CONTRACT_v1Store 3413 LOWE'S OF NORTH MIAMI BEACH, FL
850 NORTH MIAMI BEACH BLVD
NORTH MIAMI BEACH, Florida 33162
Contract
Prepared for:
78 Nw 107th St
Miami Shores, Florida 33168
8327050949
Prepared by:
Chad Ayers
786-756-2743
chad.e.ayers@lowes.com
WWW.LOWES.COM
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FLORIDA SERVICES SOLUTIONS INSTALLED SALES CONTRACT
LOWE'S AUTHORIZED REPRESENTATIVE SALES ID DATE
Chad Ayers 186554 01/31/2024
STORE NO.STREET ADDRESS
3413 850 NORTH MIAMI BEACH BLVD
CITY STATE ZIP
NORTH MIAMI BEACH FLORIDA 33162
TELEPHONE
786-756-2743
EMAIL
chad.e.ayers@lowes.com
LOWE'S CONTRACTOR LICENSE #LOWE'S REPRESENTATIVE LICENSE #
CGC1508417 (Certified GC),
CGC1531687 (Certified GC),
CCC1326824 (Certified Roofing
Contractor) and #5990 (Valparaiso)
CUSTOMER NAME
Ross Chuchla
STREET ADDRESS
78 Nw 107th St
CITY STATE ZIP
Miami Shores Florida 33168
TELEPHONE
8327050949
EMAIL
mflamingo305@gmail.com
CREDIT/DEBIT CHECK LCC CARD GIFT CARD
This is only a quote for the merchandise and services printed below. This becomes an agreement upon payment and issuance of a
Lowe’s receipt, upon pay-ment, the entire agreement, including the specifically completed pages of this document, the Terms and
Conditions included with this document and any other addenda and attachments hereto, shall be referred to herein as this “Contract."
PLEASE READ THIS ENTIRE DOCUMENT, INCLUDING THE “NOTICES," “TERMS AND CONDITIONS," AND “ADDENDUM"
CONTAINED WITHIN THIS CONTRACT ON THE FOLLOWING PAGES BEFORE SIGNING.
INSTALLATION STREET ADDRESS CITY STATE ZIP
78 Nw 107th St Miami Shores Florida 33168
Lowe's does not offer services to paint, seal or stain fences.
MERCHANDISE AND INSTALLATION SUMMARY: (I.E. ITEM NUMBERS, COLORS, DIMENSIONS, CONSIDERATIONS):
Fencing
Product
Is the removal of any fencing or fencing materials being performed? Yes
If the fence is painted, can the customer verify that the fence was not painted prior to 1978? Yes
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NA
Fencing Project
Installation of Vinyl Privacy Fence
Fence Style: 6’
Linear Feet:283
Color: Driftwood (6x8 Panels Model #73045584)
Gates: 1 Double Drive 2 Walk
Lead time: Aiming by March 1st depending on permit
Removal of old fence
What’s included in cost of project:
•Installation of Selected Fence
•Setting Posts in Concrete
•Installation of Gates and Gate Hardware
•Ensure Proper Function of Gates
•Lowe’s Delivery
Basic Labor
•Test to ensure proper operation of gates
•Final clean-up of job site (does not include debris from line clearing, old fence or dump fees as may be required
locally).
•Dirt from post holes will be spread over new post area
•Installation of fencing to manufacturers specifications and to local code. Only fencing styles offered by
manufactures that
•meet pool fence code. See SOS catalog for approved fence styles.
•Setting all posts in concrete
Additional labor included
•Labor for concealed foundations, punch through concrete/asphalt/core drill
•Clear/haul away debris from fence line
•Remove/haul away of old fence (cut off old post just below grade & covering with dirt)
•Completely remove old concrete plugs and back fill with dirt
•Tension wire at bottom of chain link fencing Installation of fence on concrete or asphalt surface
•Permit (if required
Payment Options
•Lowe’s cards, major credit cards, cash, check
•Lowes’s card
•120-month payment, 9.99%: $
•84-month payment, 9.99%: $
•60-month payment, 8.99%: $
•36-month payment, 7.99%: $
•LAC approval required
•Other payment options are available on an approved Lowes account.
•Credit cards and Lowes cards can be remote tendered
•Cash and checks must be paid in store
Next Steps
•Our independent contractor will call you to schedule a measurement
•Once we receive measurements back, one of our coordinators will call you to finalize the sale and collect payment
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(payment is due in full)
•Your Product is in! Your installer calls to schedule your project
•The installer completes installation of your project and walks you through to ensure your satisfaction
•You sign a Certificate of Completion
•Your Project coordinator calls to confirm your satisfaction before paying the installer
Review
•Sales tax if applicable is not included in this quote
•The cost of the project could change after the contractor’s visit due to any unforeseen circumstances or changes to
the project.
Project Preparation Process
◼ Dedicated project support staff keeps you up-to-date through every step of the process
◼ Installer conducts Pre-Installation Inspection
◼ Provides appropriate protection to home during installation
◼ Obtain & post any necessary permits
Installation Process
◼ Mark and prepare post hole locations
◼ Install posts and backfill holes with concrete
◼ Install fence material (gates, hardware, fasteners, etc.)
◼ Remove/haul away existing fencing material
◼ Follow all Health and Safety Guidelines
Clean-up/Final Inspection
◼ Complete final clean-up and haul away all job-related debris
◼ Test product & perform complete inspection with customer
◼ Review warranty information
Work is to commence upon reasonable availability of Contractor and/or any special order or customer made Good(s) which is
anticipated to be . Estimated completion date is .
CONTRACT TOTAL
Payment (100%)
$16,589.66
$16,589.66
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This Contract provides that You and Lowe's will resolve all claims by BINDING
ARBITRATION. You and Lowe's GIVE UP THE RIGHT TO GO TO COURT to enforce this Contract (EXCEPT for matters
that may be taken to SMALL CLAIMS COURT). A NEUTRAL ARBITRATOR will determine Lowe's and Your rights and
NOT
LIMITED THAN RULES APPLICABLE IN COURT. Arbitrator decisions are as enforceable as any court order
and are subject to VERY LIMITED REVIEW BY A COURT. FOR MORE DETAILS: Review the sections titled
ARBITRATION AGREEMENT, WAIVER OF JURY TRIAL AND WAIVER OF CLASS ACTION found in the Terms and
Conditions of this Contract.
