92330a_orcf_Final_Clean

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Contractor’s Certificate
of Actual Cost
Section 232
U.S. Department of Housing 
and Urban Development 
Office of Residential Care Facilities
OMB Approval No. 2502-0605
(exp. 03/31/2018)
Public reporting burden for this collection of information is estimated to average 8 hours.  This includes the time for collecting, reviewing, and reporting the data.  The information is being collected to obtain the supportive documentation which must be submitted to HUD for approval, and is necessary to ensure that viable projects are developed and maintained.  The Department will use this information to determine if properties meet HUD requirements with respect to development, operation and/or asset management, as well as ensuring the continued marketability of the properties.  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.   

Warning: Any person who knowingly presents a false, fictitious, or fraudulent statement or claim in a matter within the jurisdiction of the U.S. Department of Housing and Urban Development is subject to criminal penalties, civil liability, and administrative sanctions.  

Project Name:      
FHA Project Number:      
Building Number:      
Project Address:      
Borrower Name:      
Contractor Name:      

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)










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-92330-A-ORCF 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 one subcontractor is 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

Total
Supervision
$


$

Field Engineering





Field Office Expense





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 borrower 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, 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 HUD.
All amounts shown have been reduced to give effect to the amount(s) of any kickbacks, rebates, adjustments, discounts, or any other 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 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 Form HUD-93305-ORCF.


I hereby certify that all the information stated herein, as well as any information provided in the accompaniment herewith, is true and accurate. 

Signature:
Date: