos consulting services. • Name of Regulatory Oversight Agencies: Office of Historic Preservation, EPA, SCAQMD, CDC, CDPH/DHS, HUD, and CAL -OSHA. • Description: Services include lead inspections, asbestos inspections, risk assessments, abatement specifications, monitoring, and clearance testing. All services comply with California, EPA, and HUD guidelines. Barr & Clark is currently under contract to perform lead - based paint and asbestos related services for the City of Huntington Park. City of Inglewood — Community Block Grant Division • Type of Projects: Lead Inspections, Asbestos Inspections, Design of Abatement Specifications, Risk Assessments, and Clearance Testing for single family residences, multifamily housing properties, and commercial structures. • Project Name/Location: Various projects throughout the City of Inglewood. • Contact: Pamela Thigpen (310) 412 -4395 pthig eip i(,�ciytyofinglewood.org • Address: One Manchester Blvd., PO Box 6500, Inglewood, CA 90301 • Date started/completed: Have completed numerous projects from 1999 to present. Currently under contract for lead -based paint and asbestos consulting services. • Name of Regulatory Oversight Agencies: HUD, EPA, SCAQMD, CDPH/DHS, CDC, and CAL -OSHA. • Description: Services include lead inspections, asbestos inspections, risk assessments, abatement specifications, monitoring, and clearance testing. All services comply with California, EPA, and HUD guidelines. Barr & Clark is currently under contract to perform lead - based paint and asbestos related services for the City of Inglewood. r- 12684 Hoover Street • Garden Grove, California 92841 • (714) 894 -5700 • Fax (714) 894 -5702 Environmental Consulting Services —11 /2t 1 12 Proposal for Services — City of Rosemead Page 10 of 14 Additional References: Ruth Rodrigues (213) 808 -8678 Tom Ferch City of Los Angeles —Rousing Department 1200 W. 7" Street, 8 Floor Los Angeles, CA 90017 Gary Flora (310) 458 -8702 City of Santa Monica — Housing Division 2121 Cloverfield Blvd., Suite 100 Santa Monica, CA 90404 (714) 741 -5330 City of Garden Grove 11222 Acacia Parkway Garden Grove, CA 92842 Thomas Borland US Bank 633 W. Fifth St., 29th Floor Los Angeles, CA 90071 i (213) 615 -6401 Ben Phillips (213) 743 -5820 Pat Reyes (562) 929 -5952 Mercy Charities Housing (Non Profit City of Norwalk — Housing and Community Organization) Development 1500 South Grand Avenue 12700 Norwalk Blvd. Los Angeles, CA 90015 Norwalk, CA 90650 Additional references are available upon request. 6. Insurance Coverage Liability Insurance Company: American Safety Indemnity Company Coverage: Commercial General Liability Professional Liability Automobile Liability $1, 000, 000.00 each occurrence $ 2, 000, 000.00 aggregate Expiration Date: March 9, 2015 $1, 000, 000.00 Claims Made Basis (Copies of insurance binders are located in Appendix A.) Worker's Compensation: State Fund Compensation Insurance Expiration Date: July 1, 2013 (Copies of insurance binders are located,in Appendix A.) 12684 Hoover Street • Garden Grove, California 92841 • (714) 894 -5700 • Fax (714) 894 -5702 Environmental Consulting Services — 11126/12 Proposal for Services — City of Rosemead Page 11 of 14 7. Statement of Understanding the Scope of Work All services provided by Barr & Clark will conform to the requirements as described in the RFP. Combination Lead -Based Paint Inspection and Risk Assessment - The inspection will be in compliance with 24 CFR 35.930 (d) (Title XJ, California DHS Title 17, CCR, Division 1, Chapter 8, and the relevant chapters of the current version of the HUD Guidelines. Paint testing will be performed using XRF methodology, which is non - destructive. All laboratory samples (dust and soil) will be analyzed for lead content by Patriot Environmental Laboratory Services or SCILAB which are both accredited by the American Industrial Hygiene Association (AIHA), National Voluntary Laboratory Accreditation Program (NVLAP), NLLAP, and the California Department of Health Services (DHS). A sample report may be located in Appendix B. LBP Clearance Testing - Conduct clearance inspection and issue abatement certification in compliance with 24 CFR 35.930 (d) (Title X9 and the relevant chapters of the current version of the HUD Guidelines. Asbestos Inspection (including visual assessment and cost effective treatments) — The inspection will be in compliance with all applicable asbestos related rules and regulations (local, state, and federal) including EPA, HUD, DHS, NESHAP, CAL -OSHA, South Coast AQMD, Clear Air Act, TSCA, and OSHA. All laboratory samples will be analyzed by Patriot Environmental Laboratory Services which is accredited by the American Industrial Association (AIHA), the National Institute for Standards and Technology (NVLAP) and the California Department of Health Services (FLAP). A sample report may be located in Appendix C. ACM Clearance Inspection — Conduct an ACM clearance inspection after all asbestos related activities are completed and properly cleaned. After passing air clearance testing, asbestos abatement clearance to re- occupy the abated areas will be issued. 8. Standard Operating Procedures (Sample Reports Located in Appendices B and C) Scheduling of the inspection will be immediately upon receipt of the request from the City of Rosemead (sample request form in Appendix D). Three written reports will be available in approximately 4 working days (usually less!) from the completion of the field inspection. Verbal XRF results are available immediately upon completion of the field inspection (if necessary). Barr & Clark utilizes state -of -the- art- practices, equipment, and techniques in accordance with all regulatory standards while performing LBP and ACM inspections. The method employed for LBP is X -ray fluorescence (XRF) using a Radiation Monitoring Device Lead Paint Analyzer (RMD LPA -1). It is a non- destructive, non - evasive means of testing. Soil and dust samples collected are analyzed for lead content by an approved laboratory which is accredited by the American Industrial Association (AIHA), the National Institute for Standards and Technology (NVLAP), NLLAP, and the California Department of Health Services (ELAP). 12684 Hoover Street • Garden Grove, California 92841 • (714) 894 -5700 • Fax (714) 894 -5702 Environmental Consulting Services — IM6112 Proposal for Services — City of Rosemead Page 12 of 14 The ACM inspection will be in compliance with all applicable asbestos related rules and regulations (local, state, and federal) including EPA, HUD, DHS, NESHAP, CAL -OSHA, South Coast AQMD, Clear Air Act, TSCA, and OSHA. All laboratory samples will be analyzed by Patriot Environmental Laboratory Services which is accredited by the American Industrial Association (AIHA), the National Institute for Standards and Technology (NVLAP) and the California Department of Health Services (ELAP). Our office utilizes "state -of -the —art" equipment in order to process all data, laboratory results, and generate inspection reports. Our new computer system and customized software operate with the latest Microsoft Operating System and Microsoft Office Professional Suite. Other special equipment utilized includes a digital image copier, high speed/capacity fax machine, and an automated mailing system. Type of XRF: Radiation Monitoring Devices, Inc. - RMD LPA -1 (currently own 4 XRF's). • A sample Lead -Based Paint/Risk Assessment Report maybe located in Appendix B. • A sample Asbestos Inspection Report maybe located in Appendix C. Laboratory Analysis: Barr & Clark utilizes Patriot Environmental Laboratory Services which is accredited by the American Industrial Association (AIHA), the National Institute for Standards and Technology (KIST), the National Voluntary Laboratory Accreditation Program (NVLAP) and the California Department of Health Services (FLAP) for lead and asbestos sample analysis. Patriot also participates in the PAT (Performance Analytical Testing) program for PCM analysis which was developed by the American Industrial Hygiene Association (AIHA). Laboratory Address and Contact Information: Patriot Environmental Laboratory Services David Espique, Laboratory Manager 1041 South Placentia Avenue Fullerton, CA 92831 Phone: 714.899.8900 Fax: 714.899.7098 9. Statement of Litigation/Settlement Barr & Clark is proud to never have had any litigation or settlements regarding any of our services provided! 10. Request Form The City of Rosemead's Environmental Inspection Request Form maybe found - in Appendix D . 12684 Hoover Street • Garden Grove, California 92841 • (714) 894 -5700 • Fax (714) 894 -5702 Environmental Consulting Services — 11126112 Proposal for Services — City of Rosemead Page 13 of 14 11. Standard Fee Structure All of the following items are not -to- exceed fee quotes. No additional charges for travel. The date to start work is immediate. All insurance requirements, binders, etc. will be provided. Lead -Based Paint (LBP) Consulting — (Typical written report turnaround time is 4 working days or less) • Combination Lead -Based Paint Inspection and Risk Assessment (including visual assessment and cost effective treatments) - The inspection will be in compliance with 24 CFR 35.930 (d) (Title A), California Title 17 Regulations, and the relevant chapters of the current version of the HUD Guidelines. Paint testing will performed using XRF methodology. All laboratory samples (dust and soil samples) will be analyzed for lead content by Patriot Environmental Laboratory Services which is accredited by the American Industrial Association (AIHA), the National Institute for Standards and Technology (NVLAP) and the California Department of Health Services (ELAP). ➢ Comprehensive LBP Inspection -Typical Single Family Residence $ 350.00 ➢ Limited LBP Inspection -Typical SFR (Interior or Eiderior Only) $ 225.00 All laboratory sampling costs are included in the above pricing. • LBP Clearance — Conduct a lead clearance inspection and issue abatement certification in compliance with 24 CFR 35.930 (d) (Title Jf) and the relevant chapters of the current version of the HUD Guidelines. ➢ LBP Clearance Inspection - Per job site visit $ 150.00 ➢ Laboratory samples for dust wipe or soil (typically 3 samples) $ 25.00 each • Hourly rates typically do not apply to lead inspections