If this Contract includes Goods and related Installation Services sold by unit of measurement,
such as per square foot, the Price may include more Goods than the actual measurements of Your project area. The Price
includes the total amount of Goods required by Lowe's to fulfill the Contract (including surplus materials and overages)
(together the ) and the Installation Services required based upon this total amount of Goods. For
instance, a 120 square foot room may require 140 square feet of carpet to properly match the carpet seams, pattern, or
unique room characteristics, and the Price would include Installation Services based upon the 140 square feet of carpet. The
total amount of Estimated Product is based upon the total Goods recommended by the Installer, based on the Installer's
assessment of unique characteristics of Your project. If any usable Goods are left over, Lowe's may, at its discretion,
initiate a Price adjustment. Lowe's will not adjust the Contract Price for the related Installation Services. By signing this
Contract, You acknowledge You are aware of Your project area measurements and the amount of Estimated Product, and
that the Estimated Product may exceed Your actual project area. If Your project includes the installation of flooring
materials, by signing this Contract You further acknowledge having received a completed Flooring Detail Diagram (the
) prior to execution of this Contract. Upon request, Lowe's can provide You with additional copies of the Diagram, which
identifies the square footage of Your project area and the square footage of the Estimated Goods.
By signing this Contract, You grant to Lowe's, its representatives, and Installer the right to take and use
photographs, videos, or other representations of the Premises before and after the Installation Services and all work
copyright), title, and interest in the Content for use in all markets and media, worldwide, in perpetuity. Lowe's can use the
Content, in any form or medium, internally for any purpose (e.g., customer service, planning, and claims).
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prior to signing Contract.
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Installation Contract defines what You can expect in Your installation experience with what expects in return,
accepting Goods or Installation Services You are agreeing to be bound by this Contract. IF YOU DO NOT AGREE TO ALL OF THE
INSTALLATION SERVICES.
COMMON DEFINITIONS.Capitalized terms used in this Contract will either have the following stated meanings or will be
defined throughout the Contract.
Contract includes (a) any applicable State Addendum, (b) these Terms and
Conditions, (c) any documents expressly referencing and made a part of this Contract, e.g., fully executed Change
Orders, or incorporated by reference in the Contract (d) the cover page, the Merchandise and Installation Summary, and
inconsistency between these documents, the first document to appear in this definition shall take precedence; i.e., any
State Addendum shall take precedence, whether supplementing or modifying, over any conflicting provision of these
Terms and Conditions, and so on. The Contract does not include any correspondence, advertisements, quotes, or
estima
Services. The Contract replaces and supersedes all earlier written agreements and all oral agreements, whether earlier
or at the same time as this Contract, concerning the Goods and related Installation Services.
You Your(s)and Customer all mean the person executing this Contract to purchase Installation Services.
Goods Installation Services. A list of the Goods
appears on the Merchandise and Installation Summary.
Installation Services
Installation Services include delivery, handling, return, and selection and placement of Goods.
Installer
licensed when legally required, and will direct, control, and perform the Installation Services directly or through its
its employees, or its agents or subcontractors.
Limited Liability Company located at
56-0748358.
"Premises" means the Installation Address You identify where the Installation Services will occur.
Price means the Contract Total stated on the Merchandise and Installation Summary and is the complete payment due
for the Goods and Installation Services.
SCOPE.
subcontractors. Installer
Services do not include architectural or engineering services. Installer will complete Installation Services, subject to any
changes, in substantial conformance with the Merchandise and Installation Summary. reserves the right to terminate
contemplated.
EXCLUSIONS.Neither nor Installer is responsible for start or finish delays resulting from events beyond their control
including but not limited to: Change Orders, acts of nature, governmental actions, manufacturing or delivery delays or damage
to merchandise caused by third parties, labor strikes or unrest, Your credit or financing, any incorrect information You provide,
legal encumbrances on Your property, Your property's nonconformance with zoning requirements or building code
requirements, hidden or unforeseen physical or hazardous conditions (including but not limited to, environmental hazards
such as mold, asbestos, lead paint, unsound structures or points of attachment) at the Premises, or Your noncompliance with
right to terminate this Contract and/or require Installer to discontinue Installation Services given any of the conditions listed
above.
PRICING.
You sign the Contract. When the initial Price does not include all applicable charges, for example, if You order online,
have the opportunity to cancel any unperformed portion of the Contract and receive a refund for that portion. The Price
includes only those Goods and Installation services necessary to complete this Contract.
GOODS. Title to Goods does not pass to Customer and remain the property of until Goods are installed in Customer's
home, building, or on Customer's property. Customer agrees Contract is being offered for the total Price. Customer further
agrees any surplus materials upon completion of the Installation Services are not the property of customer and, if instructed
by Lowe's, such surplus materials shall be returned to Lowe's by the Installer. Upon request from Customer at the time of job
completion, Lowe's, in its discretion, may allow all or part of the unused, receipted surplus materials to be retained by the
Customer.
TERMS AND CONDITIONS
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PAYMENT.You must pay the Price in full upon execution of this Contract. Payment for any Change Order or replacement
contract is due at the time of that Change Order or replacement contract.
LICENSES, PERMITS, AND OTHER REGULATORY REQUIREMENTS. Installer will obtain any and all licenses,
Local Requirements
-party service. You agree to pay any fees
associated with the Local Requirements and to cooperate in any required inspection or permitting process. The Installer, and
codes,
Local Regulations
Regulations that exist at the time of Your signing this Contract. This Contract creates no obligation to correct these pre-
existing violations. Any change in the Local Regulations may require a Change Order, and may result in an increase in the
Price. Neither Low nor Installer willperform anyadditional work after completion of the Installation Services due to changes in
the Local Regulations.
UNDISCLOSED CONDITIONS.You represent that there are no defects, weaknesses or dangerous conditions, some
examples of which are mold, mildew, rot, asbestos, and infestation, in the Premises' structure, substructure, superstructure, or
points of attachment .has formulated the Price based on this representation. If
discovers an Undisclosed Condition before completing the Installation Services, You must remedy the Undisclosed Condition
hire
an in
satisfaction then L may terminate or rescind this Contract. If terminated or rescinded,has no obligation to return
the Premises to the original condition. If terminates or rescinds the contract before delivering Goods or beginning the
terminates or rescinds the contract after delivering Goods or beginning the Installation Services, title of the Goods passes to
exchange for Goods You validly return. You will have thirty (30) days from any termination or rescission to return any standard
Goods in the original, unopened condition for refund or credit.
RETURNS.The return period for Goods
purchased in connection with this contract begins upon completion of the project.
www.lowes.com/returns. Custom and special-order Goods may be subject to a restocking fee if returned. Custom Goods
include Goods altered, color-matched, shaped, sized, cut, or otherwise designed or fitted to accommodate the requirements
of a particular space or environment. Some examples of custom Goods are cabinets, countertops, floor and wall coverings,
and window treatments.
CHANGES AND CHANGE ORDERS.
subject to a Change Order and additional amounts payable by You to Any changes to Installation Services or Goods,
g., a
document that clearly defines the scope of the change, any difference in the Price, and new start or finish dates where
applicable Or Change Orders are only binding on if signed by both You and and will become
part of this Contract once signed.
