Exigent Health & Safety Reply Certification Form

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Helena Adams
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1 Exigent Health & Safety Reply Certification Form When you receive your official REAC inspection and the Inspector visualizes Exigent Health & Safety Issues, The HUD Office of Public Housing requires all Exigent Health and Safety hazards be mitigated immediately. Public Housing Authorities will receive an within 48 hours of the inspection notifying the PHA of the existence of Exigent Health and Safety deficiencies. PHAs are required to repair all EHS items and fax or send the signed certification form attesting that all corrections have been made to the local PIH field office within 10 days after the inspection. HUD may follow up with you to verify the correction of these deficiencies. A copy of the required certification form is attached for your use. Attached are the form and the Local Field Offices that you need to reply to.

2 PHA CERTIFICATION OF REPAIRS FOR EXIGENT HEALTH AND FIRE SAFETY HAZARDS SEND OR FAX SIGNED COPY TO LOCAL PIH OFFICE Property ID #: Inspection ID#: Inspection Date: Property Name: Property Address: City: State: ZIP: Property Phone: Owner/PHA Phone: Observed and Noted Exigent Health and Safety Hazards (If additional space is needed, continue on a separate page) Air Quality A Propane/Natural Gas/Methane Gas Detected Electrical Hazards B Exposed Wires/Open Panels C Water Leaks On or Near Electrical Equipment Emergency Equipment/Fire Exits/Fire Escapes D Emergency/Fire Exits/Blocked/Unusable Fire Escapes E Blocked Egress/Ladders Gas/Oil Hot Water Heater/Gas/Oil HVAC F Carbon Monoxide Hazard Gas/Oil Fired Unit - Missing/Misaligned Chimney Item No Site or Building location DU or CA Location Defect Type A B C D E F Corrective Action Taken Date Work order no Observed and Noted Fire Safety Hazards (If additional space is needed, continue on a separate page) Emergency Equipment/Fire Exits/Fire Escapes G Window Security Bars Prevent Egress H Fire Extinguishers Expired Smoke Detectors I Missing/Inoperative Item Site or DU or CA Defect Type(s) No Building Location Corrective Action Taken Date Work order no location G H I I certify that to the best of my knowledge and belief, the exigent and fire safety hazards noted and reported during the physical inspection described above, have been mitigated. I further acknowledge that any false, fictitious or fraudulent statement or report, or any alteration or forgery of a document, or any willful misrepresentation made to the U.S. Department of Housing and Urban Development may result in a fine or imprisonment or both pursuant to 18 U.S.C. Sec. 1001, 1010, or 1012v. Date Name of Owner/Agent s Representative Signature of Owner/Agent s Representative (Please print legibly) SEND OR FAX SIGNED COPY TO LOCAL PIH OFFICE Call (toll free) if you need assistance. Retain a copy for your records.

3 OFFICE OF PUBLIC HOUSING FIELD OFFICE DIRECTORY NEW ENGLAND REGION BOSTON Donna Ayala, Director DHUD - Massachusetts State Office Thomas P. O'Neill, Jr. Federal Building 10 Causeway Street, Room 553 Boston, MA (617) (617) (FAX) HARTFORD DHUD - Connecticut State Office One Corporate Center; 19 th Floor Hartford, CT (860) (860) (FAX) NEW YORK / NJ REGION NEW YORK Mirza Del Rosario, Director DHUD - New York State Office 26 Federal Plaza Suite New York, New York (212) , x3600 (212) (FAX) BUFFALO Joan Spilman, Director DHUD - Buffalo State Office Lafayette Court 465 Main Street, Fifth Floor Buffalo, New York DIRECT NUMBER: (716) (716) , x5400 (716) (FAX) NEWARK Carmen Valenti, Director DHUD - New Jersey State Office One Newark Center 13th Floor Newark, NJ (973) (973) (FAX) 1

4 MID-ATLANTIC REGION PHILADELPHIA Malinda Roberts, Director DHUD - Pennsylvania State Office The Wanamaker Building 100 Penn Square East Philadelphia, PA (215) , ext (215) (FAX) BALTIMORE William Tamburrino, Director DHUD - Maryland State Office City Crescent Building 10 South Howard Street, 5th Floor Baltimore, Maryland (410) ext (410) (FAX) PITTSBURGH James Cassidy, Acting Director DHUD - Pittsburgh Area Office 339 Sixth Avenue Sixth Floor Pittsburgh, PA (412) (412) (FAX) RICHMOND Pat Anderson, DHUD - Virginia State Office The 3600 Centre 3600 West Broad Street P.O. Box Richmond, VA (804) , X3775 (804) (FAX) WASHINGTON, D. C. Lee Palman, DHUD - District of Columbia Office 820 First Street, NE; Suite 450 Washington, DC (202) , x3175 (202) (FAX) 2

5 SOUTHEAST REGION ATLANTA Boyce Norris, Director DHUD - Georgia State Office Five Points Plaza 40 Marietta Street, 17 th Floor Atlanta, GA (404) , x2434 (404) (FAX) BIRMINGHAM Mack Heaton, Director DHUD - Alabama State Office Medical Forum Building nd Street North Suite 900 Birmingham, AL (205) (205) (FAX) COLUMBIA Larry Knighter, DHUD - South Carolina State Office Strom Thurmond Federal Building 1835 Assembly Street Columbia, SC (803) (803) (FAX) GREENSBORO Douglas Gager, Acting Director DHUD - North Carolina State Office Koger Building 2306 West Meadowview Road Greensboro, NC (336) (336) (FAX) JACKSON George Smith, DHUD - Mississippi State Office Doctor A. H. McCoy Federal Building 100 West Capitol Street, Room 910 Jackson, MS (601) (601) (FAX) MIAMI Karen Cato-Turner, Director DHUD - Flordia State Office Brickell Plaza Federal Building 909 S.E. First Avenue, Room 500 Miami, FL (305) , x2275 (305) (FAX) JACKSONVILLE John Niesz, Director DHUD - Jacksonville Area Office Southern Bell Tower 301 West Bay Street, Suite 2200 Jacksonville, FL (904) , X2142 (904) (FAX) LOUISVILLE Arthur Wasson, Director DHUD - Kentucky State Office 601 West Broadway Louisville, KY (502) ext 370 (502) (FAX) 3

