detail specifications

Store 0575, Detail PO 179242416, Project No. 704832623, for LINDA COLLIER of 8 Version: db (Luxury Vinyl Planking) - Vinyl Plank - SMARTCORE #1 (FW ID: 4601501)

Installer Name: Installation Services Installer Number: 42114

FLOOR - LUXURY VINYL PLANKING ESTIMATE WORKSHEET MSR. DATE: 10/23/2021

Lowe's 0575

1918 Airport Rd.

Midland, Michigan 48642

SALESPERSON:

SALESPERSON ID:

Document Print Date: 10/26/2021

FW Project ID: 4601501

S

O

L

D

T

O

Customer Name Email Primary Phone

LINDA COLLIER 734-395-7255Customer Address Secondary Phone

4412 ROBINHOOD TER 734-395-7255City State / Province Zip / Postal Code

MIDLAND Michigan 48642Installation Address

4412 ROBINHOOD TERInstallation City Installation State / Province Installation Zip / Postal Code

MIDLAND Michigan 48642

DETAIL SPECIFICATIONS

Labor Category Backsplash Carpet Ceramic Tile / Stone - Floor

Laminate Vinyl Wood

Job Type Replacement New Construction Mobile Home

Number of Areas to Update 14 Bed 1, Bed 1 Clos, Bed 2, Bed 2 Clos, Bed 3, Bed 3 Clos, Dining Clos, Hall 1, Hall 1 Clos 1, Hall 1 Clos 2, Hall 2, Hall 2 Clos 1, Kit/Dining, Living

Timeframe Built Before 1978 1978 - 1986 After 1986 Construction Date: 1971

Remove / Haul Away Yes No

Remove / Haul Carpet and Pad Carpet Tack Down on a Hard Surface Job,Single Layer, 741 SQFT;

Remove / Haul Gluedown Carpet SQFT:

Remove / Haul Ceramic Tile/Stone SQFT:

Remove / Haul Laminate SQFT:


Remove / Haul Floating Wood SQFT:

Remove / Haul Nail Down Wood 1/2 Inch Nail-Down Wood,Single Layer, 300 SQFT;

Remove / Haul Glue Down Wood SQFT:

Remove / Haul Glue Down Sheet Vinyl SQFT:

Remove / Haul Looselay or PERIM Bond Vinyl SQFT:

Remove / Haul Floating Vinyl Plank SQFT:

Remove / Haul Glue Down Vinyl Plank SQFT:

Remove / Haul Glue Down Vinyl Tile SQFT:

Vinyl Size Choices Luxury Vinyl Plank 6-ft Wide Sheet 12-ft Wide Sheet 12-in x 12-in Tile / VCT

18-in x 18-in Tile / VCT 13-ft 2in Wide Sheet

Vinyl Install Type Floating Full Glue Vinyl Composition Tile (VCT) Luxury Vinyl Tile (LVT)

Vinyl Installation Pattern No Pattern Stock Bond Type (Checker Board) Diagonal Pattern Custom Pattern

Vinyl Custom Pattern Description Plk/Hor

Vinyl Square Footage 1087 Sq. Ft.

Floor Stripping Machine Charge To Be Determined

Customer's Preferred Product Item

Customer's Preferred Molding Item #


Transition - Contractor Supplied Yes No

Transitions Metal Wood Laminate Marble

Vinyl None

Transitions LFT Transition, Vinyl, Vinyl Plank End Cap, 18 Ft.; Transition, Vinyl, Vinyl Plank Reducer, 6 Ft.; Transition, Vinyl, Vinyl Plank Stair Nose, 3 Ft.

Subfloor Prep Embossing Underlay Panels / Plywood No

Embossing Square Footage None

Plywood Underlayment SQFT None

Subfloor Composition Wood Concrete Combination Wood and Concrete (same install method)

Subfloor Wood Type OSB Particle Board Plywood

Subfloor Leveling / Damage Comments Yes No Potentially

Subfloor Leveling / Damage Charge TBD

Moisture ReadingBed 1: 41 rh 71 f; Bed 1 Clos: 41 rh 71 f; Bed 2: 41 rh 71 f; Bed 2 Clos: 41 rh 71 f; Bed 3: 41 rh 71 f; Bed 3 Clos: 41 rh 71 f; Dining Clos: 41 rh 71 f; Hall 1: 41 rh 71 f; Hall 1 Clos 1: 41 rh 71 f; Hall 1 Clos 2: 41 rh 71 f; Hall 2: 41 rh 71 f; Hall 2 Clos 1: 41 rh 71 f; Kit/Dining: 41 rh 71 f; Living: 41 rh 71 f

Moisture Barrier Charge None

Remove Molding Charge None

New Molding LFT Molding, Install 1/4 Round (Matching) - customer choice, 391.0 Ft.

