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STATE OF CALIFORNIA - HEALTH AND WELFARE AGENCY by i7Xox0

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									State of California
DEPARTMENT OF COMMUNITY SERVICES & DEVELOPMENT
Project Cost Agreement
CSD 908 (Rev 10/05)
                                                LEAD HAZARD CONTROL PROGRAM
                                          ESTIMATED INTERIM CONTROL COST AGREEMENT

Project Address              _________________________________________________________________

Project Number                                               Agency ________________________________

Costs reflected below are estimates only. The final job costs may vary as they will be based on actual
labor and material costs. The estimated HDP project cost should reflect all costs associated with the
interim control/abatement activities of the unit. After determining the total HDP Project Cost, enter the
applicable agency and/or owner’s match and deduct the total match cost from the HDP Project Cost to
determine the HUD Contribution.

HDP PROJECT COST $_____________________

Agency Match
LIHEAP Wx Match              $__________________

DOE Wx Match                 $__________________

Utility Wx Match             $__________________

PVEA Wx Match                $__________________

In-Kind Match                $__________________         Specify __________________________________

Other Match                  $__________________         Specify __________________________________

Owner’s Match                                                List Owner Services/Materials
Construction                 $_________________
                                                             ___________________________________________
Relocation                   $_________________
                                                             ___________________________________________
HUD Contribution             $_________________


I hereby certify that I am the owner of the subject property described above and I do hereby authorize the California
Department of Community Services and Development (CSD) and/or its local agents to perform the lead hazard reduction
services specified in the attached work plan prepared for the subject property. I understand that the specified services
will be performed, supervised and monitored by State-certified personnel and all phases of the project will be conducted
in accordance with State and local building codes and following protocols established by CSD.

        Each signatory agrees to the terms listed above and the attached HDP Workplan
Authorized By:

__________________________________________________________________                       _________________
Agency Representative Signature               (Print Name)                               Date

__________________________________________________________________                       _________________
Owner/Owner Representative Signature          (Print Name)                               Date

__________________________________________________________________                       __________________
CSD Representative Signature                  (Print Name)                               Date

__________________________________________________________________                       __________________
CSD Manager Signature                         (Print Name)                               Date

shared/lead/rndxi/2005 forms/project/908/10-05

								
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