or clearance testing. The above pricing includes all services as described and does not require any hourly fees. • Payment - To maintain this pricing level, we have assumed prompt payment for services. All invoices are payable within 30 days of presentation. • A sample Lead -Based Paint Inspection/Risk Assessment Report may be located in Appendix B Asbestos (ACM) Consulting — (Typical written report turnaround time is 4 working days or less.) • Asbestos Inspection Concluding visual assessment and cost effective treatments) — The inspection will be in compliance with all applicable asbestos related rules and regulations (local, state, and federal) including EPA, HUD, DHS, NESHAP, CAL -OSHA, South Coast AQMD, Clear Air Act, TSCA, and OSHA. All laboratory samples will be analyzed by Patriot Environmental Laboratory Services which is accredited by the American Industrial Association (AIHA), the National Institute for Standards and Technology (NVLAP) and the California Department of Health Services (FLAP). ➢ Comprehensive ACMInspection -Typical Single Family Residence $ 595.00 The above price includes all sample analysis cost! r ➢ Limited ACMInspection — Up to 6 Samples $ 325.00 The above limited inspection price includes up to 6laboratory samples. Additional laboratory samples (only if requested) are $15.00 per sample, " 12684 Hoover Street • Garden Grove, California 92841 • (714) 894 -5700 • Fax (714) 894 -5702 Environmental Consulting Services — IM6112 Proposal for Services — City of Rosemead Page 14 of 14 • ACM Clearance Inspection — Conduct an ACM clearance inspection after all asbestos related activities are completed and properly cleaned. After passing air clearance testing, asbestos abatement clearance to re- occupy the abated areas will be issued. ➢ ACM Clearance Inspection - Per job site visit $ 295.00 The above price includes up to 4 air clearance samples Additional samples (rarely required) are $15.00per sample. • Hourly rates typically do not apply to asbestos inspections or clearance testing. The above pricing includes all services as described and does not require any hourly fees. • Payment - To maintain this pricing level, we have assumed prompt payment for services. All invoices are payable within 30 days of presentation. • A sample Asbestos Inspection Report may be located in Appendix C- 12. Schedule of Standard Hourly Rates Hourly rates typically do not apply to lead or asbestos inspections/clearance testing. The pricing in the above section includes all services as described and does not require any hourly fees. Barr & Clark is proud of our past accomplishments and we are confident that we can continue to provide the City of Rosemead with timely and cost efficient services. If you have any questions or require additional information, please contact me at (714) 894 -5700. Sincerely, r Matt Crochet President 12684 Hoover Street • Garden Grove, California 92841 • (714) 894 -5700 • Fax (714) 894 -5702 I A1 CERTIFICATE OF LIABIUTY`INSURANCE °" 5/8/20 5 /s/zolz THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES - BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the polley(les) must be endorsed. If SUBROGATION IS WAIVED, subject tD the terms and Conditions of the policy, certain policies may require an endorsement A statement on this Certificate does not confer rights to the certificate holder In lieu of such endomement(s ). PRODUCER Phone: (714)6853200 - Legends Environmental u Fax: (714)685 -3280 hm Services, LLC c A Saea Haus AME' N fance PHONE (714)923.4287 (M No: (714)923-4010 D--MAL ne @]%Onda- enviro.00m egg, 2165 N. Glassall St WSURER(S) AFFORDING COVERAGE NAICS Orange, California 92865 wsURERA: American Safety Indemnity Company 25433 INSURED INSURERS: INSURER C: Bea &Clark 12684 Hoover Street Garden Grove, CA 92841 INSUREBD: COMIANEOSINGLEUMIT Ee .vide INSURER E: INSURER F: S. COVERAGES - CERTIFICATE NUMBER: 12 REVISION NUMBER: - • - - - -- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE ; TERME7 - EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS... HI YRR TYPEWINSURANCE ADD BR POLICYNUMBER MM IX EFF IAMN LIMITS GENERAL LIABILITY ENVO22189.12-02 319/2012 3/9/2015 EACH OCCURRENCE S A OOMMEROALGENERALLIAMLITY PREMI $ • .50000 LLAIMAMmm OCCUR - Men UP am men) 8 §Iwo Pollution Liability �/ Y PERSONAL&ADVINJURY S - 1000000 GENERAL AGGREGATE $ ' 2 000 000 GENLAGGREGATE UMIT APPLIES PER: PRODUCTS- COMP/OP AGG S 200000D POLICY I PRO- 1LOC SER S . AUTOM MUSUABILIIY 1 COMIANEOSINGLEUMIT Ee .vide 1,000;OOD BODILYINJURY(Pwpersan) S. ANYAUTO -. ENVO22189 -12-02 BODILY INJURY (Pw =Iden0 $ - A D SCTHHEDULED 3/9/2012- 3/9/2013 PROPEE T DAMAGE $ ED ✓ ✓ HIRED AUTOS AUTOS _ S .UMBRELLA OAB OCCUR EACH OCCURRENCE S AGGREGATE S CIAIMLADE F LUU1 RETENTION S WORKERS COMPENSATION WC STATU- OTH• TORY I Imffs OR . AND EMPLOYERS' LIABILITY YIN ANY PR OPRIETORFARTNEalEXEOUIVE EL EACH ACCIDENT S OFFICERMSEMBER EXCLUDED'/ NIA (Mandumryln NH) - EL DISEASE -EA EMPLOYE S rc ASS, Lambe undw O OF OPERATIONS W. EL DISEASE -P000Y UMn S A Pro£essionalLialellity 3/92012 3/9/2015 Txludedmabove CL16d6 y &NV022189 -12 -02 - CMu Mdeaeha Dde3rgB4 'i'li DESCRIPTION OF OPERATION9 /LOCATIONS /VEHICLES(Ahaah ACORD 101, AddIGAm1 ReMAft Saheftie, IF MM $Peas M raquind) The City of Rosemead, its directors, officials, officers, employees, agents, and volunteers are included as - additional insured with respects to work performed for them by the named insured. Insurance is primary and non - contributory. - *' 30 DAYS NOTICE OF CANCEI.LATION -. CERTIFICATE HOLDER CANCELLATION HoldeesNetme oflnterest : AddWonal lnsured SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE - EXPIRAT THE DATE THEREOF, WILL BE DELIVERED IN,. City of Rosemead ACCORDANCE THE POLICY PROVISIONSE 8838 E. Valley Blvd. - -- AUTHOR® REPRESENTATIVE -- Rosemead, CA 91770 ®1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD 3 i POLICY NUMBER: ENVO22189 -12 -02 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. - I ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location And Description Of Completed Operations Any person or organization with whom the Named Where specified by written contract. Insured enters into a written contract that requires them to be named as an Additional Insured for Completed Operations Coverage and the contract is executed prior to the start of the project. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section ll — Who is An insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for 'bodily injury" or 'property damage" caused, in whole or in part, by "your work" at the location designated and described in the schedule of this endorsement, performed for that additional insured and included in the "products - completed operations hazard ". l- CG 20 37 07 -04 0 ISO Properties, Inc., 2004 Page 1 of COMMON POLICY CONDITIONS All Coverage parts included in this policy are subject to the following conditions. A. Cancellation 1. The first Named Insured shown in the Declarations may cancel this policy by mailing or delivering to us advanced written notice of cancellation. 2. We may cancel this policy by mailing or delivering to the first Named Insured written notice of cancellation at least: a. 10 days before the effective date of cancellation if we cancel for nonpayment of premium; or 3. We will mail or deliver our notice to the first Named Insured's last mailing address known to us. 4. Notice of cancellation will state the effective date of cancellation. The policy period will end on that date. 5. If this policy is cancelled, we will send the first Named Insured any premium refund due. If we cancel, the refund will be pro rata If the first Named Insured cancels, the refund may be less than pro rata. The cancellation will be effective even if we have not made or offered a refund. 6. If notice is mailed, proof of mailing will be sufficient proof of notice. B. Changes This policy contains all the agreements between you and us concerning the insurance afforded. The first named Insured shown in the Declarations is authorized to make changes in the terms of this policy with our consent This pohey's terms can be amended or waived only by endorsement issued by us and made a part of this policy. C. Examination Of Your Books And Records We may examine and audit your books and records as they relate to this policy at any time during the policy period and up to three years afterward D. Inspections And Surveys 1. We have the right to: a. Make inspections and surveys at any time; b. Give you reports on the conditions we find; and c. Recommend changes. 2. We are not obligated to make any. inspections, surveys, reports or recom- mendations and any such actions we do undertake relate only to insurability and the premiums to be charged. We do not make safety inspections. We do not undertake to perform the duty of any person or organization to provide for the health or safety of workers or the public. And we do not warrant that conditions: a. Are safe or healthful; or b. Comply with laws, regulations, codes or standards. 3. Paragraphs 1. and 2. of this condition apply not only to us, but also to any rating, advisory, rate services or similar organization which makes insurance inspections, surveys, reports or recommendations. 