CALIFORNIA MONTH-TO-MONTH RENTAL AGREEMENT
THIS MONTH-TO-MONTH RENTAL AGREEMENT hereinafter known as the
"Agreement" is made and entered into this ____ day of _______________________,
20____, by and between the Landlord known as _______________________ with a
mailing address ____________________________________________________________________
____________________________________________________________________________________,
in the City of _______________________, State of California hereinafter known as the
"Landlord" and the Tenant(s) known as _______________________,
_______________________, _______________________, _______________________, hereinafter
known as the "Tenant(s)" for and in consideration of the covenants and obligations
contained herein and other good and valuable consideration, the receipt and
sufficiency of which is hereby acknowledged, the parties hereby agree as follows:
PROPERTY. Landlord owns property and improvements located at _________________
____________________________________________________________________________________,
City of _______________________, State of California (hereinafter referred to as the
"Property"). Landlord desires to lease the Property to Tenant upon the terms and
conditions contained herein. Tenant desires to lease the Property from Landlord
upon the terms and conditions contained herein.
TERM. The Agreement will start on _____________________ and will continue as a
month-to-month tenancy. In accordance with the State Statutes to terminate the
tenancy, the Landlord or Tenant must give the other party a written ____ days notice
of non-renewal. The Tenant may only terminate their Agreement on the last day of
any month and the Landlord must receive written notification of non-renewal at
least ____ days prior to the last day of that month. If the Tenant plans to leave on or
after the first of any month, they are responsible for that month’s full rent. If the
Tenant does not provide the Landlord with a written ____ days’ notice, they shall
forfeit their full deposit amount.
PAYMENTS. Tenant agrees to pay to Landlord as rent for the Property the
amount of ___________________________ dollars each month in advance on the 1st day
of each month at _________________________ or at any other address designated by
Landlord. If the Term does not start on the 1st day of the month or end on the last
day of a month, the first and last month’s rent will be prorated accordingly.
SECURITY DEPOSIT. At the signing of this Agreement, Tenant shall deposit with
Landlord, in trust, a security deposit of $_________ as security for the performance by
Tenant of the terms under this Agreement and for any damages caused by Tenant,
Tenant’s family, and visitors to the Property during the term of this Agreement. The
Landlord may use part or all of the security deposit to repair any damage to the
Property caused by Tenant, Tenant’s family, and visitors to the Property. However,
the Landlord is not just limited to the security deposit amount and Tenant remains
liable for any balance. Tenant shall not apply or deduct any portion of any security
deposit from the last or any month’s rent. Tenant shall not use or apply any such
security deposit at any time in lieu of payment of rent. If Tenant breaches any terms
or conditions of this Agreement, Tenant shall forfeit any deposit, as permitted by law.
LATE CHARGES. Rent is due on the 1st of each month. If any or all of the rent is not
received by the ____ of the month, $____ per day will be charged as late fees until full
rental payment is received. If rent is not received by the ____ of the month, Tenant
will be considered in breach of the Agreement and eviction proceedings will be
initiated.
INSUFFICIENT FUNDS. Tenant agrees to pay the charge of $____ for each check
given by Tenant to Landlord that is returned to Landlord for a lack of sufficient funds.
USE OF PROPERTY. Tenant shall only use the Property as a residence. The Property
shall not be used to carry on any type of business or trade without the prior written
consent of the Landlord. The Tenant will comply with all laws, rules, ordinances,
statutes, and orders regarding the use of the Property.
OCCUPANTS. Tenant agrees that no more than ____ persons may reside on the
Property without the prior written consent of the Landlord.
CONDITION. The Tenant has inspected the property, the fixtures, the grounds,
building, and improvements and acknowledges that the Property is in good and
acceptable condition and are habitable. If at any time during the term of this
Agreement, in Tenant’s opinion, the conditions change, Tenant shall promptly
provide reasonable notice to Landlord.
ASSIGNMENT. Under this Agreement Tenant shall shall not assign or sublease
any share in this Agreement. All sublease arrangements must be made with the
prior written consent of the Landlord, which consent shall not be unreasonably
withheld. Any assignment or sublease without the Landlord’s written prior consent
shall, at Landlord’s option, terminate this Agreement.
