HUD-92330A-OHF Contractor's Certificate of Actual Cost - Hospitals/Sect

Comprehensive Transactional Forms Supporting FHA’s Section 242 Mortgage Insurance Program for Hospitals

HUD-92330A-OHF Contractor's Certificate of Actual Cost.Final_clean

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

Section 242

U.S. Department of Housing and Urban Development

Office of Hospital Facilities


OMB Approval No. 2502-0602

(Exp. 08/31/2019)

Public reporting burden for this collection of information is 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. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Reports Management Officer, QDAM, U.S. Department of Housing and Urban Development, Washington, DC 20410-5000. Do not send this completed form to the above address. This information is required to obtain 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.  24 C.F.R. 242.42, authorizes the 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 a 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 format for cost certification.

Privacy Act Notice. The United States Department of Housing and Urban Development, Federal Housing Administration, is authorized to solicit the information 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 Federal 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

Borrower

Contractor


Name of Project

Location

This Certificate is made pursuant to the provisions of the Construction Contract, entered into by and between us under date of

Div.

Trade Item

Paid in Cash

To Be Paid In Cash

Total

Name of Subcontractor or Payee

Line

3

Concrete



1

4

Masonry

2

5

Metals


3

6

Rough Carpentry


4

6

Finish Carpentry

5

7

Waterproofing

6

7

Insulation

7

7

Roofing

8

7

Sheet Metal

9

8

Doors


10

8

Windows



11

8

Glass

12

9

Lath and Plaster


13

9

Drywall


14

9

Tile Work


15

9

Acoustical

16

9

Wood Flooring

17

9

Resilient Flooring

18

9

Painting and Decorating

19

10

Specialties


20

11

Special Equipment

21

11

Cabinets


22

11

Appliances

23

12

Blinds and Shades, Artwork

24

12

Carpets

25

13

Special Construction


26

14

Elevators


27

15

Plumbing and Hot Water

28

15

Heat and Ventilation

29

15

Air Conditioning

30

16

Electrical



31

Subtotal (Structures)


32

Accessory Structures

33

Total (Structures)

34


_____________________ and it is understood and agreed by the undersigned that this Certificate is to be submitted by you 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 changes is itemized below:

General Requirements (Job Overhead)


Other Fees–Paid by Contractor


Item

Total

Item

Total

Supervision

$

$

Field Engineering

Field Office Expense

Temporary Facilities

Temporary Utilities

Cleaning and Rubbish Removal

Watchmen Wages

Total for General Requirements


$

Total

$





























Itemized Breakdown































The undersigned hereby certifies that: (Check One)

[ ] There has not been and is not now any identity of interest between mortgagor and/or Construction Manager 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, directors 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, director or stockholder of the party of the first part has any financial interest whatsoever in the party of the second part; when the part of the second 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 than 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 stock 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 side 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 include all change orders for the project, and all amounts shown above as “to be paid in cash” will be so paid within forty-five (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 by an independent public accountant as required for Forms HUD-93305.

I/We, the undersigned, certify under penalty of perjury that the information provided above is true and correct. Warning: Anyone who knowingly submits a false claim, or makes false statements is subject to criminal and civil penalties, including confinement for up to 5 years, fines, and civil penalties. (18 U.S.C. §§ 287, 1001 and 31 U.S.C. § 3729)



Signature of Authorized Official:

Date:






Div.

Trade Item

Paid in Cash

To be Paid Cash

Total

Name of Subcontractor or Payee

Line

2

Earth Work

35

2

Site Utilities


36

2

Roads and Walks

37

2

Site Improvements

38

2

Lawns and Planting

39

2

Unusual Site Conditions

40

Total (Land Improvements)

41

Total (Structure and Land Improvements)

42

1

General Requirements

43

General Overhead

44

Miscellaneous (Labor and Materials)*

45

Bond Premium

46

Other Fees–Paid by Contractor

47

48

Total Costs


49


* Total purchases of materials and cost of labor amounting to less than $1,000 may be included as a lump sum under miscellaneous materials and labor. Costs exceeding this amount for materials and labor must be allocated to the trade item under which they were expended on HUD-92330A-OHF worksheets 3 & 4.

Note: If additional space is required for these or other items, append Rider thereto, with references and initial. When more than one subcontractor is performing a trade item, the attached work sheet must be completed giving the information indicated.




Shape1

Worksheet

Div.

Trade Item

Paid in Cash

To be Paid Cash

Total

Name of Subcontractor or Payee

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








Shape2

Div.

Trade Item

Paid in Cash

To be Paid Cash

Total

Name of Subcontractor or Payee

9

Painting and Decorating



10

Specialties




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






Previous versions obsolete Page 1 of 4 form HUD-92330A­OHF

ref. Handbook 4470.1,4470.2, & 4615.1


File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorSenator, Robin L
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File Created2021-01-15

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