4. Paragraph 2. of this condition does not apply to any inspections, surveys, reports or recommendations we may make relative to certification, under state or municipal statutes, ordinances or regulations, of boilers; pressure vessels or elevators. E. Premiums The fast Named Insured shown in the Declarations: 1. Is responsible for the payment of all premiums; and 2. Will be the payee for any return premiums we pay. F Transfer Of Your Rights And Duties Under This Policy Your rights and duties under this policy may not be transferred without our written consent except in the case of death of an individual named insured. If you die, your rights and duties will be transferred to your legal representative but only while acting within the scope of duties as your legal representative. Until your legal zepre sentative is appointed, anyone - having proper temporary custody of your properly will have your rights and duties but only with respect to that property. IL 00 17 1198 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 POLICYHOLDER COPY STATE I P.O. BOX 420807, SAN FRANCISCO,CA 94142 -0807 FUND v- ''CERTIFICATE OF WORKERS' COMPENSATION INSURANCE .ISSUE DATE.: 07 -01 -2012 GROUP: POLICY NUMBER 1917813 -2012 - CERTIFICATE 113: 83 CERTIFICATE EXPIRES' 07 -01 -2013 07 -01- 2012/07- 01-2013 CITY OF ROSEMEAD SP JOB:LEAD & ASBESTOS CONSULTING 8838 VALLEY BLVD ROSEMEAD CA 91770 -1714 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner . to the employer named below for the policy period indicated. - This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. We will also give you 30 days advance notice should this policy be cancelled prior to Its .normal expiration This certificate of .insurance is not an insurance policy and does not amend, extend or .alter the coverage - afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions. and .conditions, of such policy. - Authorized Representative - President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #1600 - .MATTHEW CROCHET, PRESIDENT - EXCLUDED. ENDORSEMENT #11300 - KIMBERLEY CROCHET, VP S T- EXCLUDED. `— ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 07 -01 -2010 IS ATTACHED TO AND FORMS A. PART OF THIS POLICY.. ENDORSEMENT #2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2012 -07 -01 IS ATTACHED TO AND FORMS -A PART OF THIS POLICY. THIRD PARTY NAME: CITY OF ROSEMEAD EMPLOYER BARR & CLARK, INC 12684 HOOVER ST GARDEN GROVE CA 92841 (REV.8 -2010) SP SP M0410 PRINTED t 06 -15 -2012 1 1 BARR & CLARK Independent Environmental Testing Asbestos • Lead • Mold • Phase I LEAD BASED PAINT INSPECTIONAUSK ASSESSMENT REPORT (SAMPLE) Isla SINGLE FAMILY RESIDENCE 14807 SAMPLE REPORT ROAD NORWALK,CA PROJECT NO. 281205 NOTE: This is a SAMPLE " LEAD BASED PAINT IN REPORT prepared especially for the City of Rosemead. from an actual report of a typical single family residence. Prepared For: Client Sample 12345 Any Boulevard Sample City, CA 99999 Prepared By: ** *SAMPLE * ** Keith Piner State of California Certified Lead Inspector / Risk Assessor 12684Hoover Street, Garden Grove, CA report was derived f Reviewed By: ** *SAMPLE * ** Matt Crochet State of California Certified Lead Inspector / Risk Assessor 928411 714.894.5700 (t) 714. 894. 5 702 (j) www.barrandclark.com OCTOBER 17, 2012 Lead Based Paint Inspection/Risk Assessment Report ** *SAMPLE * ** Single Family Residence 14807 Sample Report Road TABLE OF CONTENTS DESCRIPTION 1.0 INTRODUCTION ............................... 2.0 SCOPE OF WORK .............................. 3.0 PROPERTY DESCRIPTION ............., 4.0 INSPECTOR'S QUALIFICATIONS. 5.0 TESTING PROTOCOL ...................... 6.0 METHOD OF TESTING .................... 7.0 SUMMARY OF RESULTS ................ 8.0 RECOMMENDATIONS .................... 9.0 TITLE X REQUIREMENTS .............. 10.0 INSPECTION LIMITATIONS........... APPENDICES APPENDIX A SUMMARIES LEAD CONTAINING COMPONENTS LIST APPENDIX B XRF FIELD DATA APPENDIX C INSPECTOR'S CERTIFICATE(S) INSURANCE CERTIFICATE DHS 8552 APPENDIX D MAP(S) HUDFORMS APPENDIX E LABORATORY MANIFEST AND RESULT(S) PAGE NO. ..........3 ..........3 ..........3 ..........3 4 5 5 6 7 7 Project No. 281205 Page 2 of 7 12684Hoover Street, Garden Grove, CA 928411 714.894.5700 (t) 714.894.5702 (f) www.barrandclark.com Lead Based Paint Inspection/Rsk Assessment Report Single Family Residence 14807 Sample Report Road ** *SAMPLE * ** LEAD -BASED PAINT INSPECTIONIRISKASSESSMENT REPORT 1.0 INTRODUCTION This report presents the results of Barr & Clark Environmental's lead -based paint (LBP) inspection/risk assessment of the Single Family Residence located at 14807 Sample Report Road, Norwalk, California (Subject Property). This document is prepared for the sole use of Client Sample, and any regulatory agencies that are directly involved in this project. No other party should rely on the information contained herein without prior written consent of Client Sample. The scope of services, inspection methodology, and results are presented below. 2.0 SCOPE OF WORK The purpose of this inspection/risk assessment is to identify and assess the Lead -Based Paint (LBP) present on painted components at the subject property. On October 15, 2012, Barr & Clark performed an inspection/risk assessment for lead -based paint at the subject property in Norwalk, California. To comply with EPA and HUD guidelines, painted and varnished surfaces in every accessible "room equivalent" were sampled for the presence of LBP. The intent was to ascertain the presence of lead -based paint above the federal action level. If LBP was found, the inspection would identify individual architectural components and their respective concentrations of lead in such a manner that this report would be used to characterize the presence of LBP at this property. 3.0 PROPERTY DESCRIPTION The subject property is a single family residence that was built circa 1948. It is a one -story building that is constructed over a raised foundation. The exterior walls are covered with stucco and all of the windows are vinyl- framed types. The home consists of three bedrooms, one bathroom and a detached garage. At the time of this inspection/risk assessment, most of the painted surfaces were in fair condition. 4.0 INSPECTOR'S QUALIFICATIONS Matt Crochet of Barr & Clark performed the inspection/risk assessment at the site using an RMD LPA -1 XRF spectrum analyzer instrument. He has attended the radiation safety course for handling the instrument, and completed an EPA approved curriculum in Lead in Construction Inspector / Risk Assessor Training. .I At the time of this report, the California Department of Health Services, Childhood Lead Poisoning Branch, has implemented a State Certification Model Accreditation Plan adopted from the EPA. Matt Crochet has received certification. Personnel certificate(s) have been provided in Appendix C. Page 3 of 7 281205 12684Hoover Street, Carden Grove, CA 928411 714.894.5700 (t) 714.894.5702 (f) www.barrandclark.com Lead Based Paint Inspection/Risk Assessment Report ** *SAMPLE * ** Single Family Residence 14807 Sample Report Road 5.0 TESTING PROTOCOL XRF Testing: Testing of the painted surfaces was patterned after the inspection protocol in Chapter 7 of the HUD Guidelines for the Evaluation and Control of Lead -Based Paint Hazards in Housin> . In every "room equivalent' ' within the tested property, one representative surface of each "testing combination" was tested. Multiple readings were collected to resolve inconsistencies in the test results. Regulatory Compliance: Several public (government) agencies have a published "regulatory action level" to classify LBP. To further complicate matters, some of the established "levels" are quantified in different units of measurement. Listed below are the current regulatory agencies that have defined LBP, along with the respective action level: Agency Ordinance # Action level (mg / cm Action level (ppm") HUD / EPA 24 CFR 35.86 & 40 CFR 745.103 1.0 mg / cm 5,000 ppm L.A. County Title 11, 11.28.010 0.7 mg / cm 600 ppm "' OSHA / CAL OSHA 29 CFR 1926.62 & Title 8, 1532.1 Not Specified 600 ppm ° "Report lead paint amounts in mg/cm because this unit of measurement does not depend on the number of layers of non -lead- based paint and can usually be obtained without damaging the painted surface. All measurements of lead in paint should be in mg/cm�, unless the surface area cannot be measured or if all paint cannot be removed from the measured surface area. In such cases, concentrations may be reported in weight percent ( %) or parts per million by weight (ppm)."" Furthermore EPA has previously issued guidance on lead content classification as follows: .. The rule, at 24 CFR 35.86 and 40 CFR 745.103 states that a lead -based paint free finding must demonstrate that the building is free of `paint or other surface coatings that contain lead in excess of 1.0 milligrams per square centimeter (1.0 mg / em') or 0.5 percent by weight (5000 ppm).' The State standards are not applicable whether more or less stringent, since a In recognition of the various action levels the testing results are classified as follows for this report: • Painted surfaces with readings at or above 0.7 mg / cm are considered - Positive • Painted surfaces with readings at or below 0.6 mg / cm are considered Negative The individual readings have been provided on all field data sheets. Any future change in action levels by one of the regulating agencies may affect the classification of results. Dust Wi a Sam fin : The California DHS/HUD action level for lead dust is 40 µg/fl for floors, 250 µg / for window sills, 400 µg / ft' for window wells, and 400 µg / ft for exterior surfaces.. ..p Soil Sampling: The California DHSMM action level for lead in soil is 400 parts per million (ppm) for bare soil and 1000 ppm for soil covered with vegetation (ground cover, grass, etc,). Page 4 of 7 281205 12684Hoover Street, Garden Grove, CA 928411 714.894.5700 (t) 714.894.5702 (f) www.barrandclark.com Lead Based Paint Inspection/Risk Assessment Report ** *SAMPLE * ** Single Family Residence 14807 Sample Report Road 6.0 METHOD OF TESTING Paint Testing: The method employed was X -ray fluorescence (XRF) using a Radiation Monitoring Device Lead Paint Analyzer (RMD LPA -1). The instrument was operated in "Quick Mode," where the duration for each test result is determined by a combination of: • the actual reading relative to the designated action level; • the age of the radioactive source; and • the substrate on which the test was taken. The instrument's calibration was verified according to the manufacturer's specifications in compliance with the Performance Characteristic Sheet (PCS) developed for this instrument. The readings from this instrument produce a 95% confidence level that the "lead" reading accurately reflects the actual level of lead in the tested surfaces, relative to the federal action level. Laboratory Sample Analysis: Soil and dust samples were collected from this property and analyzed for lead content by Patriot Environmental Laboratory Services, which is accredited by the American Industrial Association (AIHA), the National Institute for Standards and Technology (NVLAP) and the California Department of Health Services (FLAP). The samples were analyzed as follows: • Dust Wipe Sampling - The method of analysis was Flame Atomic Absorption Spectroscopy (OSHA ID -121, Flame AA) performed on samples collected from measured areas. • Soil Sampling - The method of analysis was Flame Atomic Absorption Spectroscopy (SW -486, flame AA) performed on samples collected from the top '' /z" of bare soil areas (drip line, etc.). 