YOUR WARRANTY TO AGAINST VIOLATIONS OF EASEMENTS, COVENANTS, AND THIRD PARTY RIGHTS.
You warrant that performance of Installation Services will not violate any existing real property easement, covenant, historic
district regulations, homeowner's association rule or rights of third parties holding an interest in the Premises or otherwise,
and that You have the rights and authority to enter into this Contract.
CUSTOMER RESPONSIBILITIES. You agree:
To Pay only You agree to pay and only for any Goods and Installation Services, even if Installer
provides a new Contract or Change Order for your review and signature. Installer may collect payment on behalf,
but you agree not to pay the Installer separately or directly. This Contract is solely between you and
To Locate Lines and Hazards.Before Installer begins Installation Services, You will identify and mark the location of
utility lines, for example electrical, plumbing, and gas lines, and property lines that could impact the Installation Services.
To Ensure Compliance with Smoke Alarm and Carbon Monoxide Detector Requirements.Prior to the start of the
Installation Services, You will ensure the Premises have all necessary carbon monoxide detectors and smoke alarms
ler to obtain the necessary permits and complete the Installation Services. You are
solely responsible for the proper number, placement, type, functioning, operation, installation, testing, as per the
specifications, and maintenance of any Detectors required by Local Regulations. Failure to meet Federal,
state or local Detector requirements, if any, will be considered an Undisclosed Condition.
To Provide a Safe and Proper Working Environment.Before and during the Installation Services, You will ensure that
work areas are free of vermin, pre-existing physical or environmental hazards, and violations of Local Regulations. You
will allow the Installer to have access to work areas and restrooms. You will provide climate control, where applicable,
and electricity to the work areas. You agree not to allow unattended minors at the Premises during the Installation
Services. You agree to control and keep pets away from work areas. You agree to keep posted permits on display at all
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To Sign the Certificate of Completion. Once the Installation Services are complete, You agree that You will sign a
Certificate of Completion upon a request from
Not to Assign or Transfer this Contract.You cannot give Your rights under this Contract to anyone else.
If you have a claim that is in any way related to this Contract, You must make
attempt resolution of any claim(s) within sixty (60) calendar days of receiving Your notice.
That You Are Responsible If You Choose to Help.YOU ASSUME THE RISK AND THE FULL LIABILITY OF
PHYSICALLY ASSISTING WITH DELIVERY OF THE GOODS OR WITH PERFORMANCE OF THE INSTALLATION
SERVICES.
MANUFACTURER WARRANTY FOR GOODS.You are entitled to any warranty provided by a manufacturer of the Goods
the Goods, and You may also obtain such information by contacting Lowe's.LOWE'S DOES NOT WARRANT THE GOODS
AND EXPRESSLY DISCLAIMS ALL WARRANTIES, EXPRESSED OR IMPLIED, INCLUDING WITHOUT LIMITATION
THE IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE.
LOWE'S LIMITED WARRANTY FOR INSTALLATION SERVICES. Lowe's warrants that the Installer will perform the
Installation Services in a good and workmanlike manner. Lowe's warranty for Installation Services extends for a period of one
year (two years for roof replacement) from the earlier of (i) the date You sign the Certificate of Completion or (ii) the date that
Lowe's determines that theInstallation Services have been completed, or for such greater period as required by an extended
warranty, if any, or byapplicable law governing consumer warranties for workmanship (the "Warranty Period").LOWE'S
WARRANTY THAT THE INSTALLER WILL PERFORM THE INSTALLATION SERVICES IN A GOOD AND
WORKMANLIKE MANNER DOES NOTCOVER, AND LOWE'S IS NOT RESPONSIBLE FOR, ANY DEFECT IN SUCH
INSTALLATION SERVICES DUE TO (1) AN UNDISCLOSED CONDITION OR OTHER PRE-EXISTING PHYSICAL OR
ENVIRONMENTAL HAZARD, OR (2) ABUSE, MISUSE, NEGLECT, OR IMPROPER CLEANING. LOWE'S WARRANTY
FOR INSTALLATION SERVICES IS IN LIEU OF ANY OTHER WARRANTY, EXPRESS OR IMPLIED, INCLUDING
WITHOUT LIMITATION ANY IMPLIED WARRANTY OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR
PURPOSE.
LIMITATION OF LIABILITY.For any claim related to this Contract, You can only seek recourse from Lowe's or the Installer;
no parent or affiliate of Lowe's shall have any liability under this Contract. You must give Lowe's written notice within the
n
Services performed again, including any necessary repair and replacement of Goods, to correct the defective Installation
OU
SHALL HAVENO OTHER REMEDYFOR AWARRANTYCLAIM,INCLUDING WITHOUT LIMITATIONREMEDYFOR LOSS
OR DAMAGE CAUSED BY NORMAL WEAR AND TEAR, LOSS OR DAMAGE WHICH HAS NOT BEEN REASONABLY
MITIGATED, OR LOSS OR DAMAGE CAUSED BY ACTS OF GOD. IN NO EVENT SHALL LOWE'S BE LIABLE FOR
INDIRECT, PUNITIVE, CONSEQUENTIAL OR INCIDENTAL DAMAGES (SUCH AS, WITHOUT LIMITATION, LOST
PROFITS, LOST SALES, COSTS ASSOCIATED WITH PROJECT DELAYS, AND INJURIES TO PERSONS OR
PROPERTY), EVEN WHERE LOWE'S HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES. WHERE, DUE
TO OPERATION OF LAW, SUCH DAMAGES CANNOT BE EXCLUDED, THEY ARE EXPRESSLY LIMITED IN AMOUNT
TO THE PURCHASE PRICE. For warranty claims, You agree to prepare the Premises and the work area in the manner
ARBITRATION AGREEMENT, WAIVER OF JURY TRIAL, AND WAIVER OF CLASS ACTION RIGHTS.
contact Your Lowe's salesperson first or the manager of the Lowe's store that fulfilled Your order.
All claims by You, Your agents, insureds or assigns, or Lowe's related to this Contract, which You and
s cannot resolve informally shall proceed to binding
arbitration conducted by a single arbitrator under the current applicab
(www.jamsadr.com www.adr.org). You agree that if either JAMS or AAA is
unable or
n firm to arbitrate the matter. Claims subject to binding arbitration include:
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You owe;
(7)all claims asserted by You individually against Lowe's or any of Lowe's employees, agents, directors, officers,
shareholders, managers, members, parent company, or affiliated entities (collectively the "related third parties") or
the Installer, including claims for money damages and/or equitable or injunctive relief;
(8)all claims asserted on Your behalf by another person;
(9)all claims asserted by or on behalf of You as a private attorney general against Lowe's, related third parties or the
Installer;
(10)all claims arising from or relating directly or indirectly to the disclosure by Lowe's, related third parties or the
Installer of any non-public personal information about You; and
(11)all other claims related to this Contract whether or not set forth above. If the dispute falls within the jurisdiction
of a small claims court the claimant may, at its option, choose to arbitrate or file a small claims action. Any appeal of
a judgment from a small claims court shall be resolved by arbitration as provided by this Contract.