RIGHT OF ENTRY. Tenant agrees to make the Property available to Landlord or
Landlord’s agents for the purposes of inspection, making repairs or improvements,
or to supply agreed services or show the property to prospective buyers or tenants,
or in case of emergency. Except in case of emergency, Landlord shall give Tenant
____ hours notice of intent to enter. Tenant shall not, without Landlord’s prior written
consent, add, alter or re-key any locks to the Property. At all times Landlord shall be
provided with a key or keys capable of unlocking all such locks and gaining entry.
Tenant further agrees to notify Landlord in writing if Tenant installs any burglar
alarm system, including instructions on how to disarm it in case of emergency entry.
ALTERATIONS AND IMPROVEMENTS. Tenant shall make no alterations to the
building or improvements on the Property or construct any building or make any
other improvements on the Property without the prior written consent of Landlord.
Any and all alterations, changes, and/or improvements built, constructed, or placed
on the Property by Tenant shall, unless otherwise provided by written agreement
between Landlord and Tenant, be and become the property of Landlord and remain
on the Property at the expiration or earlier termination of this Agreement.
NON-DELIVERY OF POSSESSION. In the event, the Landlord cannot deliver
possession of the Property to Tenant upon the commencement of the Agreement
Term, through no fault of Landlord, then Landlord shall have no liability, but the
rental herein provided shall abate until possession is given. Landlord shall have ____
days in which to give possession and, if possession is tendered within such time,
Tenant agrees to accept the demised Property and pay the rental herein provided
from that date. In the event, possession cannot be delivered within such time,
through no fault of Landlord, then this Agreement and all rights hereunder shall
terminate.
HAZARDOUS MATERIALS. Tenant shall not keep on the Property any item of a
dangerous, flammable or explosive nature that might unreasonably increase the
danger of fire or explosion on the Property or that might be considered hazardous or
extra hazardous by any responsible insurance company.
UTILITIES. The Landlord shall provide the following utilities and services to the
Tenant(s): _____________________________________________________________________. Any
other utilities or services not mentioned will be the responsibility of the Tenant(s).
MAINTENANCE, REPAIR, AND RULES. Tenant will, at Tenant’s sole expense, keep
and maintain the Property in a good, clean and sanitary condition and repair during
the term of this Agreement and any renewal thereof. Tenant shall be responsible to
make all repairs to the Property, fixtures, appliances, and equipment therein that
may have been damaged by Tenant’s misuse, waste or neglect, or that of the
Tenant’s family or visitors. Tenant agrees that no painting will be done on or about
the Property without the prior written consent of Landlord. Tenant shall promptly
notify Landlord of any damage, defect or destruction of the Property or in the event
of the failure of any of the appliances or equipment. The Landlord will use their best
efforts to repair or replace any such damaged or defective areas, appliances or
equipment.
PETS. Tenant shall not keep any pets on the Property without the prior written
consent of the Landlord. If Landlord grants permission to Tenant to keep pets, an
additional security deposit of $____ will be required by the Landlord to keep in trust
for potential damage to the Property caused by Tenant’s pets.
QUIET ENJOYMENT. Upon payment of all the sums referred to herein as being
payable by Tenant and Tenant's performance of all Tenant's agreements contained
herein and Tenant's observance of all rules and regulations, Tenant shall and may
peacefully and quietly have, hold, and enjoy said Property for the term hereof.
INDEMNIFICATION. Landlord shall not be liable for any injury to the tenant, tenant’s
family, guests, or employees or to any person entering the property and shall not be
liable for any damage to the building in which the property is located or to goods or
equipment, or to the structure or equipment of the structure in which the Property
is located, and Tenant hereby agrees to indemnify, defend, and hold Landlord
harmless from any and all claims or assertions of every kind and nature.
DEFAULT. If Landlord breaches this Agreement, Tenant may seek any relief provided
by law. If Tenant fails to comply with any of the material provisions of this
Agreement, other than the covenant to pay rent or of any present rules and
regulations, or any that may be hereafter prescribed by Landlord, or materially fails
to comply with any duties imposed on Tenant by statute, Landlord may terminate
this Agreement ____ days after delivery of written notice by Landlord specifying the
noncompliance and indicating the intention of Landlord to terminate the
Agreement by reason thereof. If Tenant fails to pay rent when due and the default
continues for ____ days thereafter, Landlord may, at Landlord's option, declare the
entire balance of rent payable hereunder to be immediately due and payable and
may exercise any and all rights and remedies available to Landlord at law or in equity
or may immediately terminate this Agreement.