7.0 SUMMARY OF RESULTS Paint Sampling: Throughout the subject property, several of the painted components indicated the presence of lead -based paint (LBP) at or above the respective action level. The following summary lists the specific components that tested above the action level and their respective locations: Interior • The ceramic tiled countertop in the kitchen tested positive for lead. This surface was not painted and the lead is most likely in the glazing or the matrix of the file itself , Exterior • Door and door frame to the living room • Door frame to laundry room • Window components • Roof trim • Beams and ceiling at front porch Page 5 of 7 281205 12684Hoover Street, Garden Grove, CA 928411 714.894.5700 (t) 714,894.5702 (f) www. b a rrandc lark. com Lead Based Paint lnspection/Risk Assessment Report ** *SAMPLE * ** Single Family Residence 14807 Sample Report Road Garage • Roof trim • Garage door • Garage door frame Sampling for this inspection risk assessment was representative and any components that were not tested but similar to those components that tested positive for LBP should be considered and treated as lead laden. The field data and results for paint sampling may be found in Appendices A - B. Dust / Soil Samplin¢: None of the tested items indicated a level of lead above the specified regulatory limit. A copy of the laboratory manifest and results may be found in Appendix E. 8.0 RECOWIENDATIONS The greatest potential for lead exposure from lead painted architectural components occurs when: the paint has become defective; or when the paint is applied to a friction / impact component where the paint is continually disturbed; or when the paint is disturbed through routine maintenance or renovation activities. With this in mind, the following are our recommendations for this property: • The results from this inspection should be provided to any individuals that may disturb the painted surfaces. It is encouraeed to utilize professionals that have experience working with LBP. • If renovation is scheduled in the near future (less than three months), all lead painted components that have been previously targeted for replacement should be replaced utilizing "lead safe" containment and work practices. • ALL components that have been identified with defective lead paint should have the paint repaired as soon as possible. Any paint repair should be done utilizing "lead safe" containment, work practices, and clean-up techniques. • All components with lead painted friction / impact surfaces should be treated to minimize the friction or impact as necessary. • Lead painted components that have not been targeted for replacement should either be considered for abatement (replacement, enclosure, encapsulation, etc.) or included in an Operations & Management (O & M) Plan that will help to minimize exposures to lead hazards. • All lead painted surfaces that are not expected to be impacted in the near future (less than three months) should also be included the O & M plan. • In addition, the tenants or occupants of the dwelling should be notified of the test results and instructed in actions that they may perform to keep the living areas "lead safe." Page 6 of 7 281205 12684Hoover Street, Garden Grove, CA 928411 714.894.5700 (t) 714.894.5702 (f) www.barrandelark.com Lead Based Paint Inspection/Risk Assessment Report ** *SAMPLE * ** Single Family Residence 14807 Sample Report Road • The tile surfaces are not a likely source of lead dust contamination as long as they remain intact. If future renovation or repair activities require that the tile be removed, or the surfaces disturbed, it should be done in a manner that does not break the tiles. If this is not feasible, this task should be assigned to a lead certified contractor. 9.0 TITLE X REQUIREMENTS A copy (or summary) of this report must be provided to new lessees (tenants) and purchasers of this property under Federal law (24 CFR part 35 and 40 CFR part 745) before they become obligated under a lease or sales contract. The complete report must also be provided to new purchasers and it must be made available to new tenants. Landlords (lessors) and sellers are also required to distribute an educational pamphlet approved by the U.S. Environmental Protection Agency and include standard warning language in their leases or sales contracts to ensure that parents have the information they need to protect their children from lead -based paint hazards. This report should be maintained and updated as a permanent maintenance record for this property. 10.0 INSPECTION LIMITATIONS This inspection/risk assessment was planned, developed, and implemented based on Barr & Clark's previous experience in performing lead -based paint inspections /risk assessments. This inspection was patterned after Chapter 7 of the HUD Guidelines for the Evaluation and Control of Lead -Based Paint Hazards in Housing (1997 Revision). Barr & Clark utilized state -of -the- art- practices and techniques in accordance with regulatory standards while performing this inspection/risk assessment. Barr & Clark's evaluation of the relative risk of exposure to lead identified during this inspection/risk assessment is based on conditions observed at the time of the inspection. Barr & Clark cannot be responsible for changing conditions that may alter the relative exposure risk or for future changes in accepted methodology. Enclosed are the diagram(s), actual test results, and all relevant certifications and licenses. ' 1997 Revision ii Parts per million iii Applies to sale and application of LBP. iv Applies to construction related activities v Chapter 7 of the HOD Guidelines for the Evaluation and Control of Lead -Based Paint Hazards in Housing (1997 Revision). vi office of Pollution Prevention and Toxics, (August 20, 1996) Page 7 of 7 281205 12684Hoover Street, Garden Grove, CA 928411 714.894.5700 (t) 714.894.5702 (f) www.barrandcIark.com APPENDIX A SUMMARY OF INTERIOR Project Name: Single Family Residence Project Number: 281205 Address: 14807 Sample Report Road Norwalk, CA 90650 Component Number Number Percent Positive Number Percent Tested Positive Negative Negative Acoustic Ceiling 5 5 100.00% Gypsum Ceiling l I '1uu.uu1/° Plaster Ceiling 2._.._... 100.00%_._.. — .. la - _ ster Wall P -- - 32 - - -- — 100.00 %_ .— Tile Counter Top ------ ----- - - -- -- 1 100.00 %___ Wood Baseboard 6 6 100.00% Wood ._ Cabinet Door 4._.___—...___ ___� -- Wood Cabinet Frame 4 100.00 % Wood Cabinet Shelf — ^--- ^-- -- ._,____.._ - - -4 — __-- -- ...---- _ -- - -- 4 - - -- Wood Close Close Door 3 3 100,00% _ Wood Close Door Fr ame - - -- 3 — Wood Closet Shelf -- 3 — 3 x100.00% Wood Closet Shelf Support — - 3 3 100:00% Wood Door 5 5 100.00% Wood Door Frame 8 — .__.._..__._— .._. 8 —._1- 100.00% Wood Floor �--- _ - - -- -- � •-- ._— .�-- 100.00% Wood Ironing Bd Case 1 1 . 100.00% Wood Ironing Bd Door 1 -- 1 — -- 100.00% Wood Window Fr -'— - - "�— - — 5.... 5 100.00 % Wood Window Sill Totals: 98 1 97 Testing done in compliance with current L.A. County DHS guidelines for XRF. Barr & Clark Environmental (714) 894 -5700 SUMMARY OF EXTERIOR Project Name: Single Family Residence Project Number: 281205 Address: 14807 Sample Report Road Norwalk, CA 90650 Component Number Number Number Percent Tested Positive Percent Positive Negative Negative Metal Door 1 1 100.00% 4 . -. --- - - - - -- - - - - -- - 4 100A0% -- Wood Beam 1 1 100.00% Wood Ceiling -....._.-._._._._^....._..__._...•....---....__._._._.____..:_....__-_-_. __:.. Wood Column 1I100.00 " /0: -- Wood Door -�- ------ �-- .._..--- -._. -_.1 _ Wood Door Frame 2 2 100:00 _--__-.-ec_._tri.-c . U-___- -__._ Wood El tility Box ._.:- .- ..._._- _____,_._.__ Wood Fence .-__..._._.-._.. -- .- __.._.._..— .______..._1.._..- -'- - _100.00 % Wood Roof Trim .. ._- --- ' - 12 --- 9 75.00 % 3 Wood Threshold 2 2 1 00.00% Wo od Win Frame Wood Window Well - _- -_ ~ - -_ - --� -_� 2 - -- -- - -- - -- - - - - - -- - --- Totals: 33 20 -- 13 Testing done in compliance with current L.A. County DHS guidelines for XRF. Barr 8 Clark Environmental (714) 894 -5700 2 SUMMARY OF GARAGE Project Name: Single Family Residence Project Number: 281205 Address: 14807 Sample Report Road Norwalk, CA 90650 Component Number Number Percent Positive Number Percent Tested Positive Negative Negative Stucco Wall 3 3 100.00% Wood Door 1 1 100.00% Wood Door Frame 1 1 100.00% . Wood Garage Door Wood zwraie Door Frame 1 _ ^� 100.00% _ Wood Roof Trim 3 2 66.67% 1 33.33% Wood Wall --- -- 2 - _- - -' -4 2 100.00% Totals:.. 12 8 Testing done in compliance with current L.A. County DHS guidelines for XRF. Barr & Clark Environmental (714) 894 -5700 3 LEAD CONTAINING COMPONENTS LIST L° i N p j e v E a E 0 V o . t p 7 N T^ Q J a O Uk ^ M •� I O 4 V U w N E E o E r �d J �o L E ° L v s 6 ao o � c a w "a M n E W -5-2: ° 3 ro K o >' Od EU OI c psi O. 