1924-13 Estimate and Certificate of Actual Costs

Form RD 1924-13
(Rev. 12-98)

UNITED STATES DEPARTMENT OF AGRICULTURE
RURAL DEVELOPMENT

FORM APPROVED
OMB No. 0575-0042

ESTIMATE AND CERTIFICATE OF ACTUAL COST
This form is to be used by the contractor and borrower to estimate the cost of
construction and total PROJECT NUMBER (Borrower ID Number) development cost, or to
certify the actual cost of project construction and development.

BORROWER/OWNER-BUILDER

CONTRACTOR

NAME OF PROJECT

LOCATION

This certificate is made pursuant to existing regulations of the United States of America acting through the Rural Development in order to induce the Government to provide
or extend assistance. As part of that inducement, the following certifications are made:
Check and Complete Applicable Box:

A. ESTIMATE
I certify that the estimates of costs as set forth through line 44 in the ESTIMATED COST column are true and correct as computed by me
or
as given to me by the subcontractors or payees named, as general contractor or owner-builder for the development of the project described above, as determined from the plans and
specifications accepted, signed and dated by the Rural Development State Director of Rural Development or the State Directors's delegated representative, on
20
. As borrower or owner-builder for the development of the project described above, I certify that the estimates of cost as set forth from line 44 in the ESTIMATED COST
column are true and correct as computed by me or as given to me by the subcontractors or payees named. Subsequent to this estimate and prior to final payment, when directed by
Rural Development, I agree to furnish a certification of actual cost. The estimate and the final certification will be in accordance with Rural Development regulations requiring
estimates and certifications.
B. ACTUAL COST
I certify that the actual cost of labor, materials, and necessary services for the construction of the physical improvements in connection with the project described above, after
deduction of all rebates, adjustments, or discounts made or to be made to the undersigned borrower or general contractor, or any corporation, trust partnership, joint venture, or
other legal or business entity in which the undersigned borrower or general contractor, or any of their members, stockholders, officers, directors, beneficiaries, or partners hold any
interest, is as represented herein. The deduction of such rebates, adjustments, or discounts from actual hard costs will not be used to increase builder's profit over and above the
final estimated amount. I further certify that all soft costs associated with construction of the project as set forth on lines 45 through 57 are correct as represented herein.

According to the Paperwork Reduction Act of] 995, an agency may not conductor sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number The valid
OMB control number for this information collection is 0575-0042. The time required to complete this information collection is estimated to average 2 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.

Position 6

Form RD 1924-13 (Rev. 12-98)

% Diff.
Est. Actual

For Rural Development Use Only

Exceed
15%

Justification
Attached?

Page 2
Line
1

Div
.3

Concrete

2

4

Masonry

3

5

Metals

4

6

Rough Carpentry

5

6

Finish Carpentry

6

7

Waterproofinq

7

7

Insulation

8

7

Roofing

9

7

Sheet Metal

10

8

Doors

11

8

Windows

12

8

Glass

13

9

Drywall

14

9

Tile Work

15

9

Acoustical

16

9

Resilient Flooring

17

9

Painting and Decorating

18

10

Specialties

19

11

Special Equipment

20

11

Cabinets

21

11

Appliances

22

12

Blinds and Shades, Artwork

23

12

Carpets

24

13

Special Construction

25

14

Elevators

26

15

Plumbing and Hot Water

27

15

Heat and Ventilation

28

15

Air Conditioning

29

16

Electrical

30

2

Earth Work

31

2

On-Site Utilities

32

2

Roads and Walks

33

2

On-Site Improvements

34

2

Lawns and Planting

35

2

Unusual On-Site Conditions

36

2

Off-Site Development

37

Paid

Actual Cost
To Be Paid

Total

101

*

Miscellaneous (Labor and Materials)

38
39

Estimated
Cost

Trade Item

Name of Subcontractor
or Payee

Total Hard Costs
1

General Requirements

40

General Overhead

41

Other Fees Paid By Contractor

42

Total Costs

*
*
*

NOTE: (If additional space is required for these other items, append Rider thereto, with references and initial. When more than one subcontractor is performing a trade item, the attached work sheet must he completed giving the information indicated.) Form
* Breakdown on page 4.

