HUD-5460 Insurance Information

Insurance Information

U.S. Department of Housing

OMB Approval No. 2577-0157 (exp. 1/31/2017)

and Urban Development

Office of Public and Indian Housing

Project Name

Project Number

1. Fire and Extended Coverage

C. Classify all buildings according to both the arrangement of stories and the number of dwelling units. Enter in column 1 the number of buildings of each of these types. Mark those without basements "X", mark those with group heating plants in basement "H", mark those with a sprinkler system installed "S". In column 2 enter for each type of building listed in column 1 the number

A. Describe items listed below by thickness & material used in construction.

1. Exterior Walls: Load bearing

Non-bearing

Thickness:

Material:

of units under each story level. In column 3 enter the number of units between fire walls for each type of building, such as (2-4-2).

2. Interior Partitions: Thickness:

Material:

Number of

Buildings

(1)

No. of Units in Building Under Story

Level Specified

(2)

Units Between

Number of

3. Walls Between Units: Thickness: Material:

Fire Walls

1 Story

2 Story

3 Story

4 Story

(3)

a. Are firewalls built

b. Are they built to the

c.Number of inches

from the ground?

Yes

No

underside of roof sheathing?

above the roof:

Yes

No

d. Describe openings, if any:

4. Top Ceiling:

Thickness:

Material:

5. Flooring System:

a. First Floor :

Thickness

Material

b. Second Floor : Thickness

Material

c. Third Floor : Thickness

Material

d. Fourth Floor : Thickness

Material

D. Computation of Insurable Value (See instructions on back)

6. Roof:

Pitched

Flat

1. Architect's Fees (include 30% of fees)

$

a. Framing:

Thickness

Material

$

2. Structures and Equipment

3. Total of 1 and 2

$

b. Sheathing:

Thickness

Material

Deduct the following:

4. Entire cost of footing excavations and foundations (cost below level of ground, or if basement, estimated

c. Covering:

$

Thickness

Material

cost below lowest basement floor)

5. Underground Work in Buildings

B. Information for Rating Purposes

a. 25% of cost of plumbing rough-in $

1. Give greatest distance of any

b. 10% of cost of electrical rough-in $

project building from a fire hydrant:

6. Underground Work outside of Buildings 10% cost of

2. Describe city fire department

heating if central plant is involved

$

Volunteer Part paid & part volunteer

Total Deductions

$

Full Time

1/ Insurable Value

$

2. Boiler Insurance

A. Type of Heating (check ” one)

Central Heating

Group Heating

Space

Plant

Plants

Heaters

B. Type of Boiler (check ” one)

C. No. of Boilers

D. Pressure

E. Sq. Ft. of heating Surface

per Bolier

Hot Water Steam

F. Type of Fuel (check ” one)

Coal

Gas

Oil

LPG

G. Approximate value of heating plant (building and equipment). If system is composed of group

heating plants, give approximate value of largest plant. If plant is located in basement of building, $ include value of dwelling area above plant which would be subject to damage by an explosion.

1/ The insurable value for the first term can be accurately computed upon completion of a project. For subsequent renewals the Field Office will provide assistance in

determining the current insurable value. Instructions for computation of Insurable Value are on the back of this form.

Previous editions are obsolete

form HUD-5460 (1/2014)

Project Location

No. of Dwelling Units

Name & Title of Person submitting this information

Date

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

□

Public reporting burden for this collection of information is estimated to average 1 hour 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 conduct or sponsor, and a person is not required to respond to, a collection information unless that collecton displays a valid OMB control number.

The Annual Contributions Contract (ACC) between HUD and a Public Housing Agency (PHA) or Indian Housing Authority (IHA) requires the PHA or IHA to insure their property for an amount sufficient to protect against financial loss. PHAs/IHAs complete the Form HUD-5460 only when a new project is constructed. It is used to establish an insurable value at the time the project is built. The amount of insurance can then be increased each year as inflation and increased costs of construction create an upward trend on insurable values. Responses to the collection of information are voluntary. The information requested does not lend itself to confidentiality.

Instructions for Computation of Insurable Value (Block 1-D)

1. Architect's Fee (include 30% of fees). From latest Contract

Deductions

Award Budget, form HUD-52484, Account Classification 1430.1, column (f).

4. From form HUD-51000, Schedule of Amounts for Contract Payments: Add applicable items of footings and foundations.

2. Structures and Equipment. Total the following items:

5. a. 25% of plumbing rough-in only. Do not include any cost of fixtures, etc.

(a) From form HUD-52396,

(attached to Contract Award Budget):

Dwelling Structures, Account 1460; Dwelling Equipment, Account 1465; Nondwelling Structures, Account 1470;

b. 10% of cost of electrical rough-in. Do not include any cost of fixtures, etc.

6. 10% of cost of heating if central plant is provided.

Nondwelling Equipment, Account 1475.

(b) From Contract Award Budget, Column 5:

Dwelling Equipment - Non-expendable, Account 1465.1;

Nondwelling Equipment, Accounts 1475.1, 1475.2 and

1475.3.

(c) From Change Order Record Card:

Changes charged to Dwelling and Nondwelling Units.

3. Total of 1 and 2

Previous editions are obsolete

form HUD-5460 (1/2014)