Resident request form for WTC indoor dust cleaning program, 2002

NYC 9/11 Public Portal Document

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I consent to employees, authorized representatives and contractors of the EPA and contractors of the New York City Department of Environmental Protection (“NYCDEP”) having access to the Residence and the personal property in the Residence, for as long as necessary to conduct dust cleaning, and monitoring activities. I understand that these activities are to be performed in accordance with the roles of EPA and NYCDEP under the Federal Response Plan and the authority of the Robert T. Stafford Disaster Relief and Emergency Assistance Act, 42 U.S.C. § 5121 et s^

I agree to obtain any required permission for cleaning and monitoring activities from my building management if such permission has not been obtained by NYCDEP’s monitoring contractor (“Project Monitor”) prior to the commencement of work in the Residence under the Program. I also agree to inform the Project Monitor at least one business day prior to the scheduled work of any building rules that are applicable to tlie Program, including, for example, time restrictions, appropriate entrances to the building, and\elevator usage.

I agree to notify the Project Monitor as early as possible, but no later than one business day, before the scheduled date for the work inthe Residence, if it is necessary to cancel the date for the cleaning and monitoring activities. - \ I agree .Z use best efforts to ensure the safety and security of fragile and valuable objects, including

bufnot limited to jewelry, silver, fine china, decorative objects and art works located in the Residence. Such efforts will include, but not be limited to the following: Prior to the date scheduled for commencement of cleaning and monitoring, I agree to remove valuable and/or fragile objects from the Residence and/or to secure them in sealed containers for protection. I agree to identify with specificity to the Project Monitor any valuable or fragile objects that cannot be moved or secured, or that require special handling, prior to the commencement of the cleaning and monitoring in order to make provision for their safety and security. Such identification shall be in writing and shall state the estimated value of all the objects listed.

I understand that the cleaning and monitoring will be performed by contractors retained by NYCDEP. I also understand that the contractors performing cleaning and monitoring activities are required to maintain insurance coverage for commercial general liability, workers compensation and environmental impairment liability related to this work, and that they are also bonded to cover loss by theft or destruction of property. The contractors are required to maintain such insurance at all times that they are conducting cleaning and monitoring activities in the Residence.

I understand that the Program activities will require access to all the interior spaces, surfaces and personal property and use of electricity and water within the Residence. Cleaning activities will be performed throughout the entire Residence, including but not limited to the living room, bedroom(s), bathroom(s), dining areas and kitchen, as well as inside closets.

I understand that the Program will employ various methods of dust removal from all surfaces, including, hut not limited to, vacuuming, steam cleaning and wet wiping. The cleaning will address areas and items such as walls and wall hangings, floors and floors coverings, draperies and window

NYC-WTC_000140940