BROWNSTONE AGENCY
Lead Testing Request Form
To be considered to have the lead exclusion to be removed from your Brownstone Agency policy, you will need to have lead testing performed on your premises, requested by your carrier, by an approved licensed lead inspector. This testing process includes gaining access to units and taking sampling of same. Our representative will need access to units, randomly selected, on your premises. They will take a sample by swiping and rubbing the surface of a window well, window sill or a floor. These samples will be taken in various units of your premises based on the size of the building. These swipes will be forwarded to an EPA certified lab for analysis and the results will be returned to you within 48 hours. The criterion for determining if your premises are lead free is based on HUD guidelines. B & C lead Consultants will be contacting you or your broker.
Please check the appropriate box for your request:
Lead Testing
Lead Abatement
The number of units for lead testing will be determined based on the size and occupancy of your building. We will need to gain access into units where sampling needs to be taken. This Completed form can be emailed to us or sent via fax.
Email:
Fax: 718-437-2434
Please print legibly
Insured Name: Insured Address:Contact Person: Telephone Number:
Number of floors? Number of units?
For Lead Abatement:
Apartment #’s Violation #’s:B & C Lead Consultants, LLC will conduct the lead testing. All fees are to be paid before any results from the lab can be submitted to you and/or to the requesting insurance company. The minimum cost per property would be $195.00. This fee includes 3 wipes (covering 1 unit – three rooms). Additionally, swipes are $15 per dust swipe and three (3) swipes are required per apartment tested.
Example: A 10 unit building that is a four (4) story walk up will need a total of eight (8) samples – three (3) in one apartment, one (1) for each of the four (4) public hallways and one (1) blank totaling a fee of $255.00 for this building.
The fee is payable to B & C Lead Consultants, LLC upon receipt of payment report will be released. The remittance address is B & C Lead Consultants, LLC, 4907-18th Avenue, Suite#520, Brooklyn, NY 11204 ATTN: Accounts Payable (please include a copy of this request).
By endorsing this request you acknowledge that payment is due to B & C Lead Consultants, LLC. You are also permitting a copy of the report to be sent to the Brownstone Agency. All findings will be reported utilizing the HUD guidelines
______
Authorized Signature Date
Remit Payment to:
B & C Lead Consultants, LLC
4907-18th Avenue, Suite#520
Brooklyn, NY 11204
P: 718-532-1350