HOLDOVER. In the event, Tenant remains in possession of the Property for any
period after the expiration of the Agreement Term (“Holdover Period”) a new month-
to-month tenancy shall be created subject to the same terms and conditions of this
Agreement at a monthly rental rate of the same in this agreement unless otherwise
agreed by the Parties in writing. Such month-to-month tenancy shall be terminable
on thirty (30) days’ notice by either Party or on longer notice if required by law.
ABANDONMENT. If Tenant abandons the Property of any personal property during
the term of this Agreement, Landlord may at is option enter the Property by any
legal means without liability to Tenant and may at Landlord’s option terminate the
Agreement. Abandonment is defined as the absence of the Tenants from the
Property for at least ____ consecutive days without notice to Landlord. If Tenant
abandons the Property while the rent is outstanding for more than ____ days and
there is no reasonable evidence, other than the presence of the Tenants’ personal
property, that the Tenant is occupying the unit, Landlord may at Landlord’s option
terminate this Agreement and regain possession in the manner prescribed by law.
The Landlord will dispose of all abandoned personal property on the Property in any
manner allowed by law
ATTORNEYS' FEES. Should it become necessary for Landlord to employ an attorney
to enforce any of the conditions or covenants hereof, including the collection of
rentals or gaining possession of the Property, Tenant agrees to pay all expenses so
incurred, including a reasonable attorneys' fee.
COMPLIANCE WITH LAW. The Tenant(s) agrees that during the term of the
Agreement, to promptly comply with any present and future laws, ordinances,
orders, rules, regulations, and requirements of the Federal, State, County, City, and
Municipal government or any of their departments, bureaus, boards, commissions
and officials thereof with respect to the Property, or the use or occupancy thereof,
whether said compliance shall be ordered or directed to or against the Tenant(s), the
Landlord, or both.
SEVERABILITY. If any provision of this Agreement or the application thereof shall, for
any reason and to any extent, be invalid or unenforceable, neither the remainder of
this Agreement nor the application of the provision to other persons, entities, or
circumstances shall be affected thereby, but instead shall be enforced to the
maximum extent permitted by law.
SEX OFFENDER REGISTRY. NOTICE: Pursuant to Section 290.46 of the Penal Code,
information about specified registered sex offenders is made available to the public
via an Internet Web site maintained by the Department of Justice at
www.meganslaw.ca.gov. Depending on an offender’s criminal history, this
information will include either the address at which the offender resides or the
community of residence and ZIP Code in which the offender resides.
BINDING EFFECT. The covenants, obligations, and conditions herein contained shall
be binding on and inure to the benefit of the heirs, legal representatives, and assigns
of the parties hereto.
MODIFICATION. The parties hereby agree that this document contains the entire
agreement between the parties and this Agreement shall not be modified, changed,
altered, or amended in any way except through a written amendment signed by all
of the parties hereto.
NOTICE. Any notice required or permitted under this Agreement or under state law
shall be delivered to Tenant at the Property address, and to Landlord at the following
address:___________________________________________________________________________.
PARKING. The Landlord:
Shall provide ____ parking space(s) to the Tenant(s) for a fee of $____ to be paid
at the execution of this Agreement on a monthly basis in addition to the rent. The
parking space(s) are described as: ____________________.
Shall not provide parking.
SMOKING POLICY. Smoking on the Property is:
Permitted in the following areas: ____________________.
Prohibited on the Property.
ADDITIONAL TERMS AND CONDITIONS.
_____________________________________________________________________________________
ENTIRE AGREEMENT. This constitutes the entire Agreement between the Parties
and supersedes any prior understanding or representation of any kind preceding the
date of this Agreement. There are no other promises, conditions, understandings or
other agreements, whether oral or written, relating to the subject matter of this
Agreement. This Agreement may be modified in writing and must be signed by
both Landlord and Tenant.
IN WITNESS WHEREOF, the Parties have caused this Agreement to be executed in
multiple originals as of the undersigned date(s).
Landlord’s Signature ____________________________ Date _____________________
Print Name _______________________
Tenant’s Signature ____________________________ Date _____________________
Print Name _______________________
Tenant’s Signature ____________________________ Date _____________________
Print Name _______________________
Tenant’s Signature ____________________________ Date _____________________
Print Name _______________________
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REQUIRED LEASE DISCLOSURES &
ADDENDUMS IN CALIFORNIA
The following disclosures or addendums are either required for some or all
residential lease agreements in California.
