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October 29, 2019 <br />Based upon the review of your license application, the Indiana Lead and Health Homes Program has determined that you have fulfilled the <br />requirements of 410 IAC 32 and are eligible for licensing in the following lead-based discipline: Lead Contractor. <br />Enclosed is your Lead Contractor license. This card must be available for review at all times while you are implementing a lead-based <br />project. <br />This license may be revoked, pursuant to 410 IAC 32-2-8, if you: <br />(1) Violate any requirements of these rules (410 IAC 32), or any other federal, state, or local regulation pertaining to lead-based paint <br />activities. <br />(2) Falsify information on your application for licensing. <br />(3) Fail to meet any qualifications specified in 410 IAC 32. <br />(4) Conduct a lead-based paint project, or related lead-based activity, in a manner which is hazardous to the public health. <br />Your license is valid effective 10/15/2010, and will expire on 10/15/2022, as indicated on your card. We suggest that you attend the required <br />training and submit an application for license renewal early to insure your license does not lapse. In order to avoid re -taking the initial <br />training course, you must attend a refresher in the discipline you are seeking a license within three (3) years from the date of issuance of <br />your last training course certificate. <br />Indiana State Department of Health <br />i I <br />CHRIS S. HART <br />Michael R. Kirkman i <br />The Designated Representative of: ; <br />Environmental Assurance Company, Inc. <br />i. <br />i Lead Contractor License # IND000659 <br />Effective: 10/15/2010 Expiration. 10/75/2022 <br />Birth Date: u .;dor: <br />Height- Eye Color: <br />_----- fir Color. --- — <br />SfAlEFOM1 a9iIIlx,/t6ipj <br />i <br />Indiana State Department of Health <br />100 N. Senate Avenue, N855 <br />Indianapolis, Indiana 46204 <br />Lead Contractor <br />IF�D0006Sg. ---- <br />txpiration Date <br />10/15/2022 <br />CHRIS S. HART <br />Michael R. Kirkman <br />The Designated Representative of: <br />Fnvirnnmantnl Accitrnnra ('_mmnnnv Inr, <br />Kristina Box, MD, FAC <br />OG <br />State Health Commissioner <br />—,_—_ Indiana State r►a„�.:.,..,,.,« ..� Wit__,.,- - <br />