Binding arbitration means that You waive: (1) any right to a jury trial; (2) any right to bring a lawsuit in a court (other
than a small claims court as described above); and (3) any right to seek relief in any other way. An arbitrator will
decide any claim not decided by a small claims court. You agree that binding arbitration provides a simple, cost
effective method to resolve disputes quickly.
You agree that (1) You cannot pursue a class action lawsuit or class action arbitration of any type, (2) no one can
pursue a class action lawsuit or class action arbitration of any type on Your behalf, and (3) a Court or arbitrator(s)
cannot order class action proceedings under this Contract. You further agree that there shall be no joinder of parties,
except for joinder of parties to the transaction covered by this Contract. By agreeing to binding arbitration You and
Lowe's waive any right to bring or participate in a class action lawsuit or class action arbitration regarding any claim.
How Arbitration Works:
Lowe's may demand arbitration by sending written notice to You at the address listed in this Contract. You may demand
arbitration by sending written notice to Lowe's at the following address: Mail code NB6LG, P.O. Box 1000, Mooresville, NC
28115. The arbitration shall occur in the city or county of the Premises.
Lowe's shall pay the filing, administrative, hearing, and arbitrator's fees associated
with the arbitration.are
each responsible for their own attorneys' fees and other expenses, such as witness and expert witness fees.
Either party may request that the arbitrator provide a written explanation of the award,
consistent with the then current rules, procedures, and protocols of the arbitration entity selected by the parties. Any
court having jurisdiction may receive and enforce the arbitrator's award. If You fail to pay Lowe's in accordance with this
Contract, You agree that Lowe's can recover its reasonable attorneys' fees as provided by N.C. Gen. Stat. Section 6-21.2 or
other controlling law. The parties agree that this arbitration agreement is made in connection with a transaction involving
interstate commerce and that the Federal Arbitration Act, 9 U.S.C. Sections 1-
laws of the State of North Carolina shall govern this
arbitration agreement.
all claims in any way related to the signing of this arbitration agreement, the validity or scope of this arbitration
agreement, or any attempt to set aside this arbitration agreement;
all federal or state law claims relating in any way to this Contract (including this arbitration agreement), the
information You gave Lowe's before entering into this Contract, and any past agreement or agreements between You
and Lowe's;
all counterclaims, cross-claims, and third-party claims;
all common law claims of any kind including claims based upon alleged product defect, contract, tort, fraud, or
other intentional torts;
all claims based upon a violation of any state or federal constitution, statute, or regulation;
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GOVERNING LAW AND SEVERABILITY.North Carolina law shall govern and guide the interpretation of this Contract,
without regard to the choice of law rules of anystate, except that the FAA governs the ARBITRATION AGREEMENT,WAIVER
OF JURY TRIAL AND WAIVER OF CLASS ACTION RIGHTS. Should an arbitrator, court, or other interpreting entity
determine that a provision of this Contract is contrary to an applicable law, such unlawful provision shall be ineffective without
invalidating the other provisions, which shall remain in full force and effect.
CREDIT CARD / FINANCED TRANSACTIONS.If You use credit or obtain a loan to pay some or all of the Price, then the
total cost of Your purchase will depend on the terms of Your credit or loan and applicable law. Credit and loans often include
T
a party to Your cardholder agreement, financing agreement, or other lending agreement.
WAIVER OF LIENS.
its
subcontractors, and its materialmen and suppliers of all liens,liens, and other liens in the Premises
any
and all such liens in the Premises it may have or acquire in the future as a result of this Contract.
COUNTERPARTS AND AMENDMENT.
which when executed and delivered or transmitted by facsimile, e-mail or other electronic means, shall be an original and all
of which taken together shall constitute one and the same instrument. A facsimile or electronic signature is deemed an original
signature for all purposes under this Contract. No modifications or additions to this Contract are valid unless signed by both
You and
QUESTIONS OR CONCERNS.igned
your order regarding routine matters like scheduling, changes to Your order, or any concerns You have about this Contract,
the Goods, or the Installation Services. If you still have questions or concerns please contact Customer Care at
800-445-6937.
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For Installation Services performed in the State of Florida, the terms and conditions of this Florida
Conditions
the Terms and Conditions and this State Addendum, the State Addendum shall prevail. All
capitalized terms used but not otherwise defined in this State Addendum shall have the meaning ascribed to
them in the Terms and Conditions.
Contractor license number(s) and certifications
(Certified General Contractor)#C C
(Certified Contractor)
License number(s) and certifications may be subject to change in accordance with local or state government
processes. For the most current listing of license numbers and certifications held by or on beh
http://www.lowes.com/licensenumbers.
PAYMENT UP TO A LIMITED AMOUNT,
MAY BE AVAILABLE FROM THE FLORIDA HOMEO
LOSE MONEY ON A PROJECT PERFORMED UNDER CONTRACT, WHERE THE LOSS RESULTS FROM
SPECIFIED VIOLATIONS OF FLORIDA LAW BY A LICENSED CONTRACTOR. FOR INFORMATION ABOUT
THE RECOVERY FUND AND FILING A CLAIM, CONTACT THE FLORIDA CONSTRUCTION INDUSTRY
LICENSING BOARD AT THE FOLLOWING TELEPHONE NUMBER AND ADDRESS: 1940 NORTH MONROE
STREET, TALLAHASSEE, FL 32399-0783; PHONE: (850) 487-1395.
ANY CLAIMS FOR CONSTRUCTION DEFECTS ARE SUBJECT TO THE
NOTICE AND CURE PROVISIONS OF CHAPTER 558, FLORIDA STATUTES.