Move Furniture 5 Living, Bed 1, Bed 2, Bed 3, Kit/Dining

Number of Appliances 2

Ice Maker None

Remove / Replace Toilet None

Pedestal Sink (Remove Only) Yes No

Pedestal Sink Charge None

Customer Understands Vinyl Project Scope Yes No

Reconnect Adjoining Product Yes No

Permit Customer Lowe's Independent Contractor No Permit Required

Permit Fee None


Additional Miles None

Access Fee Amount None

Additional Work Yes

Additional Work ChargeCabinet, China, 2 Each(s), $150.00; Table, Oversize, 1 Each(s), $0.00; Dresser, Oversize, 2 Each(s), $0.00; Chair, Reclining, 3 Each(s), $0.00; Bed, w/ Headboard, 2 Each(s), $0.00; Cabinet, Curio, 1 Each(s), $0.00; Caulk, Color to match Grout, 1.0 Lin. Ft., $0.00; Glue, TWO PART EPOXY - FOR STAIR NOSE ONLY, 1.0 Tube(s), $0.00; Tack Strip, Remove & Dispose of Existing, 223.0 Lin. Ft., $64.67

Lead Safe Practices Yes No

Comments


PRODUCT SPECIFICATION AND ADDITIONAL MERCHANDISE

ADD'L MATERIALS TO BE SOLD TO CUSTOMER (AS NEEDED) INDICATE QUANTITIES BELOW.

Transitions/reducers: TRANSITION, VINYL, VINYL PLANK END CAP, 18.0 LIN. FT.; TRANSITION, VINYL, VINYL PLANK REDUCER, 6.0 LIN. FT.; TRANSITION, VINYL, VINYL PLANK STAIR NOSE, 3.0 EACH(S)

Base / QTR Round / Shoe Molding: MOLDING, INSTALL 1/4 ROUND (MATCHING) - CUSTOMER CHOICE, 391.0 LIN. FT.

Vinyl Cove Base:

Cove Base Adhesive: GLUE, TWO PART EPOXY - FOR STAIR NOSE ONLY, 1.0 TUBE(S)

Plywood Sub Floor Panels:

Other Underlayment:

Additional Custom Supplies: Caulk, Color to match Grout, 1.0 Lin. Ft., $0.00; Glue, TWO PART EPOXY - FOR STAIR NOSE ONLY, 1.0 Tube(s), $0.00

Note: If Waterproofed Vinyl Plank is sold, add these materials: Pergo 3/8 IN x 20 FT BACKER ROD (Vinyl Plank), 539.0 Lin. Ft., $0.00; Silicone Sealer for Pergo Backer Rod (Vinyl Plank), 539.0 Lin. Ft., $0.00

CONTACT CUSTOMER WITHIN 2 BUSINESS DAYS OF RECEIPT / RETURN THIS SHEET TO STORE WITHIN 1 BUSINESS DAY OF DETAIL APPT.

All ESTIMATED WORK IS TO BE QUOTED AT RETAIL PRICE.

COMMENTS


ADDITIONAL COMMENTS

Customer Responsibility

Note: Bookcase/Shelving Unit, Normal: Must be emptied by customer

Cabinet, China: Must be emptied by customer

Cabinet, Curio: Must be emptied by customer

Clothes/Personal Belongings:

Computers/Electronics:

Confine all animals during install

Musical Equipment:

Normal Furniture:

Remove all electronics

Remove all items (Boxes, plants, toys, ...)

Remove all items from shelves

Remove all small or glass items

Television, Normal:

To achieve proper Product Acclimation, customer to set temperature according to manufacturer's specifications

Room Perimeters

Bed 1 46 Ft. 4 In.

Bed 1 Clos 10 Ft. 10 In.

Bed 2 43 Ft. 2 In.


Bed 3 43 Ft. 0 In.


Dining Clos 10 Ft. 6 In.

Hall 1 68 Ft. 8 In.