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THIS CERTIFICATE DOES NOT AFFIRMATIVELY - ORNEGATIVELY .AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE.A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, ANDTHE CERTIFICATE HOLDER. IMPORTANT: H the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. H SUBROGATION 13 WAIVED, subject to the terms and Condition of the policy,: certain policies may require an endorsement. A statement on this certificate does not confer rights to the certiBcale holder In lieu of such andamement(a). PRODUCER Phone: (714)685 -3200 CONTACT Smo 9ma Pax: (7)41685 -3280 14 923-0267 T- agmdsEnvimummml lnsmance Servicea,LLC PHONE tT 1 FAX a . (714)923 4010 t 2165 N. Glasses St. E.MnA sea° ®t�mds- er"d`o'c°°` Orangc, California 92565 elsu AFFORDING COVERAGE NAIL# NSURERA: American Sa&V Company 25433 INSURED - INSURER B: Bag &Clark NSIIReRC: 1268411onver Street wauRlaeo: - - Garden Grove, CA 92841 - - IxsuREt6: . INSURER F: COVFAAe'PS - - CERTIFICATE NUMBER: 12 REVISION NUMBER- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, .EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LL R TYPEOFINSURANCE mY NUMaEk MMU`Y� PO EAP LMM GENERAL LIABILITY _ IINVO22189 12-02 3/9/2012 3/9/2015 EACH OCCURRENCE E A CDMMERCIALGENERAL LIABILITY - CLAMS-MADE © OCCUR - i 50.000 MED EXP (Any ae p.m) S 5,000- Pollution Liahility V y PERSONAL AADV INJURY S 1 GENERALAGGREGATE S 2, 000,000 GENL AGGREGATE UMW APPLIES PER: - - PRODUCTS- COMP/DPAGG '5 000000 - 1/7 POLICY PRO. LOO - - $ AUTOMOBILE LL MJIY - - - C OMBINED SINGLE LIMIT LEM .W a 1,000,000 - .BODILY IN (Par pemon) $ - ANY AUTO � A SCH LEO BNV02'2189.12-02 319/2012- 3/9/2013 - BODILY INURY(ParaaiaenO S ✓ HIREDAUTOS ✓ AUT O AIN A rT05 s - 'UMBP OCCUR EACH OCCURRENCE :S AGGREGATE - - S PIICESS URa CWIMB.MADE .. DED RETENTIONS $ wORwBRa CGMPENBATIDN - - VIC STATIC OrH• A EWLOYEWUIBLnY- TIN . ANY PROPRIETORMARmENEXECUrIVE❑ E.L EACH ACCIDENT S OFFICER,MEMBPA E%CLUDED7 (MMMOM In NH) NIA E.L DISEASE -EA EMPLOYEE S ffw%dm- dbewder CRT TIONOFOPERADONS balm - ELDISENSE- POUCYUMIT 'S A' Piotmaimtal USbUity .. Y - BNV022189 -12-02 3/9/2012 3/9/2015. aaeaiaabo,v Ol.IlmiA . Cb.M&Rew'Dm SJM DP. SCRIPTONOFOPEAARONSILOCATmNS/ VMCLBS(AVaeAACOM1N,AddMom[Romrb Sehedub Rnwreapm.l. gWred) The city of Norwalk (public agency), its elected officials, .officers, attorneys, agents, employees, and volunteera are named as additional . insureds with respects to work performed for them by the Gamed insured. Waiver of subrogation and primary non- contributory is blanket and applies in respects to all lines_ ITCH I W16A 11: HULUCH UANL:CLLA I IUN Iioldees Nature otTD @teat: Addittmal lmured SHOULDANY OF THE ABOVE DESCRIBEDPOLICIES BECANCELLED BEFORE. City ofNDrwdk THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ATTM. City Clerk - 12700 Norwalk Blvd. - AUTHORIZED REPRESENT Tlva PO Box 1030 Norwalk, CA 90651 -1030 ® 9888 -201 D ACORD CORPORATION. All rights reserved. ACORD :26 (2090105) _ The ACORD name and logo are registered marks of.ACORD I� POLICY NUMBER. ENV022189 -12 -02 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ii ADDITIONAL INSURED OWNERS, LESSEES OR CONTRACTORS COMPLETED OPERATIONS il l This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART scHeeuLE Name Of Additional Insured Person(s) . OrOrganization(s): Location And Description Of Completed Operations Any person or organization with whom the Named Where specified by written contract. Insured enters Into a written contract that requires them to be named as an Additional Insured for Completed Operations Coverage and the contract is executed prior to the start of the project. Information required to complete this Schedule, if not shown above will be shown In the Declarations. Section 11— Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown In the Schedule, but only with respect to liability for 'bodily injury" or "property damage" caused, in whole or In part, by "your work" at the location designated and described In the schedule of this endorsement performed for that additional insured and Included In the "products- completed operations hazard". i I, CG 20 37 07 04 ® ISO Properties, Inc., 2004 Page-1 oft i i I COMMON POLICY CONDITIONS All Coverage parts included in this policy are subject to the following conditions. A. Cancellation b. Give you reports on the conditions we ' 1. The first Named Insured shown in the find aid Declarations may cancel this policy by c. Aecommend changes. mailing or delivering to us advanced written 2. We are not obligated to make any - notice of Cancellation. inspections, surveys, reports or recom- j 2. We may cancel this policy by mailing or mendations and any such actions we do delivering to the first Named Insured written undertake relate only to insurability and the notice of cancellation atleast: premiums to be charged. We do not make i a. 10 days before the effective date of safety inspections. We do not undertake to cancellation if we cancel for nonpayment perform the duty of any person or - organization to provide for the health. or ofpremium; or safety of workers or the public. And we do b. days before the effective date of not that COndiflODS: cancellation if we cancel for any other . Are safe or healthful; or 3. We will mail or deliver our notice to the first b. Comply with laws, regulations, codes or Named Insured's last mailing address known standards. to us. 3. Paragraphs L and 2. of this 'condition apply 4. Notice of cancellation will state the effective: not only to us, but also to amY rating advisory, rate. services or similar organization date of cancellation. The policy period will end onthat date. which makes insurance inspections, surveys, reports or recommendations. 5. If this policy is cancelled, we will send the first Named Insured any premium refund due. 4. Paragraph of this condition does not apply If we cancel, the refund :will be pro rata If to any inspections, surveys, reports or . recommendations we may make relative to the first Named Insured cancels, the refund may be less than pro rata. The cancellation- certification, under state or municipal will be effective even if we have not made or statutes, ordinances or regulations, of boilers, offered arefund. pressure vessels or elevators .6. If notice is mailed, proof of mailing will be E. Premiums sufficient proof of notice. The first Named Insured shown in the R. Changes Declarations: This policy contains all the agreements between 1. Is responsible. for the payment .of all you and us conce the insurance afforded. premiums; and The first named Insured shown , 1 the 2. Will be the payee for any return premiums Declarations is authorized to make.changes in the we pay.. terms of this policy with our consent This F. Transfer Of Your Rights And Duties Under policy's terms can be amended or waived only by ThisPoliey endorsement issued by us and made a part of this .Palle} Your rights and duties under this policy maynot C. Rumination Of Books Aqd Records be transferred without our written consent except in the case of death of an individual named We may examine and audit your books and insured. records as they relate to this at 7 time If you die, your rights and duties will be du* the policy period and up to three years and transferred to your legal representative but only afi while acting within the scope of duties as your D. Inspections And Surveys legal representative. - Until your legal repre- 1. We have the right to: sentattve is appointed, anyone having proper temporary custody' of your property will have inspections and Surveys at any a. Make in your fights and duties but only with to time; that property_ IL 00 17 1198' Copyright, Insurance Services Office, Inc, 1998 Page 1 of 1 i POLICYHOLDER COPY SP STATE PRO. BOX 420807, SAN FRANCISCO,CA 94142 -0607 i'FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE .DATE: 07 -01 -2012 _ GROUP: POLICY NUMBER 1917813 -2012 CERTIFICATE ID: 16 _ CERTIFICATE EXPIRES: 07 -01 -2013 07 -01- 2012/07 -01 -2013 CITY OF ' NORWALK - SP - 12700 NORWALK BLVD - NORWALK CA 90650 -3144 - -- This is to certify that we have issued -a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon. 30 days advance written notice to the employer.. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. - This certificate of insurance is not an insurance - policy and does not amend extend or alter the coverage afforded . by the policy listed herein. Notwithstanding any requirement, term . or condition of any contract or other document - - with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions.. of such policy.. _ Authorized Representative President and CEO - - - EMPLOYER'S LIABILITY :LIMIT INCLUDING DEFENSE COSTS: 31,000,000 PER OCCURRENCE. - _I ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2010-07 -01 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: CITY OF NORWALK - - - - - ENDORSEMENT #1800 - MATTHEW CROCHET, .PRESIDENT EXCLUDED .ENDORSEMENT #1600 - -- KIMBERLEY CROCHET., VP S T - EXCLUDED. - ENDORSEMENT @2065 ENTITLED .CERTIFICATE HOLDERS' NOTICE EFFECTIVE 07 -01 -2010 IS - - ATTACHED TO AND FORMS A PART OF THIS POLICY. - - EMPLOYER - - - BARR & CLARK, !INC SIR - 12684 HOOVER ST - - - GARDEN GROVE CA 92841 - - M0410 IaEV.e -20101 - - PRINTED 06 -16 -2012 slate of Cellfomle- Health and Welfare Agency Department of Health SaMcas - - - - LEAD HAZARD EVALUATION REPORT Section 1 -Date of Lead Hazard Evaluation Section .2 -Type of Lead Hazard Evaluation (Check one box only) 0 Lead inspection O Risk assessment O Clearance Inspection 17 Other (specify) Section 3- 9tructure Where Lead Hazard Evaluation Was Conducted city county . Address (number, street, apartment (If applicable) Norwalk Los Angeles ZIP coda 90650 14807 Road - Construction date (year) of Type of structure (check one box only) . structure 1948 Q Single family dwelling O Multi -unit building O Child- occupled facility ❑ Other (specify) Section 4- Owner of Structure Ifbuslnessla enc , list contact arson Telephone number - Name Address '(numile , street, apartment (If applicable) City State CA ZIP code 90650. 14 Road Norwal Section 5- Results of Lead Hazard Evaluation (Check one box only) O No lead-based paint detected. A lead inspection was conducted following the procedures outlined in Title 17, California Code of Regulations, Division 1., Chapter 8. No lead -based paint was detected during this lead Inspection. This structure is'found to be lead -based paint free. . O No lead hazards detected. Lead hazard evaluation was conducted following the procedures outlined in Title 17, California Code of Regulations, Division 1, Chapter 8. No lead hazards, were detected: © Lead -based paint and /or lead hazards detected. Lead hazard evaluation was conducted following the procedures outlines in Title 17, California Code of Regulations, Division 1, Chapter 8. Lead -based paint and/or lead hazards were detected. Section 6- Individual Conducting Lead Hazard Evaluation Name - - Telephone number Matt Crochet 714- 894-5700 Address (number, street, apartment (if applicable) City State ZIP code 12684.Hoover Street Garden Grove CA 92841 Brand name and serial number of any portable x -ray fluorescence (XRF) instrument used (if applicable) RMD Serial # 1026 DHS certlficallon number Signature / - . Date 12��C A. A'foundation diagram or sketch of the structure indicating the specific locations of each lead hazar&or presence of lead -based paint: B. Each testing method, device, and sampling procedure used; C. All data collected, including quality control data,.laboratory results, Including laboratory name, address, and phone number. First copy and attachments retained by Inspector Second copy and attachments retained by owner Third copy only (no attachments) malted to: , Department of Health Services Childhood Lead Poisoning Prevenilon Branch Reports 860 Marina Bay Parkway, Bldg. P, Third Floor Richmond, CA 94804 -0403 Phone: (610)620 -5Bp0 DHS 8652 (2199) Fax (51 D) 020 -5656 v LAUNDRY JB v v ROOM KITCHEN ATH v B BE DROOM 1 v D v HALL LIVING ROOM v BEDROOM 3 BEDROOM 2 v v v v v A window Key: Single Family' Residence v- vinyl 14809 Sample Report Road Norwalk, CA N /, Projectl# 281205 BARR & C LARK ENVIRONMENTAL Project No, 281205 Project Name , Residence - - Address: 14807 Road, Norwalk, 90650 Date: Inspectors: Matt Crochet, Form 5.0 Resident Questionnaire Children Children's Habits 1. (a) Do you have any children that live In your home? Yes_ Nol (If no children, skip to Question 5. ) (b) If yes, how many7_ Ages?