County,
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NOTICE OF RIGHT TO CANCEL
1
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chad.e.ayers@lowes.com
850 NORTH MIAMI BEACH BLVD NORTH MIAMI BEACH, Florida 33162
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NOTICE OF RIGHT TO CANCEL
2
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chad.e.ayers@lowes.com
850 NORTH MIAMI BEACH BLVD NORTH MIAMI BEACH, Florida 33162
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The law gives you the right to cancel this Installation Services Customer Contract within three (3) business
days. However, you may waive that right provided the following criteria are met:
(i)
(ii) the Installation Services are needed to meet your bona fide immediate personal emergency;
and
(iii)
handwriting describing the situation requiring immediate remedy and expressly acknowledging
and waiving your right to cancel the sale within three (3) business days.
the three (3) business day cancellation period to expire. To waive your right to cancel due to a bona fide
1.YES NO
4. Do you expressly acknowledge and waive your right to cancel the sale within three (3)
YES NO
(Date)(Customer's Signature)
()(Customer's Printed Name)
YES NO
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LOWE’S INSTALLED SALES – FENCE EVALUATION FORM
Rev: 11.3.2022
RESIDENTIAL FENCING PROJECTS
THE PURPOSE OF THIS FORM IS TO DOCUMENT COMPLIANCE WITH THE U.S. ENVIRONMENTAL PROTECTION
AGENCY’S LEAD RENOVATION, REPAIR, AND PAINTING RULE (“RRP RULE”), 40 C.F.R. § 745.80, et seq., OR ANY
STATE OR TRIBAL PROGRAM AUTHORIZED BY THE U.S. EPATO ADMINISTER ITS OWN RRP RULE.
General Project Information:
Customer Name: _________________________________________ Phone Number:_____________________
Installation Address: _________________________________________________________________________
Complete Installation Address
Fences painted pre-1978 may contain lead at a concentration that requires state or federally mandated work
practices. The age of a fence does not necessarily align with the age of the home. The age of a fence cannot be
verified through a public records search. Lowe’s independent, third-party contractors will only disturb paint
on fences reasonably believed to have had no paint present pre-1978.
This evaluation form must be completed and submitted with the electronic job records (i.e., contract) in
IMS if a fence project will involve the removal, haul away, or disposal of any existing fencing or fence
related components including Item #73945.
Complete the following sections:
1.Is removal of any existing fencing or fencing materials being performed?Yes No
2.The existing fence IS / IS NOT painted.
(If the existing fence IS NOT painted, the form is complete, the salesperson and customer should
sign and submit with job records. If the fence is painted, please proceed to the next section.)
3.The customer must verify that the fence had no paint present pre-1978 (in the space below) or Lowe’s
must decline the job.
Customer to describe approximate date of fence painting (Enter N/A if no paint present) - and sign below.
I certify the information provided above is true and correct. I understand that Lowe’s is relying on the
information that I provided to determine whether a lead paint hazard exists, and I release Lowe’s and its
service providers from any liability stemming from their reliance on my representation.
Customer Name /Signature DatDatee
IF THE CUSTOMER REPRESENTS THAT THE FENCE HAD PAINT PRESENT PRE-1978,
OR IF THE CUSTOMER DOES NOT KNOW WHEN THE FENCE WAS BUILT,
THEN LOWE’S MUST DECLINE THE JOB.
Lowe’s Representative Name /Signature Date
Store 3413 LOWE_S OF NORTH MIAMI BEACH_ FL - Contract - 1467213 - Page 20 of 33
Ross Chuchla 8327050949
78 Nw 107th St Miami Shores, Florida 33168
4
4
N/A
0 1 /3 1 /2 4
0 1 /3 1 /2 4
Store 3413 LOWE_S OF NORTH MIAMI BEACH_ FL - Contract - 1467213 - Page 21 of 33
1-800-424-LEAD (5323)
epa.gov/getleadsafe
EPA-740-K-10-001
Revised September 2011 Important lead hazard information for
families, child care providers and schools.CERTIFIED F IR M
L E A D -SAFE
THE LEAD-SAFE CERTIFIED GUIDE TO RENOVATERIGHT
This document may be purchased through the U.S. Government Printing Office online at
bookstore.gpo.gov or by phone (toll-free): 1-866-512-1800.
Store 3413 LOWE_S OF NORTH MIAMI BEACH_ FL - Contract - 1467213 - Page 22 of 33
Store 3413 LOWE_S OF NORTH MIAMI BEACH_ FL - Contract - 1467213 - Page 23 of 33
IT’S THE LAW!
Federal law requires contractors that disturb painted surfaces
in homes, child care facilities and schools built before 1978 to
be certified and follow specific work practices to prevent lead
contamination. Always ask to see your contractor’s certification.
Federal law requires that individuals receive certain information
before renovating more than six square feet of painted surfaces
in a room for interior projects or more than twenty square feet
of painted surfaces for exterior projects or window replacement
or demolition in housing, child care facilities and schools built
before 1978.
• Homeowners and tenants: renovators must give you this
pamphlet before starting work.
• Child care facilities, including preschools and kindergarten
classrooms, and the families of children under six years of age
that attend those facilities: renovators must provide a copy
of this pamphlet to child care facilities and general renovation
information to families whose children attend those facilities.
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WHO SHOULD READ THIS PAMPHLET?
This pamphlet is for you if you:
• Reside in a home built before 1978.
• Own or operate a child care facility, including preschools and kindergarten
classrooms, built before 1978, or
• Have a child under six years of age who attends a child care facility built before 1978.
You will learn:
• Basic facts about lead and your health.
• How to choose a contractor, if you are a property owner.
• What tenants, and parents/guardians of a child in a child care facility or school
should consider.
• How to prepare for the renovation or repair job.
• What to look for during the job and after the job is done.
• Where to get more information about lead.
This pamphlet is not for:
• Abatement projects. Abatement is a set of activities aimed specifically at
eliminating lead or lead hazards. EPA has regulations for certification and training of
abatement professionals. If your goal is to eliminate lead or lead hazards, contact the
National Lead Information Center at 1-800-424-LEAD (5323) for more information.
• “Do-it-yourself” projects. If you plan to do renovation work yourself, this document
is a good start, but you will need more information to complete the work safely. Call
the National Lead Information Center at 1-800-424-LEAD (5323) and ask for more
information on how to work safely
in a home with lead-based paint.
• Contractor education. Contractors
who want information about working
safely with lead should contact
the National Lead Information
Center at 1-800-424-LEAD (5323)
for information about courses and
resources on lead-safe work practices.
1Store 3413 LOWE_S OF NORTH MIAMI BEACH_ FL - Contract - 1467213 - Page 25 of 33
RENOVATING, REPAIRING, OR PAINTING?
• Is your home, your building, or the child care facility
or school your children attend being renovated,
repaired, or painted?
• Was your home, your building, or the child care facility
or school where your children under six years of age
attend built before 1978?
If the answer to these questions is YES, there are a
few important things you need to know about
lead-based paint.
This pamphlet provides basic facts about lead and
information about lead safety when work is being
done in your home, your building or the child care
facility or school your children attend.
The Facts About Lead
• Lead can affect children’s brains and developing nervous systems, causing reduced
IQ, learning disabilities, and behavioral problems. Lead is also harmful to adults.
• Lead in dust is the most common way people are exposed to lead. People can also
get lead in their bodies from lead in soil or paint chips. Lead dust is often invisible.
• Lead-based paint was used in more than 38 million homes until it was banned for
residential use in 1978.
