аЯрЁБс>ўџ ;=ўџџџ:џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџьЅС јПгbjbjфъфъ &†€†€Сџџџџџџltttttttˆ2 2 2 8j v ,ˆуlЎ Ў Ф Ф Ф Ф :ў  bdddddd$O oЖˆt Ф Ф   ˆ’ ttФ Ф ’ ’ ’  RtФ tФ b’  b’ ’  :Т@ttФ Ђ Аш5UФˆЊ2 p ж LГ0у  %F L%’ ˆˆttttйOUR PROGRAM STREET ADDRESS CITY, STATE, ZIP PHONE PRE-CONSTRUCTION CONFERENCE CHECKLIST Date:___________________ Property Owner(s):_______________________ Rehab Specialist:______________________ ___ Address:______________________________ _____________________________________ Phone:________________________ Phone:________________________________ Fax:__________________________ Pager:_________________________ E-Mail __________________________ Contractor Name:________________________ Contract Amount:________________________ Address:________________________________ Phone:___________________________________ Fax: ____________________________________ Pager: ___________________________________ E-Mail:__________________________________ Pre-construction Conference Attendees: _________________________________ _______________________________ _________________________________ _______________________________ _________________________________ _______________________________ Items Covered in the Pre-construction Conference: _______ Final Location-by-Location Review and Agreement on Work Write-Up _______ Review and Completion of Owner Selection Sheet _______ Construction Roles Agreement _______ Occupant Protection and Temporary Relocation (if necessary) _______ EPA Lead Hazard Information Pamphlet Distributed _______ Removal of Furnishings _______ Correspondence Procedures _______ Designation of Responsible Individuals (___________________________) _______ Changes (Change Orders, Clarifications and Contract Modifications) _______ Accident Prevention Program (including name of responsible supervisor) _______ Payments Procedure Review _______ Program Regulations and General Conditions Review _______ Execute Construction Roles Agreement _______ Documents Required under the Contract - Building Permit Applied for - Warranties - Liability Insurance - Workers Compensation _______ Saturday, Sunday, holiday and night work _______ Review of Construction Schedule _______ Required Progress Inspection Checklist _______ Equal Employment Opportunity Poster given (if over $10,000) _______ Affirmative Action Plans _______ Section III Requirements _______ Initial Notice of Construction Mortgage (state-specific) _______ Notice of Construction Mortgage Requisition (state-specific) Additional Items Covered in Conference: _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ I (we) the undersigned, have on this date ______________ participated in a pre-construction conference prior to the signing of a contract for the rehabilitation of my (our) property. I (We) acknowledge that I (we) understand the terms of the contract, the explanation of the work to be performed by the contractor, the role of the contractor, the role of the construction Specialist, and my (our) responsibilities during the construction phase. I (We) have been given adequate answers to our questions, if any. I (We) further understand and acknowledge that Our Program and its employees, officers, directors, volunteers, agents, and successors and/or assigns, assume no responsibility for the work performed and do not warrant any work performed. _______________________ __________________________ ___________ Witness Homeowner Signature Date _______________________ __________________________ ___________ Witness Homeowner Signature Date I, the undersigned, hereby certify that the pre-construction conference was held on this date between the homeowner(s), construction specialist, and the undersigned General Contractor. I understand the procedures to be followed for change orders and requests for payment and inspections. I understand and agree that the work performed must meet the standards of performance required by Our Program and established by the General Requirements, Work Write-Up and Agency/Contractor Agreement _____________________________ _______________ General Contractor Date I, the undersigned, hereby certify that I participated in a pre-construction conference this date. Our Program ____________________________ _______________Construction Specialist ____________Date The National Center for Healthy Housing developed this model document; the Center makes no express or implied warranty about the document and assumes no legal liability for its use.  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