1. Asbestos Disclosure - for buildings built before 1979 with landlord
knowledge of asbestos in the property.
2. Methamphetamine Contamination Disclosure - for properties where the
landlord has knowledge or suspicion of methamphetamine production, use,
or storage without remediation.
3. Mold Disclosure - for properties with known mold that may pose a health
threat.
4. Demolition Permit Disclosure - for units with planned demolition during the
lease term.
5. Military Ordnance Disclosure - for properties within 1 mile of known military
testing sites.
6. Death in a Rental Unit Disclosure - for any property where material death
has occurred in the past 3 years, excluding HIV or AIDS-related death.
7. Pest Control Disclosure - for units with pest control schedule or who use
pesticides for infestations.
8. Shared Utility Arrangement Disclosure - for all units that share a meter with
another unit or other location
9. Bed Bug Disclosure - for all units.
10. Flood Zone Disclosure - for any property in a known flood zone
11. Lead Based Paint Disclosure - for rental units built prior to 1978.
DISCLOSURE OF INFORMATION ON ASBESTOS
THIS AGREEMENT made and entered into between ________________________________,
“Landlord" and ________________________________, ________________________________,
________________________________, and ________________________________, Tenant(s)”.
Tenant(s) is renting from Landlord the Property located at: __________________________
_____________________________________________________________________________________
LANDLORDS DISCLOSURE: (select one)
____ This property may contain asbestos
____ This property contains asbestos
This hazardous substance is contained in some of the original building materials and
in some of the products and materials used to maintain the property. Disturbance or
damage to certain interior apartment surfaces may increase the potential exposure
to these substances.
a) Tenant or the Tenant guest(s), employees and contractors shall not take or
permit any action which in any way damages or disturbs the Premises or any
part thereof, including, but not limited to:
i) piercing the surface of the ceiling by drilling or any other method;
ii) hanging plants, mobiles, or other objects from the ceiling;
iii) attaching any fixtures to the ceiling;
iv) allowing any objects to come in contact with the ceiling;
v) permitting water or any liquid, other than ordinary steam
condensation, to come into contact with the ceiling;
vi) painting, cleaning, or undertaking any repairs of any portion of the
ceiling;
vii) replacing light fixtures;
viii) undertaking any activity which results in building vibration that may
cause damage to the ceiling.
b) Tenant shall notify Landlord immediately in writing (i) if there is any damage
to or deterioration of the ceiling in the Property or any portion thereof,
including, without limitation, flaking, loose, cracking, hanging or dislodged
material, water leaks, or stains in the ceiling, or (ii) upon the occurrence of any
of the events described in Paragraph 1 above.
The following parties have reviewed the information above and certify, to the best of
their knowledge, that the information they have provided is true and accurate.
________________________________ ________________________________
Landlord Date Landlord Date
________________________________ ________________________________
Tenant Date Tenant Date
________________________________ ________________________________
Agent Date Agent Date
DISCLOSURE OF INFORMATION ON
METHAMPHETAMINE CONTAMINATION
THIS AGREEMENT made and entered into between ________________________________,
“Landlord" and ________________________________, ________________________________,
________________________________, and ________________________________, Tenant(s)”.
Tenant(s) is renting from Landlord the Property located at: __________________________
_____________________________________________________________________________________
LANDLORDS DISCLOSURE: (select one)
____ Has been found to be contaminated above safe levels and is in the process of
decontamination.
____ Has been found to be contaminated, but falls within safe levels after tests were
conducted.
____ Has no suspicion of contamination.
CERTIFICATION OF ACCURACY
The following parties have reviewed the information above and certify, to the best of
their knowledge, that the information they have provided is true and accurate.
________________________________ ________________________________
Landlord Date Landlord Date
________________________________ ________________________________
Tenant Date Tenant Date
________________________________ ________________________________
Agent Date Agent Date
DISCLOSURE OF INFORMATION ON MOLD
THIS AGREEMENT made and entered into between ________________________________,
“Landlord" and ________________________________, ________________________________,
________________________________, and ________________________________, Tenant(s)”.
Tenant(s) is renting from Landlord the Property located at: __________________________
_____________________________________________________________________________________
The Landlord has inspected the unit prior to lease and knows of no damp or wet
building materials and knows of no mold or mildew contamination. Tenant is hereby
notified that mold, however, can grow if the premises are not properly maintained or
ventilated. If moisture is allowed to accumulate in the Property, it can cause mildew
and mold to grow. It is important that Tenant regularly allow air to circulate in the
Property. It is also important that Tenant keep the interior of the unit clean and that
they promptly notify the Landlord of any leaks, moisture problems, and/or mold
growth.