• Projects that disturb painted surfaces can create dust and endanger you and your
family. Don’t let this happen to you. Follow the practices described in this pamphlet
to protect you and your family.
2 3
LEAD AND YOUR HEALTH
Lead is especially dangerous to children
under six years of age.
Lead can affect children’s brains and developing
nervous systems, causing:
• Reduced IQ and learning disabilities.
• Behavior problems.
Even children who appear healthy can have
dangerous levels of lead in their bodies.
Lead is also harmful to adults. In adults, low levels
of lead can pose many dangers, including:
• High blood pressure and hypertension.
• Pregnant women exposed to lead can transfer lead to their fetuses. Lead gets into
the body when it is swallowed or inhaled.
• People, especially children, can swallow lead dust as they eat, play, and do other
normal hand-to-mouth activities.
• People may also breathe in lead dust or fumes if they disturb lead-based paint.
People who sand, scrape, burn, brush, blast or otherwise disturb lead-based
paint risk unsafe exposure to lead.
What should I do if I am concerned about my family’s exposure to lead?
• A blood test is the only way to find out if you or a family member already has lead
poisoning. Call your doctor or local health department to arrange for a blood test.
• Call your local health department for advice on reducing and eliminating
exposures to lead inside and outside your home, child care facility or school.
• Always use lead-safe work practices when renovation or repair will disturb
painted surfaces.
For more information about the health effects of exposure to lead, visit the EPA lead
website at https://www.epa.gov/lead/learn-about-lead or call 1-800-424-LEAD
(5323).
There are other things you can do to protect your family every day.
• Regularly clean floors, window sills, and other surfaces.
• Wash children’s hands, bottles, pacifiers, and toys often.
• Make sure children eat a healthy, nutritious diet consistent with the USDA's dietary
guidelines, that helps protect children from the effects of lead.
• Wipe off shoes before entering the house.
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4
WHERE DOES THE LEAD COME FROM?
Dust is the main problem.
The most common way to get lead in the body is from dust. Lead dust comes from
deteriorating lead-based paint and lead-contaminated soil that gets tracked into
your home. This dust may accumulate to unsafe levels. Then, normal hand to-mouth
activities, like playing and eating (especially in young children), move that dust from
surfaces like floors and window sills into the body.
Home renovation creates dust.
Common renovation activities like sanding, cutting, and demolition can create
hazardous lead dust and chips.
Proper work practices protect you from the dust.
The key to protecting yourself and your family during a renovation, repair or painting
job is to use lead-safe work practices such as containing dust inside the work area,
using dust-minimizing work methods, and conducting a careful cleanup, as described
in this pamphlet.
Other sources of lead.
Remember, lead can also come from outside soil, your water, or household items
(such as lead-glazed pottery and lead crystal). Contact the National Lead Information
Center at 1-800-424-LEAD (5323) for more information on these sources.
5
CHECKING YOUR HOME FOR LEAD-BASED PAINT
Older homes, child care facilities, and schools are more likely to contain
lead-based paint.
Homes may be single-family homes or apartments. They may be private, government-
assisted, or public housing. Schools are preschools and kindergarten classrooms. They
may be urban, suburban, or rural.
You have the following options:
You may decide to assume your home, child care facility, or school contains lead.
Especially in older homes and buildings, you may simply want to assume lead-based
paint is present and follow the lead-safe work practices described in this brochure
during the renovation, repair, or painting job.
You can hire a certified professional to check for lead-based paint.
These professionals are certified risk assessors or inspectors, and can determine if
your home has lead or lead hazards.
• A certified inspector or risk assessor can conduct an inspection telling you whether
your home, or a portion of your home, has lead-based paint and where it is located.
This will tell you the areas in your home where lead-safe work practices are needed.
• A certified risk assessor can conduct a risk assessment telling you if your home
currently has any lead hazards from lead in paint, dust, or soil. The risk assessor
can also tell you what actions to take to address any hazards.
• For help finding a certified risk assessor or inspector, call the National Lead
Information Center at 1-800-424-LEAD (5323).
You may also have a certified renovator test the surfaces or components being
disturbed for lead by using a lead test kit or by taking paint chip samples and sending
them to an EPA-recognized testing laboratory. Test kits must be EPA-recognized and
are available at hardware stores. They include detailed instructions for their use.
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6
FOR PROPERTY OWNERS
You have the ultimate responsibility for the safety of your family, tenants, or children
in your care.
This means properly preparing for the renovation and keeping persons out of the work
area (see p. 8). It also means ensuring the contractor uses lead-safe work practices.
Federal law requires that contractors performing renovation, repair and painting projects
that disturb painted surfaces in homes, child care facilities, and schools built before 1978
be certified and follow specific work practices to prevent lead contamination.
Make sure your contractor is certified, and can explain clearly the details of the job
and how the contractor will minimize lead hazards during the work.
• You can verify that a contractor is certified by checking EPA’s website at
epa.gov/getleadsafe or by calling the National Lead Information Center at
1-800-424-LEAD (5323). You can also ask to see a copy of the contractor’s
firm certification.
• Ask if the contractor is trained to perform lead-safe work practices and to see a
copy of their training certificate.
• Ask them what lead-safe methods they will use to set up and perform the job in your
home, child care facility or school.
• Ask for references from at least three recent jobs involving homes built before 1978,
and speak to each personally.
Always make sure the contract is clear about how the work will be set up,
performed, and cleaned.
• Share the results of any previous lead tests with the contractor.
• You should specify in the contract that they follow the work practices described on
pages 9 and 10 of this brochure.
• The contract should specify which parts of your home are part of the work area and
specify which lead-safe work practices will be used in those areas. Remember, your
contractor should confine dust and debris to the work area and should minimize
spreading that dust to other areas of the home.
• The contract should also specify that the contractor will clean the work area, verify
that it was cleaned adequately, and re-clean it if necessary.
If you think a worker is not doing what he is supposed to do or is doing something
that is unsafe, you should:
• Direct the contractor to comply with regulatory and contract requirements.
• Call your local health or building department, or
• Call EPA's hotline 1-800-424-LEAD (5323).
If your property receives housing assistance from HUD (or a state or local agency that
uses HUD funds), you must follow the requirements of HUD’s Lead-Safe Housing Rule
and the ones described in this pamphlet.
7
FOR TENANTS AND FAMILIES OF CHILDREN UNDER SIX
YEARS OF AGE IN CHILD CARE FACILITIES AND SCHOOLS
You play an important role ensuring the ultimate
safety of your family.
This means properly preparing for the renovation
and staying out of the work area (see p. 8).
Federal law requires that contractors performing
renovation, repair and painting projects that disturb
painted surfaces in homes built before 1978 and in
child care facilities and schools built before 1978, that
a child under six years of age visits regularly, to be
certified and follow specific work practices to prevent
lead contamination.
