92448 Contractor's Requisition Project Mortgages

OMB Approval No. 2502-0028 (exp. 10/31/2013)

Project Mortgages

To be submitted to mortgagee in quadruplicate
This information is used to verify program benefits consisting of distribution of insured mortgage proceeds when construction costs are involved. The
information regarding completed work items is used by HUD to ensure that payments from mortgage proceeds are made for work actu ally completed in
a satisfactory manner. This information is a requirement under Section 207(b) of the National Housing Act (Public Law 479, 48    
Stat. 1246, 12 U.S.C. 1701
et. seq) authorizing the Secretary of HUD to insure mortgages. The information collection does not contain information of a sensitive nature.
Public reporting burden for this collection of information is estimated to average 6 hours per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.  This agency may
not collect this information, and you are not required to complete this form, unless it displays a currently valid OMB control number.

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

Contractor's Requisition

To (owner)

Requisition Number

Project

Project Number

Location

In accordance with the provision of the Construction Contract dated ________________ and Contractor's and/or Mortgagor's Cost
Breakdown (Schedule of Values) attached thereto, this requisition is submitted for the amount of $ __________________ due for work
performed up to the ____________ day of ______________ and as itemized below by the trades listed in the Schedule of Values.
DIV
3
4
5

Concrete
Masonry
Metals

6
6
7
7
7
7
8
8
8
9
9
9
9
9
9
9
10
11
11

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

11
12
12
13
14
15
15
15
16

Appliances
Blinds and Shades, Artwork
Carpets
Special Construction
Elevators
Plumbing and Hot Water
Heat and Ventilation
Air Conditioning
Electrical
Accessory Buildings
Earth Work
Site Utilities
Roads and Walks
Site Improvement
Lawns and Planting
Unusual Site Conditions
General Requirements
Bond Premium ($

2
2
2
2
2
2
1
1

Previous editions are obsolete.

Enter Amounts to Nearest Even Dollar
Amounts Complete
For HUD-FHA Use
(B)
(C)

Cost as per Cost Breakdown
(A)

Trade Item
$

$

$

)
Page 1 of 2

form HUD-92448 (1/91)

DIV
1
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
(13)

Enter Amounts to Nearest Even Dollar
Amounts Complete
For HUD-FHA Use
(B)
(C)

Cost as per Cost Breakdown
(A)

Trade Item

Other Fees
($
)
Subtotal of Breakdown Items
$
Builder's Overhead
$
Builder's Profit
$
Total of Cost Breakdown Items
$
Inventory of Materials Stored On-site (See Note Below)
Inventory of Materials Stored Off-Site (See Note Below)
Sum of Cost Breakdown Items Plus Inventories of Materials
Less Net Decrease in Cost as a Result of Approved Changes
Total After Adjusting for Net Decrease to Approved Changes
Less Retained 10%
Bal.: Total Amount Due to Date on Account of Construction Contract
Less Previous Payments
Net Amount of This Requisition

0 *

% $
% $
% $
$
$
$
$
$
$
$
$
$
$

0 **

% $
% $
% $
$
$
$
$
$
$
$
$
$
$

I certify that the Work covered by this requisition has been completed in accordance with the Contract Documents, and that I have actually received
$
for Work performed and materials purchased up to the ______________ day of ____________ (date of previous requisition).
Date

Contractor

* Percentage derived from subtotal of Breakdown Items (col. B divided by col. A)
** (col. C divided by col. A) Exclusive of Bond Premium

Note: Attached inventory of materials item ized as to quantities and costs.

For Use of HUD-Federal Housing Commissioner
Date
Net Amount Approved for Payment
Reviewed and Approved by (Chief, Mortgage Credit)

Column C Completed by
(Mortgage Credit Examiner)
Director, Housing Development

Architect's Certificate I certify, based on my on-site observations (or those of my authorized representative) and the data comprising this requisition,
that the Work has progressed to the point indicated; that to the best of my knowledge, information and belief the Work is in accordance with the Contract
Documents; and that the Contractor is entitled to payment of the amount certified.
Date

Architect

Inspector's Certificate
Amount Modified
No Modification
I certify that I have visited the site on this date ______________________________, observed the Work, and monitored the log and reports of the
Architect (if an architect is administering the Construction Contract); that to the best of my knowledge, information and belief the amount certified
represents acceptable Work; and that I have no personal interest, present or prospective, in the property, applicant or proceeds of the mortgage.
Date

Inspector

Contractor's Prevailing Wage Certificate (For use under all sections of the National Housing Act requiring certification as to payment of prevailing
wages. To be completed with each request for insurance of advance of mortgage proceeds which includes a payment on account of construction cost,
or at the time the mortgage is presented for insurance pursuant to a commitment to insure upon completion.)
To

Date

Manager

Project Name

Field Office

Project Number

Advance No.

The undersigned, as principal contractor in connection with the construction of the above project, states that he/she is fully familiar with applicable
wage determination decision of the Secretary of Labor and certifies that:
a. A copy of the applicable wage determination decision is posted in a conspicuous place at the site of the work and he/she has required each
subcontractor as a part of his/her contract, to agree to pay wages at rates not less than those contained in the decision.
b. All laborers and mechanics employed in the construction of the project have been, to the date hereof, paid for such employment at wage rates not
less than those contained in the applicable wage determination decision of the Secretary of Labor and no deductions or rebates have been made, either
directly or indirectly, from the full weekly wages earned by any person, other than permissible deductions as defined in Regulations of the Secretary
of Labor, Part 3 (29 CFR Part 3).
c. He/She has fulfilled his/her obligations, to the date hereof, under The Labor Standards Provisions of the Supplementary Conditions of the Contract
for Construction and has included said conditions in all subcontracts.
This certificate is executed by the undersigned for the purpose of inducing the Commissioner to approve for insurance that certain mortgage loan, or
an advance thereof, made or to be made by the mortgagee in connection with the construction of the project, and with the intent that the Commissioner
rely upon this certification to establish compliance with the provisions of Section 212 of the National Housing Act, which provides in part: The
Commissioner shall not insure ... unless the principal contractor files a certificate ... certifying that the laborers and mechanics ... have not been paid
not less than the wages prevailing ... as determined by the Secretary of Labor...”
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).
Contractor
By
Date:
Previous editions are obsolete.

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form HUD-92448 (1/91)