Tenant agrees to maintain the Property in a manner that prevents the occurrence of
an infestation of mold or mildew in the premises. Tenant agrees to uphold this
responsibility in part by complying with the following list of responsibilities:
1) Tenant agrees to keep the unit free of dirt and debris that can harbor
mold.
2) Tenant agrees to immediately report to the Landlord any water
intrusion, such as plumbing leaks, drips, or "sweating"
3) pipes.
4) Tenant agrees to notify owner of overflows from bathroom, kitchen, or
unit laundry facilities, especially in cases where the
5) overflow may have permeated walls or cabinets.
6) Tenant agrees to report to the Landlord any significant mold growth on
surfaces inside the premises.
7) Tenant agrees to allow the Landlord to enter the unit to inspect and
make necessary repairs.
8) Tenant agrees to use bathroom fans while showering or bathing and to
report to the Landlord any non-working fan.
9) Tenant agrees to use exhaust fans whenever cooking, dishwashing, or
cleaning.
10) Tenant agrees to use all reasonable care to close all windows and other
openings in the premises to prevent outdoor water
11) from penetrating into the interior unit.
12) Tenant agrees to clean and dry any visible moisture on windows, walls,
and other surfaces, including personal Property, as
DISCLOSURE OF INFORMATION ON MOLD (CONT.)
13) soon as reasonably possible. (Note: Mold can grow on damp surfaces
within 24 to 48 hours.)
14) Tenant agrees to notify the Landlord of any problems with the air
conditioning or heating systems that are discovered
15) by the Tenant.
Tenant agrees to indemnify and hold harmless the Landlord from any actions,
claims, losses, damages, and expenses, including, but not limited to, attorneys' fees
that the Landlord may sustain or incur as a result of the negligence of the Tenant or
any guest or other person living in, occupying, or using the premises.
LANDLORDS DISCLOSURE: (select one)
____ Has been found to be contaminated above safe levels and is in the process of
decontamination.
____ Has been found to be contaminated, but falls within safe levels after tests were
conducted.
____ Has no suspicion of contamination.
CERTIFICATION OF ACCURACY
The following parties have reviewed the information above and certify, to the best of
their knowledge, that the information they have provided is true and accurate.
________________________________ ________________________________
Landlord Date Landlord Date
________________________________ ________________________________
Tenant Date Tenant Date
________________________________ ________________________________
Agent Date Agent Date
DISCLOSURE OF DEMOLITION PERMIT
THIS AGREEMENT made and entered into between ________________________________,
“Landlord" and ________________________________, ________________________________,
________________________________, and ________________________________, Tenant(s)”.
Tenant(s) is renting from Landlord the Property located at: __________________________
_____________________________________________________________________________________
LANDLORDS DISCLOSURE:
On __/__/__, the following unit(s) are scheduled for demolition. On or after this date,
active lease agreements will terminate for the affected unit(s).
CERTIFICATION OF ACCURACY
The following parties have reviewed the information above and certify, to the best of
their knowledge, that the information they have provided is true and accurate.
________________________________ ________________________________
Landlord Date Landlord Date
________________________________ ________________________________
Tenant Date Tenant Date
________________________________ ________________________________
Agent Date Agent Date
DISCLOSURE OF ORDNANCE
THIS AGREEMENT made and entered into between ________________________________,
“Landlord" and ________________________________, ________________________________,
________________________________, and ________________________________, Tenant(s)”.
Tenant(s) is renting from Landlord the Property located at: __________________________
_____________________________________________________________________________________
LANDLORDS DISCLOSURE:
This property is located within 1 mile of a former federal or military facility which may
contain explosive munitions.
CERTIFICATION OF ACCURACY
The following parties have reviewed the information above and certify, to the best of
their knowledge, that the information they have provided is true and accurate.