The law requires anyone hired to renovate, repair, or do
painting preparation work on a property built before
1978 to follow the steps described on pages 9 and 10 unless the area where the work
will be done contains no lead-based paint.
If you think a worker is not doing what he is supposed to do or is doing something
that is unsafe, you should:
• Contact your landlord.
• Call your local health or building department, or
• Call EPA's hotline 1-800-424-LEAD (5323).
If you are concerned about lead hazards left behind after the job is over, you can
check the work yourself (see page 10).
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8
PREPARING FOR A RENOVATION
The work areas should not be accessible to occupants while the work occurs.
The rooms or areas where work is being done may need to be blocked off or sealed
with plastic sheeting to contain any dust that is generated. Therefore, the contained
area may not be available to you until the work in that room or area is complete,
cleaned thoroughly, and the containment has been removed. Because you may not
have access to some areas during the renovation, you should plan accordingly.
You may need:
• Alternative bedroom, bathroom, and kitchen arrangements if work is occurring in
those areas of your home.
• A safe place for pets because they too can be poisoned by lead and can track lead
dust into other areas of the home.
• A separate pathway for the contractor from the work area to the outside in order to
bring materials in and out of the home. Ideally, it should not be through the same
entrance that your family uses.
• A place to store your furniture. All furniture and belongings may have to be moved
from the work area while the work is being done. Items that can’t be moved, such as
cabinets, should be wrapped in plastic.
• To turn off forced-air heating and air conditioning systems while the work is being
done. This prevents dust from spreading through vents from the work area to the
rest of your home. Consider how this may affect your living arrangements.
You may even want to move out of your home temporarily while all or part of the
work is being done.
Child care facilities and schools may want to consider alternative accommodations
for children and access to necessary facilities.
9
DURING THE WORK
Federal law requires contractors that are hired to perform renovation, repair and painting
projects in homes, child care facilities, and schools built before 1978 that disturb painted
surfaces to be certified and follow specific work practices to prevent lead contamination.
The work practices the contractor must follow include these three simple procedures,
described below:
1. Contain the work area. The area must be contained so that dust and debris do not escape
from that area. Warning signs must be put up and plastic or other impermeable material
and tape must be used as appropriate to:
• Cover the floors and any furniture that cannot be moved.
• Seal off doors and heating and cooling system vents.
• For exterior renovations, cover the ground and, in some instances, erect vertical
containment or equivalent extra precautions in containing the work area.
These work practices will help prevent dust or debris from getting outside the work area.
2. Avoid renovation methods that generate large amounts of lead-contaminated dust.
Some methods generate so much lead-contaminated dust that their use is prohibited.
They are:
• Open flame burning or torching.
• Sanding, grinding, planing, needle gunning,
or blasting with power tools and equipment
not equipped with a shroud and HEPA
vacuum attachment.
• Using a heat gun at temperatures greater
than 1100°F.
There is no way to eliminate dust, but some renovation methods make less dust than others.
Contractors may choose to use various methods to minimize dust generation, including
using water to mist areas before sanding or scraping; scoring paint before separating
components; and prying and pulling apart components instead of breaking them.
3. Clean up thoroughly. The work area should be cleaned up daily to keep it as clean as
possible. When all the work is done, the area must be cleaned up using special cleaning
methods before taking down any plastic that isolates the work area from the rest of the
home. The special cleaning methods should include:
• Using a HEPA vacuum to clean up dust and debris on all surfaces, followed by
• Wet wiping and wet mopping with plenty of rinse water.
When the final cleaning is done, look around. There should be no dust, paint chips, or debris
in the work area. If you see any dust, paint chips, or debris, the area must be re-cleaned.
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10
FOR PROPERTY OWNERS: AFTER THE WORK IS DONE
When all the work is finished, you will want to know if your home, child care facility, or
school where children under six attend has been cleaned up properly.
EPA Requires Cleaning Verification.
In addition to using allowable work practices and working in a lead-safe manner,
EPA’s RRP rule requires contractors to follow a specific cleaning protocol. The protocol
requires the contractor to use disposable cleaning cloths to wipe the floor and other
surfaces of the work area and compare these cloths to an EPA-provided cleaning
verification card to determine if the work area was adequately cleaned. EPA research
has shown that following the use of lead-safe work practices with the cleaning
verification protocol will effectively reduce lead-dust hazards.
Lead-Dust Testing.
EPA believes that if you use a certified and trained renovation contractor who follows
the LRRP rule by using lead-safe work practices and the cleaning protocol after the
job is finished, lead-dust hazards will be effectively reduced. If, however, you are
interested in having lead-dust testing done at the completion of your job, outlined
below is some helpful information.
What is a lead-dust test?
• Lead-dust tests are wipe samples sent to a laboratory for analysis. You will get a
report specifying the levels of lead found after your specific job.
How and when should I ask my contractor about lead-dust testing?
• Contractors are not required by EPA to conduct lead-dust testing. However,
if you want testing, EPA recommends testing be conducted by a lead
professional. To locate a lead professional who will perform an evaluation near
you, visit EPA’s website at https://cfpub.epa.gov/flpp/pub/index.cfm?do=main.
firmSearchAbatement or contact the National Lead Information Center at 1-800-
424-LEAD (5323).
• If you decide that you want lead-dust testing, it is a good idea to specify in your
contract, before the start of the job, that a lead-dust test is to be done for your job
and who will do the testing, as well as whether re-cleaning will be required based on
the results of the test.
• You may do the testing yourself.
If you choose to do the testing,
some EPA-recognized lead
laboratories will send you a kit
that allows you to collect samples
and send them back to the
laboratory for analysis. Contact
the National Lead Information
Center for lists of EPA-recognized
testing laboratories.
11
You may need additional information on how to protect yourself and your children
while a job is going on in your home, your building, or child care facility.
The National Lead Information Center at 1-800-424-LEAD (5323) or
epa.gov/lead/nlic can tell you how to contact your state, local, and/or tribal programs
or get general information about lead poisoning prevention.
• State and tribal lead poisoning prevention or environmental protection programs
can provide information about lead regulations
and potential sources of financial aid for reducing
lead hazards. If your state or local government has
requirements more stringent than those described in
this pamphlet, you must follow those requirements.
• Local building code officials can tell you the
regulations that apply to the renovation work that you
are planning.
• State, county, and local health departments can
provide information about local programs, including
assistance for lead-poisoned children and advice on
ways to get your home checked for lead.
The National Lead Information Center can also provide
a variety of resource materials, including the following
guides to lead-safe work practices. Many of these
materials are also available at
https://www.epa.gov/lead/lead-safety-documents-and-
outreach-materials
• Steps to Lead Safe Renovation, Repair and Painting.
