Form with illegible text and reference number NYC-WTC_000155837

NYC 9/11 Public Portal Document

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CLEANING REQUEST FORM On behalf of myself and any other residents of apartment ____ , 125 Cedar Street, Manhattan (the “Residence”), I hereby request that the New York City Department of Environmental Protection (DEP) perform the cleaning and monitoring work specified in the attached documents entitled “cleaning Procedures for 125 Cedar street” and “Monitoring contractor - Scope of Work for 125 Cedar Street” (the “cleaning Work”) in said apartment. To facilitate the performance of the Cleaning Work, I agree to the following: 1. Employees, authorized representatives, and contractors of DEP shall have access to all areas of the Residence and all personal property in the Residence for as long as necessary to perform the cleaning Work. 2. The cleaning Work is to be performed in accordance with DEP’s role under the Federal Response Plan and pursuant to the authority of the Robert T. Stafford Disaster Relief and Emergency Assistance Act. 3. I will inform DEP as to any considerations which would affect the Cleaning work, including, for example, time restrictions, appropriate means to access the Residence, and elevator usage. 4. The cleaning Work will be performed by contractors retained by DEP. Said contractors are required to maintain, at all times during the cleaning work, insurance coverage for commercial general liability, workers compensation and environmental impairment liability related to the cleaning Work, and are bonded to cover loss by theft or destruction of property. 5. The Cleaning work will require use of the Residence’s electricity and water. 6. Insurance payments or any other form of compensation received by the Building owner which have been or will be received for activities covered by the Cleaning work and which have not been spent for such purposes will be paid to DEP. 7. I will use best efforts to ensure the safety and security of fragile or valuable objects located in the Residence, including but not limited to jewelry, silverware, fine china, decorative objects and works or art. such efforts will include, at a minimum, either the removal of such items from the Residence prior to the beginning of the Cleaning work or the securing of such items in sealed containers. I will identify in writing to DEP all fragile or valuable objects which cannot be removed or secured as described above so that provision may be made for their protection. The estmated value of such objects shall be i ndi cated.

DRAFT NYC-WTC_000155839