________________________________ ________________________________
Landlord Date Landlord Date
________________________________ ________________________________
Tenant Date Tenant Date
________________________________ ________________________________
Agent Date Agent Date
DISCLOSURE OF INFORMATION ON DEATH IN A RENTAL UNIT
THIS AGREEMENT made and entered into between ________________________________,
“Landlord" and ________________________________, ________________________________,
________________________________, and ________________________________, Tenant(s)”.
Tenant(s) is renting from Landlord the Property located at: __________________________
_____________________________________________________________________________________
LANDLORDS DISCLOSURE:
At the time of this lease agreement, Landlord certifies the following information
pertaining to the history of death in the rental property:
____ No death reported
____ Death by natural causes
____ Death by violent crime: ________________________________________________________
____ Death by communicable disease: ______________________________________________
Tenant has a right to have questions answered pertaining to death in the rental unit
to the best of the Landlord’s knowledge upon request.
CERTIFICATION OF ACCURACY
The following parties have reviewed the information above and certify, to the best of
their knowledge, that the information they have provided is true and accurate.
________________________________ ________________________________
Landlord Date Landlord Date
________________________________ ________________________________
Tenant Date Tenant Date
________________________________ ________________________________
Agent Date Agent Date
DISCLOSURE OF INFORMATION ON PESTS
THIS AGREEMENT made and entered into between ________________________________,
“Landlord" and ________________________________, ________________________________,
________________________________, and ________________________________, Tenant(s)”.
Tenant(s) is renting from Landlord the Property located at: __________________________
_____________________________________________________________________________________
LANDLORDS DISCLOSURE:
On __/__/__, the following unit or surrounding unit(s) is scheduled for a pesticide
treatment to control/remove pests and/or insects.
____ This is a one-time treatment
____ This is one of a routine treatment, scheduled for: __________________________
The pest(s) to be controlled are: __________________________
The pesticide to be used is: __________________________
CERTIFICATION OF ACCURACY
The following parties have reviewed the information above and certify, to the best of
their knowledge, that the information they have provided is true and accurate.
________________________________ ________________________________
Landlord Date Landlord Date
________________________________ ________________________________
Tenant Date Tenant Date
________________________________ ________________________________
Agent Date Agent Date
DISCLOSURE OF SHARED UTILITIES ARRANGEMENTS
THIS AGREEMENT made and entered into between ________________________________,
“Landlord" and ________________________________, ________________________________,
________________________________, and ________________________________, Tenant(s)”.
Tenant(s) is renting from Landlord the Property located at: __________________________
_____________________________________________________________________________________
LANDLORDS DISCLOSURE:
____ This rental unit shares the following utilities with another unit or common area:
____ Electricity
____ Water
____ Gas
____ Sewage
____ Other: _________________________________________
____ This lease uses the following method for calculating utility charges between
Tenant(s):
____ Home Square Footage
____ Number of Tenants
____ Even Split Between Tenants
____ Other:___________________________________________________________
____Tenant agrees to pay the monthly utility charge to Landlord, plus a $___________
service charge as part of each month’s rental payment.
CERTIFICATION OF ACCURACY
The following parties have reviewed the information above and certify, to the best of
their knowledge, that the information they have provided is true and accurate.
________________________________ ________________________________
Landlord Date Landlord Date
________________________________ ________________________________
Tenant Date Tenant Date
________________________________ ________________________________
Agent Date Agent Date
FLOOD ZONE DISCLOSURE
THIS AGREEMENT made and entered into between ________________________________,
“Landlord" and ________________________________, ________________________________,
________________________________, and ________________________________, Tenant(s)”.
Tenant(s) is renting from Landlord the Property located at: __________________________
_____________________________________________________________________________________
LANDLORD’S DISCLOSURE:
This property is located in a known flood zone, putting it at a higher risk of flooding.
Landlord and Landlord’s insurer are NOT responsible for personal loss occurring at
this rental unit due to flooding or other hazards. It is recommended that Tenant
pursues renter’s insurance and flood insurance. Information about hazards can be
found on the California Office of Emergency Services’ website at
https://myhazards.caloes.ca.gov
The above notice is pursuant to section 1632 of the Civil Code and absolves Landlord
of liability to flood-related damages.
CERTIFICATION OF ACCURACY
The following parties have reviewed the information above and certify, to the best of
their knowledge, that the information they have provided is true and accurate.