• Protect Your Family from Lead in Your Home
• Lead in Your Home: A Parent’s Reference Guide
FOR ADDITIONAL INFORMATION
For the hearing impaired, call the Federal Information Relay Service at 1-800-877-8339
to access any of the phone numbers in this brochure.
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1312
EPA Regional Offices
EPA addresses residential lead hazards through several different regulations.
EPA requires training and certification for conducting abatement and renovations,
education about hazards associated with renovations, disclosure about known lead
paint and lead hazards in housing, and sets lead-paint hazard standards.
Your Regional EPA Office can provide further information regarding lead safety and
lead protection programs at epa.gov/lead.
Region 1
(Connecticut, Massachusetts,
Maine, New Hampshire,
Rhode Island, Vermont)
Regional Lead Contact
U.S. EPA Region 1
Suite 1100
One Congress Street
Boston, MA 02114-2023
(888) 372-7341
Region 2
(New Jersey, New York,
Puerto Rico, Virgin Islands)
Regional Lead Contact
U.S. EPA Region 2
2890 Woodbridge Avenue
Building 205, Mail Stop 225
Edison, NJ 08837-3679
(732) 321-6671
Region 3
(Delaware, Maryland,
Pennsylvania, Virginia,
Washington, DC, West
Virginia)
Regional Lead Contact
U.S. EPA Region 3
1650 Arch Street
Philadelphia, PA
19103-2029
(215) 814-5000
Region 4
(Alabama, Florida, Georgia,
Kentucky, Mississippi, North
Carolina, South Carolina,
Tennessee)
Regional Lead Contact
U.S. EPA Region 4
61 Forsyth Street, SW
Atlanta, GA 30303-8960
(404) 562-9900
Region 5
(Illinois, Indiana, Michigan,
Minnesota, Ohio, Wisconsin)
Regional Lead Contact
U.S. EPA Region 5
77 West Jackson Boulevard
Chicago, IL 60604-3507
(312) 886-6003
Region 6
(Arkansas, Louisiana, New
Mexico, Oklahoma, Texas)
Regional Lead Contact
U.S. EPA Region 6
1445 Ross Avenue,
12th Floor
Dallas, TX 75202-2733
(214) 665-7577
Region 7
(Iowa, Kansas, Missouri,
Nebraska)
Regional Lead Contact
U.S. EPA Region 7
901 N. 5th Street
Kansas City, KS 66101
(913) 551-7003
Region 8
(Colorado, Montana,
North Dakota, South Dakota,
Utah, Wyoming)
Regional Lead Contact
U.S. EPA Region 8
1595 Wynkoop Street
Denver, CO 80202
(303) 312-6312
Region 9
(Arizona, California, Hawaii,
Nevada)
Regional Lead Contact
U.S. Region 9
75 Hawthorne Street
San Francisco, CA 94105
(415) 947-8021
Region 10
(Alaska, Idaho,
Oregon, Washington)
Regional Lead Contact
U.S. EPA Region 10
1200 Sixth Avenue
Seattle, WA 98101-1128
(206) 553-1200
EPA CONTACTS OTHER FEDERAL AGENCIES
CPSC
The Consumer Product Safety
Commission (CPSC) protects the public
from the unreasonable risk of injury or
death from 15,000 types of consumer
products under the agency’s jurisdiction.
CPSC warns the public and private
sectors to reduce exposure to lead and
increase consumer awareness. Contact
CPSC for further information regarding
regulations and consumer product safety.
CPSC
4330 East West Highway
Bethesda, MD 20814
Hotline 1-(800) 638-2772
cpsc.gov
CDC Childhood Lead Poisoning
Prevention Branch
The Centers for Disease Control and
Prevention (CDC) assists state and local
childhood lead poisoning prevention
programs to provide a scientific basis
for policy decisions, and to ensure that
health issues are addressed in decisions
about housing and the environment.
Contact CDC Childhood Lead Poisoning
Prevention Program for additional
materials and links on the topic of lead.
CDC Childhood Lead Poisoning
Prevention Branch
4770 Buford Highway, MS F-40
Atlanta, GA 30341
(770) 488-3300
cdc.gov/nceh/lead
HUD Office of Healthy Homes and Lead
Hazard Control
The Department of Housing and Urban
Development (HUD) provides funds
to state and local governments to
develop cost-effective ways to reduce
lead-based paint hazards in America’s
privately-owned low-income housing. In
addition, the office enforces the rule on
disclosure of known lead paint and lead
hazards in housing, and HUD’s lead safety
regulations in HUD-assisted housing,
provides public outreach and technical
assistance, and conducts technical
studies to help protect children and their
families from health and safety hazards
in the home. Contact the HUD Office of
Healthy Homes and Lead Hazard Control
for information on lead regulations,
outreach efforts, and lead hazard control
research and outreach grant programs.
U.S. Department of Housing and Urban
Development
Office of Healthy Homes and
Lead Hazard Control
451 Seventh Street, SW, Room 8236
Washington, DC 20410-3000
HUD’s Lead Regulations Hotline
(202) 402-7698
hud.gov/offices/lead/
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SAMPLE PRE-RENOVATION FORM
This sample form may be used by renovation firms to document compliance with the Federal
pre-renovation education and renovation, repair, and painting regulations.
Occupant Confirmation
Pamphlet Receipt
q I have received a copy of the lead hazard information pamphlet informing me of the
potential risk of the lead hazard exposure from renovation activity to be performed in my
dwelling unit. I received this pamphlet before the work began.
Printed Name of Owner-occupant
Signature of Owner-occupant Signature Date
Renovator’s Self Certification Option (for tenant-occupied dwellings only)
Instructions to Renovator: If the lead hazard information pamphlet was delivered but a tenant
signature was not obtainable, you may check the appropriate box below.
q Declined – I certify that I have made a good faith effort to deliver the lead hazard
information pamphlet to the rental dwelling unit listed below at the date and time indicated
and that the occupant declined to sign the confirmation of receipt. I further certify that I
have left a copy of the pamphlet at the unit with the occupant.
q Unavailable for signature – I certify that I have made a good faith effort to deliver the lead
hazard information pamphlet to the rental dwelling unit listed below and that the occupant
was unavailable to sign the confirmation of receipt. I further certify that I have left a copy of
the pamphlet at the unit by sliding it under the door or by (fill in how pamphlet was left).
Printed Name of Person Certifying Delivery Attempted Delivery Date
Signature of Person Certifying Lead Pamphlet Delivery
Unit Address
Note Regarding Mailing Option — As an alternative to delivery in person, you may mail the
lead hazard information pamphlet to the owner and/or tenant. Pamphlet must be mailed at
least seven days before renovation. Mailing must be documented by a certificate of mailing
from the post office.
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