— _ (c) Record blood levels, if known. (d) Are there women of child - bearing age present? Yes_ No i — ,.F ♦h r / ereee where -.A rhhdi nlaans ants anti nlai .q -Name of Location of bedroom Location of all rooms where child eats - ' Primary location where child plays Indoors - Primary location where child plays outdoors 3, Where are toys stored / kept? 4. Is there any visible evidence of chewed orpeeling paint on the woodwork, furniture, or toys? Yes_ No_ Family Use Patterns p/ 5. Which entrances are used most frequently? 6. Which windows are opened most frequently? 7. . Do you use window.alr conditioners? If yes, where? B. (a) Do any household members garden? Yes_ No - 4_ ( b) Location of arden - - - - -- 9 (c) Are you planning any landscaping activities that will remove grass or ground covering? 9. _ (a) How often is the household cleaned? (b) What cleaning methods do you use? Yes_ No_ C C 1 0 0(5 7 � I 10, (a) Did you recently complete any building renovations? Yes_ No (b) If yes, where? (c) Was building debris stored in the yard? If yes, where 11. Are you planning any building renovations? If yes, where? — OtVa,I 12. (a) Do any household members work in a lead related industry? Yes_ No- (b). If yes, where are dirty work clothes placed and cleaned? Protocol: HUD 97 Reviewed By: Inspector (XRF) Inspector (Scribe) - Input By: BARR & CLARKENVIRONMENTAL Project No. 281205 - - - - -- Project Name: Residence - - Address: 14807 Road, Norwalk, 90650 Date: Inspectors: Matt Crocbet, Form 5.1 Building Condition Form Condition Yes No Roof missing parts of surfaces (tiles, boards, shakes, etc.) Roof has holes or large cracks Gutters or downspouts broken Chimney masonry cracked, bricks loose or missing, obviously out of plumb Exterior or Interior walls have obvious large cracks or holes, requiring more than routine pointing (if masonry) or painting Exterior siding has missing boards or shingles Water stains on interior walls or ceilings Plaster walls or ceilings deteriorated Two or more windows or doors broken, missing, or boarded up Porch or steps have major elements broken, missing, or boarded up Foundation has major cracks, missing material, structure leans, or visibly unsound' *Total number " If the "Yes" column has two or more checks, the dwelling Is usually considered to be In poor condltlon for the purpose of a risk - - assessment. However, specific conditions and extenuating circumstances should be considered before determining the fln I condition of the dwelling and the appropriateness of a lead hazard screen. - Notes: Reviewed By: Inspector (XRF) Inspector (Scribe) Input By: _BARR & CLARK ENTJR ONMENTAL Project No. 281205 Project Name: Residence Address: 14807 1 Road, Norwalk, 90650 Date: Inspectors: Matt Crochet, Form 5.2 Paint Conditions on Selected Surfaces Minnla_Famihr nwnar- hrrunledl Building component Location Notes Paint condition (intact, fair, poor, or not present) to-be completed by risk assessor Deterioration due to friction or impact? Deterioration due to moisture? Location of painted component with visible bite marks Building siding Exterior trim Exterior windows Exterior doors Railings Porch floors Other porch surfaces Interior doors Ceilings Walls Interior windows Interior floors Interior trim Stairways Radiator (or radiator cover Kitchen cabinets Bathroom cabinets' Other surfaces: If the overall condition of a component Is similar throughout a dwelling, that condition should be recorded. If a component In a couple of locations Is in poor condition, but the overall condition is good or fair, the specific sties of the badly deteriorated paint should be noted. The specific location of any component with bite marks should be recorded. - Protocol: HUD 07 Reviewed By: Inspector (XRF) Inspector (Scribe) Input By.: PATRIOT ENVIRONMENTAL LABORATORY SERVICES, INC. Lead Analysis Results In Dust Wipe EPAMetbod 30505/7000A Barr and Clark ReportNumber; . 338896 12684 Hoover Street Project Number: 281205 Garden Grove CA 92841 ProjeotName: i2esidence Project Location: 14807 Rd Norwalk CA 90650 Date Received: ClalmNumber: Date Analyzed _ PO Number; Data Reported: Number of Samples: 3' Date Collected: Lab /Client]D Location MaterinlDescrip Result(gg /ft') 338896 -001 Kitchen • Interior Floor 12x12 Dust Wipe None 291205 -DS l Detected 338896-002 Laundry- Interior Floor 12x12 DustWlpe 11.7 281205 -DS2 - ,t ✓.t David Espique Cristina E. Tabatt Analyst Approved Signatory . Reporting Limit 10 agMvlpe. Pago I of 1 7271 Garden Grove Blvd,, Suite A - Garden Grove, CA 92B41 • Tell 714/899 -8900 Fart 714/899 -7098 www.patrtotlab.com BARR & CLARKENTITRONMENTAL Project No. 281205 Projaot Nante; Residence - Addr�ss; 74807 , • Road, Norwalk, 90650 Date: - - Inspectors; Matt Crochet, REQUEST FOR LABORATORY SERVICES - DUST SAMPLES No, of Samples Collected No. of Samples Submitted 2, Submitted By; Analysis Type: AAS - Report all samples in up Turn Around: (Circle One) A`rnr) RUSH Other_ Sample Number Room; Size of Subsatrl le (Inches x Inches). Surface Type: 'Lab Result due / ft ) 281205 DS 1 (IY��c �Interlor Floor Int. Window 5111 Ext. Window Well Exterior Floor Other 281205 DS 2 � J1 k x �Interlor Floor Int. Window 8111 Ext. Window Well Exterior Floor Other 281205 DS 3 x Interior Floor _ Int. Window Sill _ Ext. Window Well Exterior Floor Other 281205 DS 4 X — Interior Floor Int. Window 8111 EA Window Well — Exterior Floor Other 281205 DS 5 X , Interior Floor Int Window Sill Ext. Window Well Exterior Floor Other Relinquished By: Name: Matt Crochet signature: ^ Date: Received By:��11 Name: lulu � Signature: Date: Protocol: HUp 97 Revicwed By; Inspector(XRP) T Inspector (Scribe) . Input By; Page I of I 7271 Garden Grove Blvd., Suite A Garden Grove, CA 92841 • Tel; 714/899 -8900 Faxt 7141899 -7098 www,patriotiab. com ..... I PATRIOT ENVIRONMENTAL LABORATORY SERVICES, INC. Lead Analysis Result Soil - CPA Method 3080B17000A Barr and Clark Report Number: 338896 12684 Hoover Street - -_ Project Number: 281205 Garden Grove CA 92941 - Project Nemao: Residence Project Location: 14807: ., Rd Norwalk CA 90650 Date Received:` ClairaNumber: Date Analyzed: PO Number: Date Reported: Number of Samploa: 3 Data Collected: Lab /Ctlent 1D Location Material Deserlption Result (mg/kg) 338896 -003 Perimeter Drip Line 18.4 281205 -SSI s _...... David Espique Crlstlna E, Tabatt Analyst Approved Slgaatory ' Roporting Limit t0 mgtkg, Page I of I 7271 Garden Grove Blvd., Suite A Garden Grove, CA 92841 • Tel; 714/899 -8900 Faxt 7141899 -7098 www,patriotiab. com BARB & CLARK ENT .T RON.IVILG`NTAL ProJeatNo.281205 _ PrelectNama;'_ Residence Address: 14807 Road,Nomvalk, 90650, bate:: Inspectors; Matt Croohet, REQUEST FOR LABORATORY SERVICES � S41•L SAMPLES No. of Samples Collected No, of Samples Submitted Submitted By: Analysis Type: AAS Report all samples Pin Turn Around: (Circle One) 24}>r RUSH Other Sample Number Area: Number of. Surface Type: Lab Result Subsamples (at (east a; no more (Ppm) Than 10 281205 SS 1 : _ 5011— Non PIaJ Area ✓fir p Line _Covered Area — _Bare Boll — P1lq Other 281205 SS 2 3olI —NOn Ploy Area T Drip Line — Covered Area Bate Soil— Pho Area Other 281245 8$ 3 Soil —Non Plgy Area _Drip Lino Y Covered Area Bare Boil —Play Area Other 28120b SS 4 Soil — Non Play Area - -Drip Lino _ Covered Ame, Bare Soil —Play Area Other 281205 SS 5 Soil —NOB Plaj Area _Drip Line _ Coveted Area Bate 3oil -Play Area Other Ratinquished By: Name: Matt Oro Signature: Date: 4a= Protocol: HUD 97 Received By: Name: . Signature: Date:� _ Reviewed By: htsptotor (XRi) _ Inspector (Scribe) • Input By: I I BARR & CLARK Independent Environmental Testing Asbestos • Lead • Mold • Phase I ASBESTOS INSPECTION REPORT (SAMPLE) OF SAMPLE RESIDENCE 12345 E. AVENUE LITTLEROCK, CA 93543 PROJECT NO. 290467 NOTE. This is a SAMPLE " Asbestos Inspection Rosemead. This comprehensive report was derived family residence. Prepared For: Client Sample 12345 Circle Drive Any City, CA 99999 Prepared By: ** *SAMPLE * ** Robert Pitzer California Certified Site Surveillance Technician t_'prepared especially for the City of an actual report of a typical single Reviewed By: f ** *SAMPLE * ** Keith Piner California Certified Asbestos Consultant I 12684Hoover Street, Garden Grove, CA 928411 714.894.5700 (t) 714.894.5702 (f) www.barraadelark.com TABLE OF CONTENTS DESCRIPTION 1.0 INTRODUCTION ............................................ ............................... 2.0 SCOPE OF WORK ........................................... ............................... 3.0 PROPERTY DESCRIPTION ..................................................... I.... 4.0 INSPECTOR'S QUALIFICATIONS ............... ............................... 5.0 SAMPLING PROTOCOL / SAMPLE ANALYSIS :....................... 6.0 SUMMARY OF RESULTS .............................. ............................... 7.0 RECOMMENDATIONS .................................. ............................... 8.0 INSPECTION LIMITATIONS ........................ ............................... APPENDICES APPENDIX A LABORATORY RESULT(S) APPENDIX B INSPECTOR'S CERTIFICATE(S) APPENDIX C INSURANCE CERTIFICATE MAP(S) PAGE NO. ....................... 3 ....................... 3 ....................... 3 ....................... 3 ........................ 