92330A Contractor's Certificate of Actual Cost

Office of Hospital Facilities Transactional Forms for FHA Programs 242, 241, 223(f), 223(a)(7)

HUD 92330-A-OHF Contractor's Cert of Actual Costs

Hospital Facilities projects pursuant to FHA Programs 242, 241, 223(f), 223(a)(7)

OMB: 2502-0602

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Contractor's Certificate
of Actual Cost

  OMB No. 2502-xxxx (Exp. xx/xx/xxxx)

U.S. Department of Housing and
Urban Development
Office of Housing
Federal Housing Commissioner

Public reporting burden for this collection of information is average 8 hours per response, including the time for reviewing in
structions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the collection of information. This information is required to obtai
n benefits, HUD may not collect this information, and you
are not required to complete this form, unless it displays a currently valid OMB Control Number.
Section 227 of the National Housing Act (Section 126 of the Housing Act of 1954, Public Law 560, 12 U.S.C. 1715r), authorizeshe
t collection of this information. The information is
required for a general contractor when an identity of interest exists between the general contract and the mortgagor or when th
e mortgagor is a non-profit entity and a cost plus contract
has been used. The information is required from the contractor to convey its actual construction cost in a standardized formatfor cost certification.
Privacy Act Notice. The United States Department of Housing and Urban Development, Federal Housing Administration, is authorized to solicit theinformation requested in this form
by virtue of Title 12, United States Code, Section 1701 et seq., and regulations promulgated thereunder at Title 12, Code of Fe
deral Regulations. While no assurances of confidentiality
is pledged to respondents, HUD generally discloses this data only in response to a Freedom of Information request.
Project Number

Building Number

Contractor

Name of Project

Mortgagor

Location

Gentlemen:
This Certificate is made pursuant to the provisions of the Construction Contract, entered into by and between us under date of
_____________________________ and it is understood and agreed by the undersigned that this Certificate is to be submitted by yo
u to
the Federal Housing Commissioner in order to induce the Commissioner to finally endorse the mortgage for insurance.
The actual cost incurred in the completion of construction under the above Construction Contract and accepted construction chan ges
exclusive of all kick-backs, rebates and discounts received in connection with the construction of the project is itemized belo w:
Div.
3
4
5
6
6
7
7
7
7
8
8
8
9
9
9
9
9
9
9
10
11
11
11
12
12
13
14
15
15
15
16

Trade Item

Paid in Cash

To Be Paid In Cash

Concrete
Masonry
Metals
Rough Carpentry
Finish Carpentry
Waterproofing
Insulation
Roofing
Sheet Metal
Doors
Windows
Glass
Lath and Plaster
Drywall
Tile Work
Acoustical
Wood Flooring
Resilient Flooring
Painting and Decorating
Specialties
Special Equipment
Cabinets
Appliances
Blinds and Shades, Artwork
Carpets
Special Construction
Elevators
Plumbing and Hot Water
Heat and Ventilation
Air Conditioning
Electrical
Subtotal (Structures)
Accessory Structures
Total (Structures)

Replaces FHA-2330-A, which is obsolete.

Total

Name of Subcontractor or Payee

Line
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33

Page 1 of 4

form HUD-92330-A­OHF (3/94)
ref. Handbook 4470.1 & 4470.2

Div.

Trade Item

2
2
2
2
2
2

Earth Work
Site Utilities
Roads and Walks
Site Improvements
Lawns and Planting
Unusual Site Conditions
Total (Land Improvements)
Total (Structure and Land Improvements)
General Requirements
General Overhead
Miscellaneous (Labor and Materials)*
Bond Premium
Other Fees–Paid by Contractor