Hall 1 Clos 1 10 Ft. 6 In.



ADDITIONAL COMMENTS

Hall 2 37 Ft. 8 In.


Kit/Dining 81 Ft. 0 In.

Living 73 Ft. 0 In.

Total: 465 Ft. 4 In.

Notes to Store Associates

*** customer thinking about laminate

Additional charges may apply

Additional work cannot be determined until existing flooring is removed

All areas confirmed w/ customer during measure

All transitions are required per manufactures specifications

Demonstration of flatness of floors completed at detail

Floor prep is quoted to meet the manufacturer's guidelines for install, not to "level" the floor

Lead assessment completed, no lead test required

Please ensure customer is aware of customer responsibility and reads full disclaimer on contract

Please go over furniture policy with customer

Tack Strip is present at time of measure

Installer will only be removing: 1/2 INCH NAIL-DOWN WOOD,SINGLE LAYER; CARPET TACK DOWN,SINGLE LAYER

Installer Disclaimer Statement

Customer must have heat and electricity. Customer is responsible for dusting after install. Customer to remove all electronics and small items, breakables, pool tables, exercise equipment, and pianos. May need floor prep for any unforeseen problem, and if needed, additional charges may apply. Our company does all refigures; any change in pattern repeat requires a refigure. Additional charges will apply if doors need to be cut. Our company does not disconnect/reconnect gas lines. Our company does not re-locate/re-establish cable or phone lines. For VCT, sealing and waxing will be the responsibility of the customer. Our company cannot install over 9x9 asbestos tiles unless customer takes certain actions; contact us for discussion. Customer will be responsible for repairing any leaking valves. Paint touch-up on walls are normal and the customer will be responsible for all paint touch-ups in their home. Customers are responsible for all hanging items on their walls. If an items falls off the walls, we will not be held liable for damaged items. Customers should be advised that there may be seams in doorways or openings. Customer is Responsible for drywall repairs due to removal process. *** Special Note: Door Casings*** When installer removes flooring that is higher in height than what is sold, there may be a gap issue under the casing. This gap is the responsibility of the customer to fix.

Store 0575, Detail PO 179242416, Project No. 704832623, for LINDA COLLIER of 8 Version: db (Luxury Vinyl Planking) - Vinyl Plank - SMARTCORE #1 (FW ID:

4601501)

Installer: Installation Services Installer Number: 42114 Install PO:

Summary of Custom Charges for Vinyl Plank - SMARTCORE #1 - Vinyl Plank *

Item Description Category Item Number Quantity Price/UOM Retail Price

--- Supply Items ---Caulk, Color to match Grout Custom 0 1.0 $0.00/Lin. Ft. $0.00

Glue, TWO PART EPOXY - FOR STAIR NOSE ONLY Custom 1.0 $0.00/Tube(s) $0.00

Pergo 3/8 IN x 20 FT BACKER ROD (Vinyl Plank) Custom 539.0 $0.00/Lin. Ft. $0.00

Silicone Sealer for Pergo Backer Rod (Vinyl Plank) Custom 539.0 $0.00/Lin. Ft. $0.00

--- Labor Items ---Cabinet, China Custom 2 $75.00/ $150.00

Table, Oversize Custom 1 $0.00/ $0.00

Dresser, Oversize Custom 2 $0.00/ $0.00

Chair, Reclining Custom 3 $0.00/ $0.00

Bed, w/ Headboard Custom 2 $0.00/ $0.00

Cabinet, Curio Custom 1 $0.00/ $0.00

Removal,1/2 Inch Nail-Down Wood,Single Layer Custom 300 $0.00/Sq. Ft. $0.00

Disposal,1/2 Inch Nail-Down Wood,Single Layer Custom 300 $0.00/Sq. Ft. $0.00

Caulk, Color to match Grout Custom 228209 1.0 $0.00/Lin. Ft. $0.00

Tack Strip, Remove & Dispose of Existing Custom 0 223.0 $0.29/Lin. Ft. $64.67

* Please review pricing carefully as some pricing may not be current or some items may not be priced.