RD 1924-13 (Rev. 12-98)

Page 3
CONTRACTOR'S AND BORROWER'S ESTIMATE AND CERTIFICATE OF ACTUAL COST
Line
43

44
45
46
47
48
49
50
51
52
53
54
55

Trade Item
Balance Brwt. Forward (line 42)
Builder's Profit

Estimated
Cost

Paid

Actual Cost
To Be Paid

Total

Name of Subcontractor
or Payee

Total Construction Cost
Architectural Fees
Survey and Engineering
Financing Costs Loan Fees
Interest During Construction
Closing Costs & Legal Fees
Land Cost or Value
Nonprofit O&M Capital
Tap and or Impact Fees
Tax Credit Fees
Environmental Fees
Market Study Cost

56
57

58

Total Development Cost

''Whoever, in any matter, with the jurisdiction of any department or agency of the United States knowingly and willfully falsifies, conceals or covers up by trick, scheme, or device a
material fact, or makes any false, fictitious or fraudulent statements or representations; or makes or uses any false writing or statement or entry, shall be fined under this title or
imprisoned not more than five years, or both.''
WARNING: Section 1001 of Title 18, United States Code provides: Furthermore, submission of false information relating to the content of this Estimate and Certificate
of Actual Cost will subject the submitter to any and all administrative remedies available to USDA. Such remedies may include suspension and debarment from
participating in any Rural Development or other Federal program.

Form RD 1924-13 (Rev. 12-98)

Page 4
ITEMIZED BREAKDOWN - ESTIMATED COSTS

CONTRACTOR'S GENERAL REQUIREMENTS

CONTRACTOR'S GENERAL OVERHEAD

OTHER FEES - PAID BY CONTRACTOR

(Job Overhead)
ITEM

TOTAL

ITEM

TOTAL

ITEM

TOTAL

$

$

$

$
$
$

$
$
$

$

$
$
$

$
$
$

$

$
$
$
$

TOTAL (Line 39)

TOTAL (Line 40)

$

TOTAL (Line 41)

$

$

ITEMIZED BREAKDOWN - ACTUAL COST

CONTRACTOR'S GENERAL REQUIREMENTS

CONTRACTOR'S GENERAL OVERHEAD

OTHER FEEDS - PAID BY CONTRACTOR

(Job Overhead)
ITEM

TOTAL

ITEM

TOTAL

ITEM

TOTAL

$

$

$

$
$
$

$
$
$

$

$
$
$

$
$
$

$

$
$
$
$

TOTAL (Line 39)

$

TOTAL (Line 40)

$

TOTAL (Line 41)

$

Form RD 1924-13 (Rev. 12-98)

Page 5

The undersigned hereby certifies that: (check as appropriate)
There has not been and is not now any identity of interest between or among the borrower and/or general contractor on the one hand and any subcontractor, material supplier,
equipment lessor, or payee on the other (including any of their members, officers, directors, beneficiaries, or partners).
Attached to and made part of this certificate is a signed statement fully describing any rebates, adjustments, discounts, or any other devices which may have or have had the effect

of reducing cost, and all amounts shown above as "to be paid in cash" will be so paid within forty-five (45) days.

ESTIMATES:
Date

Date

Lines I through 44 (Name of Contractor)

Lines 44 through 58 (Name of Mortgagor)

By:

By:
(Signature)

Title:

(Signature)
Title:

ACTUAL
Date

Date

Lines I through 44 (Name of Contractor)

Lines 44 through 58 (Name of Mortgagor)

By:

By:
(Signature)

Title:

(Signature)
Title:

Form RD 1924-13 (Rev. 12-98)