Form XIII-15 ASBESTOS/HAZARDOUS MATERIALS SURVEY

Form XIII-15
ASBESTOS/HAZARDOUS MATERIALS SURVEY AGREEMENT
THIS AGREEMENT (“Agreement”) is dated __________________ 20___ by and between
___________________ (“Contractor”), with a mailing address of ________________________, OH 44___,
and _________________ County Land Reutilization Corporation (“Owner”).
WHEREAS, Contractor is licensed and certified by the State of Ohio to conduct
asbestos abatement projects (License No. ____________). All persons working on any asbestos
abatement project on Contractor’s behalf are also licensed and certified by the State of
Ohio.
WHEREAS, Contractor proposes, and Owner accepts Contractor’s proposal to
perform the following Work (as hereinafter defined) for the price quoted below.
The price agreement will be in effect from the time of contract signing to December 31,
2011. Prices are as follows:
Building Size
Price
1-3 family
$425 each
1-3 family (2 on one lot)
4-6 units
$350 each
$800 each
Commercial/Mixed Use
$ 0.35/sf
SCOPE OF WORK
PROJECT DATE(S): Commencing _______________, and completion approximately December
31, 2011. The owner commits to provide a minimum of _______ survey requests to the
contractor during the aforementioned time period. The promised survey quantities apply
to residential properties. Surveys of commercial properties will be requested on an asneeded basis. All survey reports will be provided to the owner in the format outlined and
attached (Attachment 1).
PROJECT LOCATION(S): as described in the applicable proceed order(s).
The scope of works shall consist of the items below that describe the requirements
of the work required for the owner which may from time to time change as the Ohio
Department of Health, the Ohio Environmental Protection Agency, and or the U.S.
Environmental Protection Agency change or update guidelines and or requirements for
asbestos surveys and related work.
a. Confirm with the owner or owner’s representative the exact area under
investigation, exact nature of demolition/renovation and identify all materials that
will be disturbed or accessed.
b. Determine and investigate each building’s structural, mechanical, and roofing
systems that are to be disturbed.
c. Perform a comprehensive investigation of areas to identify suspect materials to be
sampled and/or assumed to contain asbestos.
d. Create a sampling plan based on suspect materials present and requirements of 40
CFR 763.86.
e. Collect bulk samples of all suspect materials that will be disturbed and not assumed
to be asbestos and submit them to a certified laboratory for analysis.
f. Document where asbestos materials exist and record their exact location, condition
and quantity. “Condition” shall include a physical assessment to determine whether
or not each asbestos material is “friable.”
g. Document all sampled materials found to be negative for asbestos, including original
location, condition, and quantity.
h. Identify the different building systems which may involve concealed asbestos
materials such as the heating/cooling system, domestic water lines, roof drainage
lines, miscellaneous piping lines, underlying roofing, etc.
i.
Open hidden areas and inspect each system in at least three (3) locations for each
area of construction.
j.
Focus the inspection on likely areas for suspect materials (i.e. where insulated pipe
enters walls or ceilings, behind heating units, etc.).
k. Examine additional areas if results of inspection are inconsistent.
l.
List all concealed areas which have not been inspected, and explain why they were
not inspected. Reasons why may include: (1) records showing recent access to such
spaces and sample results, (2) safety hazards, and (3) restrictions imposed by the
property owner.
m. Contractor agrees to supply all labor, supplies, expertise, supervision, work
scheduling, and financial invoices to the Owner within two weeks(at least monthly if
performance of the Scope of Work exceeds two weeks in duration) related to the
Scope of Work from the date of the proceed order issued for each survey.
n. Contractor agrees to do the work in a workmanlike professional manner, and shall
hold harmless, defend and indemnify Owner for any losses, claims, liabilities and
enforcement action as a result of acts or omissions or negligence of Contractor.
Contractor shall supply owner with a Certificate of Insurance evidencing
Contractor’s insurance covering Contractor’s work.
This Contract may not be assigned by Contractor under any circumstances. Only the Owner
may assign or transfer this Contract.
WHEREOF, the parties signed this agreement this _____ day of ___________, 20____.
Date______________________
Contractor
by: ____________________________
Title: __________________________
Date______________________
_____________ County Land Reutilization
Corporation, Owner
by: ____________________________
Title: __________________________
Attachment 1: Required Format
Asbestos Survey Report
(Note: Title Page to be provided by CLRC
with each assignment)
Prepared For
____________________ County Land Reutilization Corporation
[ADDRESS]
[phone/fax]
Photo to be provided
Project Location:
.
Parcel Number:
.
Building Description: .
Year Built:
.
Approximate SF:
SF
Date of Survey:
.
Prepared By
Name, Title:
Company Name:
Address:
Phone, Fax:
E-mail:
.
.
.
.
.
Asbestos Survey Report for _________________________________ PPN _________________
Date of Submittal:
_________________________________________________________
Please complete the following sections, appending required documentation:
Scope of Work and Methodology
(A narrative of work undertaken and methods used, including date of survey and no. of
samples taken)
Summary of Findings
(Please provide: a. a summary narrative of findings, including type and amount of
abatement required; include a table showing sample description, location, analytical
lab results; b. laboratory reports and documentation; c. certifying signature; and, d.
license number of the responsible ODH Certified Asbestos Hazard Evaluation Specialist)
using the following format:
Name of Certifying Officer:
License Number:
Signature:
________________________________________
Photographs and/or Drawings (where needed to highlight areas of concern)
(At minimum, provide photograph of front of house and also, core areas of concern/
contamination, such as hot plaster, pipe wrap, tape, transite, in order to document
existing conditions)