Request form for WTC indoor dust cleaning program, date unknown

NYC 9/11 Public Portal Document

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» REQUEST FORM FOR WORLD TRADE CENTER INDOOR DUST CLEANING PROGRAM

Name of Authorized Building Represe

Address

New York, New York

Telephone Number:

REQUEST

As authorized representative for the B Sheet, Common Area and HVAC) o (“Program”) and considered the infom Agency (“EPA”). Having considered participate in the following cleaning a

Initial one of the following:

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

OR

I request monitoring of the Building.

AGREEMENT

I consent to employees, authorized representatives and contractors oi Department of Environmental Protection (“NYCDEP") and contracto the Building and the personal property in the Building, for as long as and monitoring activities. I understand that these activities are to be roles of EPA and NYCDEP under the Federal Response Plan and the Disaster Relief and Emergency Assistance Act, 42 U.S.C. § 5121 a

I agree to inform EPA or its representatives or NYCDEP’s contractor । the Project Monitor of any building rules that are applicable to the Pro restrictions, appropriate entrances to the building, and elevator usage. contractors retained by NYCDEP as early as possible, but no later thar urvivic me 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 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 Building.

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