Total Supplies:

Total Labor:

Total All:

$0.00

$139.67

$139.67

Store 0575, Detail PO 179242416, Project No. 704832623, for LINDA COLLIER Page 1 of 5 Version: db (Luxury Vinyl Planking) - Vinyl Plank - SMARTCORE #1 (FW ID: 4601501)

Flooring Detail Diagram - Level: MAIN - LVL 1Customer: LINDA COLLIER Store #0575 Detail PO: 179242416 Installer: Installation Services

**Draw layout diagram and seam locations on the grid - Return by Fax to Installed Sales Production Office or CPO, if applicable.**Matl. Type Room Recommended

Material NeededActual Room

Size

V Bed 1 142.6 Sq. Ft. 129.6 Sq. Ft.

V Bed 1 Clos

7.6 Sq. Ft. 6.9 Sq. Ft.

V Bed 2 118.9 Sq. Ft. 108.1 Sq. Ft.

V Bed 2 Clos

7.6 Sq. Ft. 6.9 Sq. Ft.

V Bed 3 122.4 Sq. Ft. 111.2 Sq. Ft.

V Bed 3 Clos

7.6 Sq. Ft. 6.9 Sq. Ft.

V Dining Clos

7.1 Sq. Ft. 6.5 Sq. Ft.

V Hall 1 112.7 Sq. Ft. 102.4 Sq. Ft.

V Hall 1 Clos 1

7.1 Sq. Ft. 6.4 Sq. Ft.

V Hall 1 Clos 2

3.7 Sq. Ft. 3.3 Sq. Ft.

V Hall 2 51.3 Sq. Ft. 46.6 Sq. Ft.

V Hall 2 Clos 1

8.4 Sq. Ft. 7.7 Sq. Ft.

V Kit/Dining 182.4 Sq. Ft. 165.8 Sq. Ft.

V Living 306.9 Sq. Ft. 278.9 Sq. Ft.

TOTAL: 1087.0 Sq. Ft. 988.0 Sq. Ft.

Installation fees will be and additional charges may be based on total flooring recommended by the installer (based on the installer's assessment of unique characteristics of your project). The installer's recommendation will include waste and will exceed actual room square footage.

Material Type Legend: "C" (Carpet), "H" (Hardwood/Laminate), "V" (Vinyl), "T" (Tile)

Project Name: COLLIER LINDA Account: Lowe's 0575 Customer: LINDA COLLIER

Project Id: 4601501 Prepared By: Address: 4412 ROBINHOOD TER

Retail Order #: 179242416 Print Date: 10/26/2021 MIDLAND, Michigan 48642

Bed 1 Vinyl Plank - SMARTCORE #1 - Vinyl Plank Bed 1 Clos Vinyl Plank - SMARTCORE #1 - Vinyl Plank

MAIN - LVL 1 MAIN - LVL 1

Subfloor: Plywood Lab Inst Vinyl Plank (Float-Click) Straight - Plk/Hor Subfloor: Plywood Lab Inst Vinyl Plank (Float-Click)

Straight - Plk/Hor

ID 1 2

SIZE 2 / 6 2 / 6

TO VP VP

ID 1

SIZE 2 / 6

TO VP




Straight - Plk/Hor

ID 1 2

SIZE 2 / 4 2 / 6

TO VP VP

ID 1

SIZE 2 / 6

TO VP







Straight - Plk/Hor

ID 1 2

SIZE 2 / 6 2 / 4

TO VP VP

ID 1

SIZE 2 / 6

TO VP

Dining Clos Vinyl Plank - SMARTCORE #1 - Vinyl Plank Hall 1 Vinyl Plank - SMARTCORE #1 - Vinyl Plank



Straight - Plk/Hor

ID 1

SIZE 2 / 6

TO VP

ID 1 2 3 4 5 6 7 8

SIZE 2 / 8 2 / 4 2 / 6 1 / 6 2 / 4 3 / 0 3 / 11 2 / 8

TO None Vnl VP VP VP None VP Step-D




Hall 1 Clos 1 Vinyl Plank - SMARTCORE #1 - Vinyl Plank Hall 1 Clos 2 Vinyl Plank - SMARTCORE #1 - Vinyl Plank



Straight - Plk/Hor

ID 1

SIZE 2 / 4

TO VP

ID 1

SIZE 1 / 6

TO VP

Hall 2 Vinyl Plank - SMARTCORE #1 - Vinyl Plank Hall 2 Clos 1 Vinyl Plank - SMARTCORE #1 - Vinyl Plank