3 ........................ 4 ........................ 4 ........................ 5 Pmjec[No. 290467 Page 2 of 5 12684Hoover Street, Garden Grove, CA 928471 714.894.5700 (t) 714.894.5702 (f) www.barrandelark.com Asbestos Inspection Report ** *SAMPLE * ** Sample Residence 12345 E. Avenue ASBESTOS INSPECTION REPORT 1.0 INTRODUCTION This report presents the results of Barr & Clark Environmental's asbestos inspection of the Sample Residence located at 12345 E. Avenue, Littlerock, California (Subject Property). This document is prepared for the sole use of Client Sample, and any regulatory agencies that are directly involved in this project. No other party should rely on the information contained herein without prior written consent of Client Sample. The scope of services, inspection methodology, and results are presented below. 2.0 SCOPE OF WORK The purpose of this inspection is to identify and assess accessible Asbestos Containing Construction Materials (ACCM) at the subject property. On October 15, 2012, Barr & Clark performed an inspection for asbestos at the subject property in Littlerock, California Physical bulk samples were collected of suspect materials from representative locations and submitted to an independent laboratory for analysis. If asbestos was detected at any concentration within a sample of a construction material, it was concluded that the material contains asbestos. Suspect materials were also visually inspected to assess their condition. 3.0 PROPERTY DESCRIPTION The subject property is a single family residence that was built circa 1975. It is a one -story building that is constructed over a slab foundation. The exterior walls are covered with stucco and all of the windows are aluminum -framed types. The home consists of four bedrooms, two bathrooms and an attached garage. At the time of this inspection, most of the ACCM were in good condition. 4.0 INSPECTOR'S QUALIFICATIONS Keith Piner of Barr & Clark performed the inspection at the site. Personnel certificate(s) have been provided in Appendix B. 5.0 SAMPLING PROTOCOL / SAMPLE ANALYSIS Sampling Protocol: Sampling was patterned after the Asbestos School Hazard Emergency Response Act (40 CFR 763 Subpart E) as mandated by Cal/OSHA (Title 8 Section 1529) and South Coast Air Quality Management District (Rule 1403). - Page 3 of 5 12684Hoover Street, Garden Grove, CA 928471 714.894.5700 (t) 714.894.5702 (f) www.barrandclark.com Asbestos Inspection Report 'SAMPLE' Sample Residence 12345 E. Avenue e A Sample Analysis: Physical bulk samples were collected from this property and analyzed for asbestos content by Patriot Environmental Laboratory Services, which is accredited by the National Voluntary Laboratory Accreditation Program (Lab Code 200358 -0). The method of analysis was Polarized Light Microscopy (EPA 600/M4 -82 -020). Additional laboratory information can be found on the last page of the laboratory results (Appendix A). 6.0 SUMMARY OF RESULTS Asbestos Containing Construction Materials: Asbestos was detected in samples of several construction materials. The following summary identifies these materials, their location within the property, the condition in which they were observed at the time of inspection, approximate quantity of material and percentage of asbestos contained in the material as reported by laboratory analysis. Material Sample # Location Condition Quantity* % Asbestos Flooring 13 Bath 1 and All Like Good 80 S.F. 20% Flooring Throughout Flooring 15 Bath 2 and All Like Good 80 S.F. 20% Flooring Throughout Flooring 16 Kitchen and All Like Good 95 S.F. 20% Flooring Throughout Roofing Mastic 20 -22 Roof at Penetrations Good 30 S.F. 12% Asbestos Cement Visual Garage Above Water Good 10 L.F. Assumed Pipe(s) Heater *Note: All quantification estimates are approximate and based on information and materials that were accessible at the time of inspection. The chosen contractor is solely responsible for verifying all final ACM quantities for bidding, abatement, and disposal purposes. 7.0 RECOMMENDATIONS ACCM in Damaged or Significantly Damaged Condition: These materials present the greatest risk for asbestos exposure. It is recommended that all damaged areas of these materials be repaired immediately. If it is not feasible to repair these materials it is recommended that they be removed immediately. An asbestos abatement contractor registered with the Division of Occupational Safety and Health should perform any work that disturbs these materials. ACCM in Good Condition: No action is recommended for these materials. Asbestos containing materials that are maintained in good condition present minimal risk for asbestos exposure. r Page 4 of 5 12684Hoover Street, Garden Grove, CA 928411 714.894.5700 (t) 714.894.5702 (f) www.barrandelark.com Asbestos Inspection Report 'SAMPLE' Sample Residence 12345 E. Avenue Note: if renovation or demolition activities are to affect these materials, an asbestos abatement contractor registered with the Division of Occupational Safety and Health should be contracted to perform all portions of the work affecting these materials. 8.0 INSPECTION LUMTATIONS This inspection was planned, developed, and implemented based on Barr & Clark's previous experience in performing asbestos inspections. Barr & Clark utilized state -of -the -art- practices and techniques in accordance with regulatory standards while performing this inspection. Barr & Clark's evaluation of the relative risk of exposure to asbestos identified during this inspection is based on conditions observed at the time of the inspection. Barr & Clark cannot be responsible for changing conditions that may alter the relative exposure risk or for future changes in accepted methodology. Enclosed are the diagram(s), actual test results, and all relevant certifications and licenses. Page 5 of 5 12684Hoover Street, Garden Grove, CA 928411 714.894.5700 (t) 714.894.5702 (f) www.barrandcIark.com Certificate of Analysis PLM Asbestos Identification 7VT Carden OrovdBlvd- SOI Barr and Clark 12684 Hoover. Street Fax: 7 &4.st99,769ti WWW.PavlMabxQMPA7 ReportNumber: 548530 Project Number: 290467 Garden Grove, CA 92841 .. . ...... .. Date Received: Date Analyzed: Number of Samples: 21... Date Reported: Lab/Client IDIL 348530-001 1 PO Number: NA Location Material Description Color Composition (DY DiningRoom, Di-ywqll and Joint te )yh' I 86% Sulfate Compound, 10% Carbonate 7% Cellulose 3% Paint Total Asbestos None Detected 348530-002 Living Room Drywall and Joint White 80% Sulfate 2 Compound 10% Carbonate 7% Cellulose 3% Paint Total Asbestos None Detected 348530-003 Bedroom] Dr ywall and Joint White 80 % Sulfate 3 Compound 10% Carbonate 7% Cellulose 3% Paint Total AsbestosL None Detected 348530-004 Bedroom 2 Drywall and Joint White 79% Sulfate 4 Compound' 11 % CarIhonate 7% Cellulose 3%Paint Total Asbestos None Detected 348530-005 79% Sulfate Bedroom 4 Drywall and Joint White 5 Compound 3 1 % Carbonate 7% Cellulose 3%Paint Total Asbestos None Detected Page I of Certificate of Analysis - 348530 -007 'Bath 2 PLM Asbestos Identification White Tel: 714.8".0100 ' . Eree:: o8s.7a3 -ttae$ _ Fax: 714299 . . - - - tarps' /+vww.Patrtotlatxtoril .. Patriot EmAyarratrental Laboratory Services, Inc. . .. _ .. 7n"I aGarden�Grove.91'uxM.. CR C&rdereCaro!r ,Clt42$4:1. Barr and Clark RepoitNumber: 34'$530. - - 12684 Hoover Street - Project Number: 290467 None Detected Garden Grove, CA 92841 - - - - D ate Received: F. 'Claim Number_ NA Exterior Walls Date Analyzed: Number of Samples'. 23 85 %Minerals Date Reportedr PO Nurn er" N. r a ; - 12% Carbonate - Lab /Client ID /Layer L.oca : Material Description Color Composition ( %) 348530 -006 Bath I -. - Drywall and Joint White _ 79 %n Sulfate 6 Compound I I% Carbonate - 7% Cellulose 348530.009 Exterior Walls Stucco 3% Paint 85% Minerals Total Asbestos None Detected - - 348530 -007 'Bath 2 Drywall and Joint White 79% Sulfate 7 Compound 11 %Carbonate 7% Cellulose i 3% Paint Total Asbestos None Detected 348530 -008 Exterior Walls Stucco - Beige 85 %Minerals I 8 - 12% Carbonate 3 %u Paint Total Asbestos None Detected - - 348530.009 Exterior Walls Stucco Beige 85% Minerals 9 12% Carbonate 3 %Paint Total Asbestos i i None Detected - 348530 -010 Exterior Walls Stucco Beige 85% Minerals 10 12% Carbonate - - 3% Paint - Total Asbestos None Detected - Page of Certificate of Analysis PLM Asbestos Identification B ra dClark 4e1; nUR9,4900 - '.rrece oae.Za3D?J78 . . 1'+Mx /Jw�v��RUYQtiair.Cwal Ratrbtfinvlrommntal FabOM- aryrS+ervlsna, Inc. .9271 C,ardeurt`i {bvec9;;5uiteA �Garden�vrau�.Cft42$4�t - ReporfNumber :348530 12684 Hoover Street Project Number: 290467 " Garden Grove, CA 92841 Date Received: Claim Number:. NA - - Date Analyzed: Number. of Samples:. ,23 Date Reported' V PGNutdber NA - . -. :.. .. Lab /Client 1D /Layer Location - ''. 4 Material.Description 'Color. "' Composition ( 6 / 6 ) 348530 -01] Exterior Walls_ -, . 85% 12% Carbonate 3% Paint Total Asbestos None Detected - 348530 -012 Exterior Walls Stucco Beige 85% Minerals 12. - 12% Carbonate 3 %Paint Total Asbestos . None Detected 348530 -013 - Bath - 1 Flooring. Material White Tan 20 % Linoleum - 13 50% Vinyl Binder 10% Cellulose Chrysotile 20 % - - Total Asbestos 20 %° 348530 -014 Bath 2 Top Layer Flooring Material Light Grey 80% Carbonate 14 20% Vinyl Binder - Total Asbestos None Detected .. 348530 -015 Bath 2 Bottom Layer Flooring Material Beige 20% Linoleum 15 50% Vinyl Binder 10% Cellulose Chrysotile 20 % Total Asbestos 20 % - Page of Certificate of Analysis PLM Asbestos Identification Barr and Clark 12684 Hoover Street Garden Grove, CA 92941 Date Received: Date Analyzed: Date Reported: Lab /Client ID/Layer 348530 -016 16 Kitchen 'FlooringMatenal .. Ten Brovvn - 26% Linoleum " 50% Vinyl - .Binder 10% Cellulose Chrysotile 20 ° /v I Total Asbestos - 20 White 75 % Carbonate I 348530 -017 Bedroom 3 Closet - .Acoustic Ceiling White 75% Carbonate 19 20% Foam 17 _ 5 %Paint Total Asbestos None Detected Black 88% Tar 348530 -018 Bedroom 4 Closet - Acoustic Ceiling_ White 75% Carbonate 20% Foam 18 5 %Paint i Total Asbestos - None Detected - 348530 -019 Bedroom ICloset Acoustic Ceiling White 75 % Carbonate 20 %Foam 19 5% Paint Total Asbestos None Detected _ Black 88% Tar 348530 -020 Roof At Penetrations Roof Mastic 20 Chrysotile 12 Total Asbestos 12 % Location' - Td: 774.899,:999Q ,Treo: 893,743,4978 .. 