Form HUD- Choice Neighborhoods Extraordinary Site Costs Certificat

OMB Approval No. XXX

(exp. X/XX/XXXX)

CHOICE NEIGHBORHOODS – EXTRAORDINARY SITE COSTS CERTIFICATION

I hereby certify that:

1. I am a licensed engineer architect (check one).

2. I am not an employee of the Lead Applicant, Co-Applicant (if any), Principal Team Member (if any), or unit of local government in which the housing project identified below is located.

3. Extraordinary site costs may be incurred in the revitalization and demolition of existing property, as well as in the development of new and rehabilitated units. Examples of such costs include, but are not limited to: abatement of extraordinary environmental site hazards; removal or replacement of extensive underground utility systems; extensive rock and/or soil removal and replacement; removal of hazardous underground tanks; work to address unusual site conditions such as slopes, terraces, water catchments, lakes, etc.; and work to address flood plain and other environmental remediation issues. Costs to abate asbestos and lead-based paint should be included in normal demolition costs where such items are found within the structures themselves. An example of extraordinary lead-based paint would be where the lead has leached into the soil and extraordinary measures are needed to remove the lead.

4. I have reviewed the attached description of the extraordinary site costs requested by the Lead Applicant identified below, and affirm that these costs qualify as extraordinary site costs (as that term is defined in Paragraph 3 above) and that the costs are justified and reasonable in light of my assessment of the site of the severely distressed project and the work proposed to be completed at that site.

Name: _____________________________________________ ____ _______ __

Signature: _____________________________________________ Date: _____

License number: _____________ _______ State of Registration: ________ _____

Lead Applicant: _______________________ __________________ ________

Name of Targeted Public and/or Assisted Housing Site(s):

_______________________________________ ______

Required Attachment: Description and itemized listing of extraordinary site costs.

Warning: HUD will prosecute false claims and statements. Conviction may result in the imposition of criminal and civil penalties. (18 U.S.C. 1001, 1010, 1012, 31 U.S.C. 3729, 3802)