________________________________ ________________________________
Landlord Date Landlord Date
________________________________ ________________________________
Tenant Date Tenant Date
________________________________ ________________________________
Agent Date Agent Date
DISCLOSURE OF INFORMATION ON BED BUGS
THIS AGREEMENT made and entered into between ________________________________,
“Landlord" and ________________________________, ________________________________,
________________________________, and ________________________________, Tenant(s)”.
Tenant(s) is renting from Landlord the Property located at: __________________________
_____________________________________________________________________________________
BED BUG APPEARANCE. Bed bugs have six legs. Adult bed bugs have flat bodies about 1/4
of an inch in length. Their color can vary from red and brown to copper colored. Young bed
bugs are very small. Their bodies are about 1/16 of an inch in length. They have almost no
color. When a bed bug feeds, its body swells, may lengthen, and becomes bright red,
sometimes making it appear to be a different insect. Bed bugs do not fly. They can either
crawl or be carried from place to place on objects, people, or animals. Bed bugs can be hard
to find and identify because they are tiny and try to stay hidden.
LIFE CYCLE AND REPRODUCTION. An average bed bug lives for about 10 months. Female
bed bugs lay one to five eggs per day. Bed bugs grow to full adulthood in about 21 days. Bed
bugs can survive for months without feeding.
BED BUG BITES. Because bed bugs usually feed at night, most people are bitten in their
sleep and do not realize they were bitten. A person’s reaction to insect bites is an immune
response and so varies from person to person. Sometimes the red welts caused by the bites
will not be noticed until many days after a person was bitten, if at all. Common signs and
symptoms of a possible bed bug infestation:
1) Small red to reddish brown fecal spots on mattresses, box springs, bed frames,
mattresses, linens, upholstery, or walls.
2) Molted bed bug skins, white, sticky eggs, or empty eggshells.
3) Very heavily infested areas may have a characteristically sweet odor.
4) Red, itchy bite marks, especially on the legs, arms, and other body parts exposed while
sleeping. However, some people do not show bed bug lesions on their bodies even
though bed bugs may have fed on them.
For more information, see the Internet Web sites of the United States Environmental
Protection Agency and the National Pest Management Association.
CERTIFICATION OF ACCURACY. The following parties have reviewed the information above
and certify, to the best of their knowledge, that the information they have provided is true
and accurate.
________________________________ ________________________________
Landlord Date Landlord Date
________________________________ ________________________________
Tenant Date Tenant Date
________________________________ ________________________________
Agent Date Agent Date
DISCLOSURE OF INFORMATION ON LEAD-BASED PAINT AND/OR LEAD-BASED
PAINT HAZARDS LEAD WARNING STATEMENT
Housing built before 1978 may contain lead-based paint. Lead from paint, paint
chips, and dust can pose health hazards if not managed properly. Lead exposure is
especially harmful to young children and pregnant women. Before renting pre-1978
housing, lessors must disclose the presence of known lead-based paint and/or lead-
based paint hazards in the dwelling. Lessees must also receive a federally approved
pamphlet on lead poisoning prevention.
Lessor’s Disclosure
a) Presence of lead-based paint and/or lead-based paint hazards (check (i) or (ii)
below):
i) ______ Known lead-based paint and/or lead-based paint hazards are
present in the housing (explain).
_________________________________________________________________________________
_________________________________________________________________________________
ii) _____ Lessor has no knowledge of lead-based paint and/or lead-based
paint hazards in the housing.
b) Records and reports available to the lessor (check (i) or (ii) below):
i) ______ Lessor has provided the lessee with all available records and reports
pertaining to lead-based paint and/or lead-based paint hazards in the
housing (list documents below).
_________________________________________________________________________________
_________________________________________________________________________________
ii) _____ Lessor has no reports or records pertaining to lead-based paint
and/or lead-based paint hazards in the housing.
Lessee’s Acknowledgment (initial)
c) ________ Lessee has received copies of all information listed above.
d) ________ Lessee has received the pamphlet Protect Your Family from Lead in Your
Home.
Agent’s Acknowledgment (initial)
e) ________ Agent has informed the lessor of the lessor’s obligations under 42 U.S.C.
4852d and is aware of his/her responsibility to ensure compliance.
Certification of Accuracy
The following parties have reviewed the information above and certify, to the best of
their knowledge, that the information they have provided is true and accurate.
________________________________ ________________________________
Lessor Date Lessor Date
________________________________ ________________________________
Lessee Date Lessee Date
________________________________ ________________________________
Agent Date Agent Date