Straight - Plk/Hor

ID 1 2 3 4 5 6

SIZE 2 / 4 2 / 4 2 / 6 2 / 6 2 / 6 2 / 6

TO Vnl VP VP VP VP VP

ID 1

SIZE 2 / 4

TO VP




Kit/Dining Vinyl Plank - SMARTCORE #1 - Vinyl Plank Living Vinyl Plank - SMARTCORE #1 - Vinyl Plank



Straight - Plk/Hor

ID 1 2 3 4 5 6 7

SIZE 7 / 3 2 / 6 2 / 8 4 / 6 2 / 1 2 / 6 3 / 6

TO Cab Cab VP Cab Cab VP VP

ID 1 2 3 4 5

SIZE 3 / 6 3 / 11 1 / 5 6 / 2 1 / 5

TO VP VP Brck-R Brck-R Brck-R

Always Improving!

Powered by FloorWizard Vinyl Plank - SMARTCORE #1 - Vinyl Plank : Page 1 of 2 Version: db

Customer InformationName: LINDA COLLIER Primary Phone: 734-395-7255

Address: 4412 ROBINHOOD TER Secondary Phone: 734-395-7255

MIDLAND, Michigan 48642 Home Phone: 734-395-7255

Mobile Phone:

Email: Work Phone: 734-395-7255

Contact InformationTitle Person Company Work Phone Mobile Phone Fax Number Email

Project Contact: LS 0575 Lowe's 0575 989-832-6347 989-832-8063

Address: 1918 Airport Rd. - Midland, Michigan 48642

Sales Associate: N/A

AppointmentsAppointment Type Date Confirmation Assigned Person Mobile Number Scheduled By

Measure 10/23/2021 - 8:00 AM Unconfirmed Mikka Davis 989-996-1765 Mikka Davis

Note:

Customer ResponsibilitiesBed 1 Handle: Clothes/Personal Belongings

Bed 1 Clos Handle: Clothes/Personal Belongings; Normal Furniture

Bed 2 Handle: Television, Normal; Clothes/Personal Belongings


Bed 3 Handle: Musical Equipment; Clothes/Personal Belongings


Dining Clos Handle: Clothes/Personal Belongings; Normal Furniture

Hall 1 Clos 1 Handle: Clothes/Personal Belongings; Normal Furniture



Living Handle: Clothes/Personal Belongings; Computers/Electronics

Transition DetailsID Description Length

22 Transition, Vinyl, Vinyl Plank Reducer 2' 4"

8 Transition, Vinyl, Vinyl Plank Reducer 2' 4"

14 Transition, Vinyl, Vinyl Plank End Cap 3' 0"


56 Molding, Install 1/4 Round (Matching) - customer choice 2' 1"




1 Caulk, Color to match Grout 1' 5"






12 Transition, Vinyl, Vinyl Plank Stair Nose 2' 8"

12 Glue, TWO PART EPOXY - FOR STAIR NOSE ONLY 2' 8"

Always Improving!

Powered by FloorWizard Vinyl Plank - SMARTCORE #1 - Vinyl Plank : Page 2 of 2 Version: db