35
36
37
38
39
40
41
42
43
44
45
46
47
48

Total Costs

49

1

Paid in Cash

To be Paid Cash

Total

Name of Subcontractor or Payee

Line

* Total purchases of materials and cost of labor amounting to less than $1,000 may be included as a lump sum under miscellaneousmaterials and labor.
Costs exceeding this amount for materials and labor must be allocated to the trade item under which they were expended on HUD-9
2330-A worksheets
3 and 4.
Note: If additional space is required for these or other items, append Rider thereto, with references and initial. When more than on
performing a trade item, the attached work sheet must be completed giving the information indicated.
Itemized Breakdown
General Requirements (Job Overhead)
Other Fees–Paid by Contractor
Item
Total
Item
Supervision
$
$
Field Engineering
Field Office Expense

e subcontractor is

Total

Temporary Facilities
Temporary Utilities
Cleaning and Rubbish Removal
Watchmen Wages

Total for General Requirements

$

Total

$

The undersigned hereby certifies that: (Check One)
There has not been and is not now any identity of interest between mortgagor and/or general contractor on the one hand and any
subcontractor, material supplier or equipment lessor on the other.
The accompaniment contains a statement fully describing any identities of interest. Identity of Interest is defined as follows: When there
is any financial interest of the party of the first part in the party of the second part; when one or more of the officers,ectors
dir or stockholders
or the part of the first part is also an officer, director or stockholder of the party of the second part; when any officer,rector
di
or stockholder
of the party of the first part has any financial interst whatsoever in the party of the second part; when the part of the secon
d part advances
any funds to the party of the first part; when the party of the second part provides and pays on behalf of the party of the first part the cost
of any architectural services or engineering services other thatn those of a surveyor, general superintendent, or engineer employed by a
general contract in connection with its obligations under the construction contract; when the party of the second part takes st ock or any
interest in the party of the first part as part of the consideration to be paid them; when there exist or come into being any s
ide deals,
agreements, contracts or undertakings entered into or contemplated, thereby altering, amending or cancelling any of the required closing
documents except as approved by the Commissioner.
All amounts shown have been reduced to give effect to the amount(s) of any kickbacks, rebates, adjustments, discounts, or anyther
o devices
which had the effect of reducing the actual cost, and all amounts shown above as “to be paid in cash” will be so paid within rty-five
fo
(45) days
after final endorsement.
Note: This certificate must be supported by a certification as to actual cost by an independent Certified Public Accountant or byindependent
an
public accountant as required for Forms HUD-3305 or 3306.
I hereby certify that all the information stated herein, as well as any information provided in the accompaniment herewith, is
true and
accurate. Warning:
HUD will prosecute false claims and statements. Conviction may result in criminal and/or civil penalties.
(18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802)

Signature:

Date:

X
Replaces FHA-2330-A, which is obsolete.

Page 2 of 4

form HUD-92330-A­OHF (3/94)
ref. Handbook 4470.1 & 4470.2

Worksheet
Div.

Trade Item

3

Concrete

4

Masonry

5

Metals

6

Rough Carpentry

6

Finish Carpentry

7

Waterproofing

7

Insulation

7

Roofing

7

Sheet Metal

8

Doors

8

Windows

8

Glass

9

Lath and Plaster

9

Drywall

9

Tile Work

9

Acoustical

9

Wood Flooring

9

Resilient Flooring

Replaces FHA-2330-A, which is obsolete.

Paid in Cash

To be Paid Cash

Page 3 of 4

Total

Name of Subcontractor or Payee

form HUD-92330-A­OHF (3/94)
ref. Handbook 4470.1 & 4470.2

Div.
9

Trade Item

Paid in Cash

To be Paid Cash

Total

Name of Subcontractor or Payee

Painting and Decorating

10

Specialities

11

Special Equipment

11

Cabinets

11

Appliances

12

Blinds and Shades, Artwork

12

Carpets

13

Special Construction

14

Elevators

15

Plumbing and Hot Water

15

Heat and Ventilation

15

Air Conditioning

16

Electrical

2

Earth Work

2

Site Utilities

2

Roads and Walks

2

Site Improvements

2

Lawns and Planting

2

Unusual Site Conditions

Replaces FHA-2330-A, which is obsolete.

Page 4 of 4

form HUD-92330-A­OHF (3/94)
ref. Handbook 4470.1 & 4470.2


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File Modified2011-12-23
File Created2011-12-19

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