'hTR�:1 /*vi".vrl�LlaSFdIxC485 . P nInrtBn*oa mentallabomtnrySeMces,.lnc. 1 t?a4deti�{,r omOlv.SulWA drardcnGtarqCA9 t1 . RepottNumber .348530 Proj eot,Numbdr: 29.0467 _ Claim Number: NA: - Number of Samples: 23, - PO Number: NA .. 1 Material Description Colors - Composition ( 0 /6) Page 4 of 5 Certificate of Analysis PLM Asbestos Identification Barr and Clark. - 12684 Hoover Street Garden Grove, CA 92841 Date Received: Date Analyzed: �. Date Reported: - Lob /ClientlD /Layer 348530 -023 23 Claim Numb ers,NA N b f5 I``23 - Tat 7f9499.fl94G Freer 888.74J.M99 F= p 754.899.7b98 : - _: firtgy�w:ti�rcrat6iwtlatwcvm . tcii iinvirorxrnerttal R.aborato y Serrices, Inc .2 7i Gar�oul t~rre5vr'enrd » Stlftn ACrardon Grov CA 4288;1 Report Number: 348530 Projecf.Number: 290467 - - um er o amp es. PO Number;: NA Material Description 'Color Roof .. ,,. Rooting,., - :Black ' 65% Tar 8% Glass Fibers 27 %Minerals Total Asbestos None Detected - 348530 -024 _Roof Roofing Black 65% Tar 24 8% Glass Fibers 27% Minerals Total Asbestos None Detected _ 348530.025 Roof - Roofing Black 65% Tar 25 8% Glass Fibers 27% Minerals Total Asbestos None Detected 348530 -020 Stopped at First Positive Bulk sampie(s) submitted was (were) analyzed in accordance with the procedure outlined hi the US Federal Register 40 CPR 763, Subpart F, Appendix A; EPA -600 /R- 93/116 (Method for Determination of Asbestos in Building Materials), and-EPA- 600/M4 -82 -020 (US EPA Interim Method for the Determination of Asbestos in Bulk Insulation Samples).Samples were analyzed using Calibrated Visual Fstimations (CUES); therefore, results may not be reliable for samples of low asbestos concentration levels. Samples of wall systems containing discrete and separable layers are analyzed separately and reported as composite unless specifically requested by the customer to report analytical results for individual layers. This report applies only to the items tested. Results are representative of the samples submitted and may not represent the entire material from which the samples were collected. "None Detected" means that no asbestos was observed in the sample. " <1 W (less than one percent) means that asbestos was observed in the sample but the concentration is below the quantifiable level of l %. Rosa Mendoza- Analyst CristinaE. Tabatt - Approved By This report was issued by a NIST/NVLAP (Lab Code 200358 -0) and CADOES- ELAP (Cert No. 2540) accredited laeomtory and may not be reproduced without the expressed written consent of Patriot Environmental Laboratory Services, Inc. This report may not be used to claim product certification, approval or endorsement by NISI, NVLAP, ELAP or any government agency. Page 5 of 5 W v � z. MM ^� a �Y g(M a A pp� E^� y Y .p E q A .a s 2 p C4 Qi �, e C C I N � y Ln l� oo Ol N a A pp� E^� y Y .p E q A .a s 2 p C4 Qi Q }`/ \ IQ / m Z f m \ � }� } ) kk � �k \ A/ f� LY. . 00 ON / R ` Q 3 m \ � }� } ) kk � �k \ A/ Q \ /\ q /2/ � m ] .< q § � � .No ). .�. ƒk /> &�A \ \ \ \ \ / « / Q \ \ % \ 2 . � m ] .< q § � � .No ). .�. ƒk /> &�A - a o e o as ® o �1�'A Ppn�x CerHf e, tion r ,Q Tin urtilxaGan was dsued by the t wWon of Oa Atinel Sal6ty sul Hao SsaupwAzed by Sedons MO at wit at His Business and Proleasiods code. ,d►NrrU CERTIFICATE OF LIABILITY INSURANCE �TE3/912012�) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsament(s ). PRODUCER Phone: (7141685 -3200 Paz: (714)685 -32BO Legends Environmental Insurance Services, LLC - CoNTAOr ""Neel Manawil NAME PxoNE (714)685 -3200 F nlc Na: (714)923 -4008 I. Exa. ADDRESS: michaelQlegendsenviro.com 2165 N. Glassell St. INSURER AFFORDING COVERAGE NAICtl Orange, California 92865 INSURERA: American Safety Indernaity Company 25433 ' INSURED INSURER 8: S 1 INSURER C: GENERALAGGREGATE Harr & Clark 12684 Hoover Street Garden Grove, CA 92841 INEURER D S 2000000 IN$URERE: INSURER F: AIROMOBILELIABILRY COVERAGES CERTIFICATE NUMBER: 12 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I TYPE OF INSURANCE AWL SUER POLICYEFF POLICYEXP IMP Wvn POLICY NUMBER fi N1NUDD1YYYYI I NIHIDDlYNNY) LIMITS GENERAL LMBLIW ENV022189.12.02 3/9/2012 3/9/2015 EACH OCCURRENCE S A CONMERCML GENERAL LIABILITY PREMI Ea occunmce S 50000 CLAMS -MADE © OCCUR IV W EXP (Any one paraon) S 5 000 PERSONAL dA]V INJURY S 1 GENERALAGGREGATE $ 2,000, GEN'LAGGREGATEDMR APPLIES PER: PRODUCTS- COMP/OPAGG S 2000000 POLICY PRO- LOC JECT $ AIROMOBILELIABILRY Eee D . IT S BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per aWId8n0 E ALL OWNED SCHEDULED AUTOS AUTOS PROPERN DAMAGE Pereorldenl $ HIREDAUTOS AUTOS E UMBRELLA LIAR OCCUR EACH OCCURRENCE E AGGREGATE $ EXCESS LAS CLAIMS -HARE DEO I I RETENTIONS $ WORKERS COMPENSATION WC STATU- OTH- DRY LIM ANDENPLOYERS'LMeIDTY YIN ANY PROPRIETORIPARTNEIVE(ECUTNE❑ E.L. EACH ACGDENT- S OFFICERINWI ER EXCLUDED? NIA (Mendatoryin NH) E.L DISEASE -EA EMPLOY S E.L.DISEASE- POUCYLIMrr $ If yea, describe order DESCRIPTION OF OPERATIONS below A Professional Liability, — F 3/9/2012 3/9/2015 pnv.ConadaROrLieb, 1 ,000,000 189 -1 - - Clnu Mde RNro Dne ON /94 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Anach ACORD 101, Additional Hamaraa Sella w Hmare a pace Ia rationed) Holder's Nature of Interest: Certificate Holder FOR INFORMATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AND BIDDING PURPOSES 00000 ACORD 26 (2010105) The ACORD name and logo are registered marks of ACORD rights reserved. POLICY NUMBER: ENV022189 -12 -02 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART I 4 4=1111111= Name Of Additional Insured Person(s) Or Organization(s): Location And Description Of Completed Operations Any person or organization with whom the Named Where specified by written contract. Insured enters Into a written contract that requires them to be named as an Additional Insured for Completed Operations Coverage and the contract is executed prior to the start of the project. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II —Who Is An Insured Is amended to include as an additional Insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or 'property damage" caused, in whole or in part, by "your work" at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the 'products- completed operations hazard ". CG 20 37 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 ED THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ENV 98 036 1104 PRIMARY NON CONTRIBUTORY INSURANCE ENDORSEMENT FOR SPECIFIED PROJECT This Endorsement shall not serve to increase our limits of insurance, as described in SECTION III - LIMITS OF INSURANCE. In consideration of the payment of premiums, it is hereby agreed as follows. Solely with respect to the specified project listed below and subject to all terms, conditions and exclusions of the policy, this insurance shall be considered primary to the Additional Insured listed below if other valid and collectible insurance is available to the Additional Insured for a loss we cover for the Additional Insured under COVERAGE A. It is also agreed that any other insurance maintained by the additional insured shall be non - contributory. Any person or organization with whom the Named Insured enters into a.written contract that requires them to be named as an Additional Insured and the contract Where specified by written contract. is executed prior to the start of the project. All other terms, conditions and exclusions under the policy are applicable to this Endorsement and remain unchanged. ENV 98 036 11 04 Copyright© 2004 American Safety Indemnity Company Page 1 of 1 www.amsafety.com POLICYHOLDER COPY P.O. BOX 420807, SAN FRANCISCO,CA 94142 -0807 Z, -; CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 07 -01 -2012 CITY OF ROSEMEAD 8838 VALLEY BLVD ROSEMEAD CA 91770 -1714 GROUP: POLICY NUMBER 1917813 -2012 CERTIFICATE ID; 83 CERTIFICATE EXPIRES: 07 -01 -2013 07 -01- 2012/07 -01 -2013 SP JOB:LEAD & ASBESTOS CONSULTING This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 3 0 days advance written notice to the employer. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions. and conditions, of such policy. Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #1600 - MATTHEW CROCHET, PRESIDENT - EXCLUDED. ENDORSEMENT #1600 - KIMBERLEY CROCHET, VP S T - EXCLUDED. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 07 -01 -2010 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. ENDORSEMENT #2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2012 -07 -01 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: CITY OF ROSEMEAD EMPLOYER BARR & CLARK, INC 12684 HOOVER ST GARDEN GROVE CA 92841 SP SP M0410 (REV.8 -2010) PRINTED : 06 -16 -2012 C LI14amch, CA PMIaO 9290467 BEDROOM 4 +u— MTCHEN '. DINING ROOM . BATH2 6 ' BEDROOMS may OL CL HALL ENTRY OL CL WADE n ROOM - BEDROOM N N A m wx Sample RealEenn A{ ' xl - ' e 'r 12946F.AveRee I V LI14amch, CA PMIaO 9290467 . a BARR & CLARK Independent Environmental Testing Asbestos • Lead • Phase I Lead -Based Paint andlor Asbestos Consulting Request Form (Please Print Clearly) Order Date: Your Name: Company: City of Rosemead Address: Your Project Number. Phone: Fax: Email. Inspection and Subject Property Information (Please check 1comptetealltha :appl Type of Inspection 0 LBP ImpectionlRisk Assessment 0 LBP Clearance (after abatement) 0 ACMInspection 0 ACM Clearance (after abatement) 0 Other: General Information Year Built (appr=): Square Footage (approx.): # of Stories: Occupied: Yes or No (circle one) # of Bedrooms # of Bathrooms # of Units # of Buildings Inspection Reason 0 Assisted Housing 0 Remodel / Repairs 0 New Purchase 0 Other: Planned Rehabilitation (iek-o ) 0 Replace Windows 0 Replace Doorways 0 New Roof 0 Interior Painting 0 Exterior Painting 0 Other: Tyne ofPronerty 0 Single Family Residence 0 Condo 0 Duplex 0 Other: HUD Financial Participation 0 Less than $5,000 0 $5,001 to $25,000 0 $25,001+ 0 Other: Payment Method 0 Check 0 Credit Card 0 COD $ 0 Other Subject Property Address: Site Contact: (Name) (Daytime Phone #) (Evening Phone #) Special Notes / Comments: *Please complete this request form as fully as possible and fax to (7 14) 894 -5702. Thank you!!! ONLINE ORDER FORM AL SO AVAILABLEAT W W W. BA R RA ND CLA R K. COM 12684 Hoover Street • Garden Grove, California 92841 •714- 894 -5700 -Fax: 714- 894 -5702