Room/Product ConnectionsTrans ID Level Type Level Change

1 MAIN - LVL 1 Opening No level change from Vinyl Plank (Living) to Brick Rough (Fireplace)



8 MAIN - LVL 1 Door No level change from Vinyl Plank (Hall 1) to Vinyl (Bath 2)

9 MAIN - LVL 1 Door No level change from Vinyl Plank (Hall 1) to No Flooring (Outside)

12 MAIN - LVL 1 Door No level change from Vinyl Plank (Hall 1) to Step Down (Step Down)

14 MAIN - LVL 1 Door No level change from Vinyl Plank (Hall 1) to No Flooring (Outside)

22 MAIN - LVL 1 Door No level change from Vinyl Plank (Hall 2) to Vinyl (Bath 1)

44 MAIN - LVL 1 Door No level change from Vinyl Plank (Bed 1 Clos) to Vinyl Plank (Bed 1)



47 MAIN - LVL 1 Door No level change from Vinyl Plank (Hall 2) to Vinyl Plank (Hall 1)

48 MAIN - LVL 1 Door No level change from Vinyl Plank (Hall 1 Clos 2) to Vinyl Plank (Hall 1)


50 MAIN - LVL 1 Door No level change from Vinyl Plank (Bed 3) to Vinyl Plank (Hall 2)




54 MAIN - LVL 1 Opening No level change from Vinyl Plank (Hall 1) to Vinyl Plank (Living)

56 MAIN - LVL 1 Opening No level change from Vinyl Plank (Kit/Dining) to Cabinet (Cabinets)




61 MAIN - LVL 1 Opening No level change from Vinyl Plank (Kit/Dining) to Vinyl Plank (Living)

62 MAIN - LVL 1 Opening No level change from Vinyl Plank (Kit/Dining) to Vinyl Plank (Hall 1)

65 MAIN - LVL 1 Door No level change from Vinyl Plank (Dining Clos) to Vinyl Plank (Kit/Dining)

Powered by FloorWizard Page 1 of 1 Version: db

MAIN - LVL 1 | 993 Sq. Ft. | Customer: LINDA COLLIERRoom Area (SF)

Bed 1 130

Bed 1 Clos 7

Bed 2 109

Bed 2 Clos 7

Bed 3 112

Bed 3 Clos 7

Dining Clos 7

Hall 1 103

Hall 1 Clos 1 7

Hall 1 Clos 2 4

Hall 2 47

Hall 2 Clos 1 8

Kit/Dining 166

Living 279

Total 993

Note to Installer: ONLY use installer cut sheet for cross-cut values.

Always Improving!





Mobile Phone:








Note:

Project Photos

Always Improving!


Project Photos

Always Improving!





Mobile Phone:








Note:

Check ListItem Complete? Warning

Rooms Drawn Yes

Rooms Specified Yes

Rooms Estimated Yes

Room Details - Subfloor Type Yes

Room Details - Subfloor Flatness Yes

Room Details - Existing Flooring Yes

Room Details - Installation Method Yes

Project Details - Site Info Yes

Lead Assessment/Safe Practices Checklist Yes The EPA Checklist has been signed

Alerts No

Cut Sheets Verified No

Transition Details No

Door Details No

Level Change No No Level Changes

Room/Product Connections No

Room Details - Handling No

Room Details - Notes No Missing Room Notes

Product Details - Supplies No

Project - Signed Documents No

Project Details - Notes No

Project - Payments No No Payments Recorded

Project - Photos No

Project Details - Charges No

Charges - Flooring No 1 Generic Flooring

Charges - Services No 5 Services w/ Zero Price

Charges - Supplies No 8 Supplies w/ Zero Price

Charges - Taxes No

Store: Lowe's 0575, Project No: 704832623 for LINDA COLLIER

SAMPLE PRE-RENOVATION FORMThis sample form may be used by renovation firms to document compliance with the Federalpre-renovation education and renovation, repair, and painting regulations.

Occupant Confirmation

Pamphlet ReceiptI have received a copy of the lead hazard information pamphlet informing me of the potential risk of thelead hazard exposure from renovation activity to be performed in my dwelling unit. I received thispamphlet before the work began.

LINDA COLLIER

Printed Name of Owner-occupant

10/24/2021

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 tenantsignature was not obtainable, you may check the appropriate box below.

Declined - I certify that I have made a good faith effort to deliver the lead hazardinformation pamphlet to the rental dwelling unit listed below at the date and time indicatedand that the occupant declined to sign the confirmation of receipt. I further certify that Ihave left a copy of the pamphlet at the unit with the occupant.

Unavailable for signature - I certify that I have made a good faith effort to deliver the leadhazard information pamphlet to the rental dwelling unit listed below and that the occupantwas unavailable to sign the confirmation of receipt. I further certify that I have left a copy ofthe pamphlet at the unit by sliding it under the door or by (fill in how pamphlet was left).

Mikka Davis 10/24/2021

Printed Name of Person Certifying Delivery Attempted Delivery Date

Signature of Person Certifying Lead Pamphlet Delivery

4412 ROBINHOOD TER

Unit Address


City State Zip

4412 ROBINHOOD TER

Billing Address


City State Zip

LOWE'S INSTALLER LRRP CHECKLIST FOR RENOVATIONS PERFORMED IN PRE-1978 HOUSING AND CHILD-OCCUPIED FACILITIES

Rev. 02.2018 Rev. 10.2021, Store: Lowe's 0575, Project No: 704832623 for LINDA COLLIER, Measure PO: 179242416 1 of 6

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. Â§ 745.80, et seq., OR ANY APPLICABLE U.S. EPA-AUTHORIZED STATE OR TRIBAL PROGRAM REGULATING LEAD-BASED PAINT SAFE WORK PRACTICES.