6 KNOXVILLE Vicky A. Martin DHUD - Knoxville Area Office John J. Duncan Federal Building 710 Locust Street, Third Floor Knoxville, TN (865) , x130 (865) (FAX) NASHVILLE Michael Farley, DHUD - Tennessee State Office 235 Cumberland Bend Drive Suite 200 Nashville, TN (615) ext (615) (FAX) SAN JUAN Hildamar Ortiz, Director DHUD - Caribbean Office Administracion de Terrenos Building 171 Carlos E. Chardon Avenue Suite 301 San Juan, PR (787) X2032 (787) (FAX) 4

7 MID-WEST REGION CHICAGO Linford Coleman, Director DHUD - Illinois State Office Ralph H. Metcalf Federal Building 77 West Jackson Boulevard Chicago, IL (312) , x2308 (312) (FAX) CLEVELAND Thomas Marshall, Director DHUD - Cleveland Area Office Renaissance Building 1350 Euclid Avenue, Suite 500 Cleveland, OH (216) , x7120 (216) (FAX) COLUMBUS David Kellner, DHUD - Ohio State Office 200 North High Street Columbus, OH (614) , X8224 (614) (FAX) DETROIT Joann L. Adams, Director DHUD - Michigan State Office Patrick V. McNamara Federal Building 477 Michigan Avenue Detroit, MI (313) , X8111 (313) (FAX) INDIANAPOLIS Forrest Jones, DHUD - Indiana State Office 151 North Delaware Street Suite 1200 Indianapolis, IN (317) , x6557 (317) (FAX) MILWAUKEE John Finger, DHUD - Wisconsin State Office Henry S. Reuss Federal Plaza 310 West Wisconsin Avenue Suite 1380 Milwaukee, WI (414) , Ext (414) (FAX) MINNEAPOLIS Diane Cmiel, Director DHUD - Minnesota State Office 220 South Second Street Minneapolis, Minnesota (612) , Ext (612) (FAX) 5

8 SOUTHWEST REGION FORT WORTH Eileen Rogers, Director DHUD - Texas State Office 801 Cherry Street, 26th Floor Burnett Plaza Fort Worth, Texas (817) (817) (FAX) ALBUQUERQUE Floyd R. Duran, Acting DHUD - New Mexico State Office 625 Truman Street, N.E. Albuquerque, N.M (505) (505) (FAX) HOUSTON Antonio Mosqueda, Acting DHUD - Houston Area Office Norfolk Tower 2211 Norfolk, Suite 200 Houston, TX (713) (713) (FAX) NEW ORLEANS Chester Drozdowski, Director DHUD - Louisiana State Office 501 Magazine Street Ninth Floor New Orleans, LA (504) (504) (FAX) OKLAHOMA CITY Robert Vasquez, DHUD - Oklahoma State Office 500 West Main Street Oklahoma City, OK (405) (405) (FAX) SAN ANTONIO Diana Armstrong, Director DHUD - San Antonio Area Office Washington Square 800 Dolorosa Street San Antonio, TX (210) , x2215 (210) (FAX) LITTLE ROCK Jesse Westover, Acting Director DHUD - Arkansas State Office TCBY Tower 425 West Capitol Avenue, Suite 900 Little Rock, AR (501) (501) (FAX) 6

9 GREAT PLAINS REGION KANSAS CITY Andrew Boeddeker, Director DHUD -Kansas/Missouri State Office Gateway Tower II 400 State Avenue Kansas City, KS (913) (913) (FAX) OMAHA Joni Hendricks, Acting DHUD - Nebraska State Office Executive Tower Centre Mill Valley Road Omaha, NE (402) (402) (FAX) ROCKY MOUNTAIN REGION DENVER John Dibella, Director DHUD - Colorado State Office First Interstate Tower North th Street 12th Floor Denver, CO (303) ext 1244 (303) (FAX) ST. LOUIS Patricia Straussner, DHUD - St. Louis Area Office Robert A. Young Federal Building 1222 Spruce Street St. Louis, MO (314) (314) (FAX) 7

10 PACIFIC HAWAII REGION SAN FRANCISCO Joyce Lee, Director DHUD - California State Office Phillip Burton Federal Building/Courthouse 450 Golden Gate Avenue, Ninth Floor San Francisco, CA (415) (415) (FAX) LOS ANGELES Bob Cook, Director DHUD - Los Angeles Area Office AT&T Center 611 West 6th Street, Suite 800 Los Angeles, CA (213) ext 3500 (213) (FAX) NW/ALASKA REGION SEATTLE Lynn Martin, Director DHUD - Washington State Office Seattle Federal Office Building 909-1st Avenue, Suite 360 Seattle, WA (206) Ext 3694 (206) (FAX) PORTLAND Elizabeth Santone, DHUD - Oregon State Office 400 Southwest Sixth Avenue Suite 700 Portland, OR (503) (503) (FAX) 8

FBI Drug Demand Reduction Coordinators

FBI Drug Demand Reduction Coordinators Alabama 2121 Building, Room 1400 Birmingham, AL 35203 (205) 252 7705 One St. Louis Centre One St. Louis Street Mobile, AL 36602 (334) 438 3674 Alaska 222 West Seventh