HVAC cleanup proposal for residential units, Feb 2003

NYC 9/11 Public Portal Document

SEP-05-2002 15:02 FROM DEP LEGAL TO 4422 P.05/06

REQUEST EORM FOR WORLD TRADE CENTER INDOOR DUST CLEANING PROGRAM

Name of Authorized Building Representative

Address New York, New York

Telephone Number:

REQUEST As authorized representative for the Building, I have read the fact sheets (Clsanin^ and Testift^Fast. Sheet. Common Area and HVAC) on the World Trade Center Indoor Dust Cleaning Program ("Program”) and considered the information provided to me by the U.S. Environmental Protection Agency (“EPA”). Having considered the cleaning and monitoring offered, the Building would like to participate in the following cleaning and monitoring alternatives under the Program.

Initial one of the following:

I request dust cleaning of tire Building identified above and monitoring after the cleaning.

OR

I request monitoring of the Building. AGREEMENT 1 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 Building and the personal property tn the Building, 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. § S121 et ssg.

I agree to inform the Project Monitor at the schedulhig meeting of any building rules that are applicable to ths Program, including, for example, time restrictions, appropriate entrances to the building, and elevator usage. I agree to notify die Project Monitor as early as possible, but no later than three business days, before rhe scheduled date for the work in the Building, if it is necessary to cancel the date for the cleaning and monitoring activities.

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, employee dishonesty and environmental impairment liability related to this work. The contractors are required to maintain such insurance at all times that they are conducting cleaning and monitoring activities in the Building. The contractors are responsible for damage or loss of property.

NYC-WTC_000148066