General Project Information:

Customer Name: LINDA COLLIER Contract Number: 704832623

Customer Address: 4412 ROBINHOOD TER MIDLAND Michigan 48642City State Zip

Installation Address:(if different than above) City State Zip

Installer Firm Name and Certification Number (copy of the firm certificate must he on file with Lowe's):

Installation Services NAT-R-R-108302-20-00012Firm Name Certification Number

Assigned Renovator Name & Certification Number (copy of initial and refresher training certificate must be available on the work site):

Mikka Davis R-I-108302-15-000017Renovator Name Certification Number

Brief Description of Renovation Project (include painted surfaces disturbed and estimated size):

MEASURE DETAIL ONLY Lowes Contract Number: 704832623

Did the Installer obtain a written determination from a certified inspector or risk assessor that lead-based paint wasnot present on the components affected by the renovation?

X Yes and a copy of the determination is on file. (Form is COMPLETE. Sign Certification on last page.)

X No (Continue to Next Section, "Lead Testing Information.")



LEAD TESTING INFORMATION:

Were EPA or applicable state recognized lead test kits used by certified renovator on each and every component (forexample, each window to be replaced must be tested unless it is assumed to have lead-based paint) to determinewhether lead was present on components affected by renovation?

X Yes X N/A

Identify workers and kits used and describe components tested, sampling locations, and results below. Follow the lead test kit directions completely when testing components. Document paint chip sampling and laboratory results.

Certified Renovator Name Certification NumberMikka Davis R-I-108302-15-000017

Attach additional sheets as needed.

Test Kit Manufacturer and Model Component and Location Tested ResultHybrivet Systems Leadcheck Lead Test Dining Clos Not TestedHybrivet Systems Leadcheck Lead Test Kit/Dining Not TestedHybrivet Systems Leadcheck Lead Test Bed 3 Clos Not TestedHybrivet Systems Leadcheck Lead Test Bed 3 Not TestedHybrivet Systems Leadcheck Lead Test Bed 2 Clos Not TestedHybrivet Systems Leadcheck Lead Test Bed 2 Not TestedHybrivet Systems Leadcheck Lead Test Bed 1 Clos Not TestedHybrivet Systems Leadcheck Lead Test Bed 1 Not TestedHybrivet Systems Leadcheck Lead Test Hall 2 Clos 1 Not TestedHybrivet Systems Leadcheck Lead Test Hall 2 Not TestedHybrivet Systems Leadcheck Lead Test Hall 1 Clos 2 Not TestedHybrivet Systems Leadcheck Lead Test Hall 1 Clos 1 Not TestedHybrivet Systems Leadcheck Lead Test Hall 1 Not TestedHybrivet Systems Leadcheck Lead Test Living Not TestedAttach additional sheets as needed.

Note -- Each window to be replaced must he tested unless it is assumed to have lead-based paint.

Was lead-based paint determined to be present on the components affected by the renovation?

X Yes (Continue to Next Section, "Notification, Work Practices, and Record-keeping.)

X Presumed to be present on the components affected by the renovation (Continue to Next Section, "Notification, Work Practices, and Record-keeping).

X Area of disturbance is less than six (6) square feet of painted surfaces for interior projects and less than twenty (20) square feet of painted surfaces for exterior projects.

Minor repair and maintenance activities that disturb 6 square feet or less of paint per room inside, or 20 square feet or less on the exterior of a home or building. (Note: Window replacement, and partial and full demolition activities, are always covered regardless of square footage. Activities designated as "prohibited" are prohibited regardless of square footage.)

X No (Form is COMPLETE, sign Certification on last page.)



NOTIFICATION, WORK PRACTICES, AND RECORD-KEEPING:(40 C.F.R. Parts §§ 745.84-745.86 or applicable state program)

Please acknowledge one of the following:

Signed and dated acknowledgments of receipt of the Renovate Right pamphlet from, as applicable: owners and, if not owner-occupied, adult occupants of dwelling units, owners of multi-unit housing for renovations in common areas; and owners and adult representatives of child-occupied facilities are on file;

OR

Certificates of mailing of the Renovate Right pamphlet to the following, as applicable: owners and, if not owner-occupied, adult occupants of dwelling units; owners of multi-unit housing for renovations in common areas; and owners and adult representatives of child-occupied facilities are on file.

OR

Certificates of attempted delivery of the Renovate Right pamphlet to adult occupants of dwelling units or adult representatives of child-occupied facilities are on file.

If the Renovation Project involved a common area of a multi-unit building, was a signed statement describing the steps performed to notify all occupants of multi-unit housing of the renovation activities, to provide the Renovate Right pamphlet to all occupants, and to inform of any changes to the renovation activities, obtained and on file?

X Yes X N/A

If the Renovation Project was performed in a child-occupied facility, was a signed statement describing the steps performed to notify all parents and guardians of children using child-occupied facilities of the renovation activities, to provide the Renovate Right pamphlet, and to provide a copy of the records showing compliance with the LRRP Rule and any dust clearance sampling reports, is on file.

X Yes X N/A

Name(s) of Dust Sampling Technician, Inspector, or Risk Assessor, if used:



NOTIFICATION, WORK PRACTICES, AND RECORD-KEEPING: continuedIf applicable, Certified renovator provided training to workers on (check all that apply):

Posting warning signs Setting up plastic containment barriers

Maintaining containment Avoiding spread of dust to adjacent areas

Waste handling Post-renovation cleaning

List names of workers trained:

Renovator posted signs defining work area to keep others out of renovation work area. Warning signs were posted at entrance to work area.

X Yes X N/A

Work area contained to prevent spread of dust and debris? (Check all that apply)

(INTERIOR)

All objects in the work area were removed or covered (interiors).

HVAC ducts in the work area were closed and covered (interiors).

Windows and doors in the work area were closed and sealed (interiors).

Floor surfaces covered by plastic extending 6 feet from work area (interiors).

Doors in the work area were closed and sealed (interiors).

Doors that must be used in the work area were covered to allow passage but prevent spread of dust (interiors).

Floors in the work area were covered with taped-down plastic (interiors).

(EXTERIOR)

Windows in and within 20 feet of the work area were closed (exteriors).

Doors in and within 20 feet of the work area were closed and sealed (exteriors).

Ground was covered by plastic extending 10 feet from work area - plastic anchored to building and weighed down by heavy objects (exteriors).

If necessary, vertical containment was installed if property line prevents 10 feet of plastic ground cover, or if necessary to prevent migration of dust and debris to adjacent property (exteriors).



NOTIFICATION, WORK PRACTICES, AND RECORD-KEEPING: continued

Please acknowledge the following if applicable:

None of the prohibited and restricted work practices were employed.

X Yes X N/A

Waste was contained on-site and while being transported off-site.

X Yes X N/A

Work site was properly cleaned after renovation:

X Yes X N/A

All chips and debris were picked up, protective sheeting misted, folded dirty side inward, and taped for removal;

Plastic sheeting misted, folded dirty side inward, and taped for removal; and

Work area surfaces, walls, and objects were cleaned using HEPA vacuum and/or wet-cloths or mops (interiors).

Certified renovator performed post-renovation cleaning verification. Describe results, including the number of wet and dry cloths used:

OR

If dust clearance testing was performed instead of cleaning verification, the sample results were below clearance standards and a copy of the report was provided to property owners and, if not owner-occupied, adult occupants of residential dwellings or adult representatives of child-occupied facilities and posted in common areas of any multi-unit housing.

X Yes X N/A

If the renovation is an emergency renovation under the LRRP Rule, describe the nature of the emergency and document the provisions of the LRRP Rules that were not followed:



INSTALLER CERTIFICATION

I, the undersigned Installer, certify under penalty of law that the above information is true and complete, and do hereby certify that I have complied with all requirements of the Lead Renovation, Repair, and Painting Rule ("LRRP RULE", 40 C.F.R. Â§ 745.80, et seq., or any applicable state laws or program regulating lead-based paint safe work practices, including compliance with all information distribution, notice requirements and work practice standards in performing this Renovation Project. I certify that I have provided the Customer with all documentation required to be supplied under the LRRP Rule or state program, shall retain all records required by law for at least 3 years or longer if required by state law, and shall provide copies of all the records required to be retained by the LRRP Rule or applicable state program upon request. If requested by the Customer, I have provided the Customer with a completed copy of this Renovation Record-keeping Checklist.

Mikka Davis (Representative) 10/24/2021

Installer Name and Title Signature Date