Document
Form HUD-92330A-OHF
ICR 202206-2502-001 · OMB 2502-0602 · Object 122253101.
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| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
|---|---|
| File Title | Form HUD-92330A-OHF |
| Last Modified By | Writer |
| File Modified | 2022-07-22 |
| File Created | 2026-10-13 |
| Conversion State | complete |
Extracted Text
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. 11/30/2022) Public Burden Statement: According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. Public reporting burden for this collection of information is estimated to average 2 hours per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. The information requested is required in order to receive the benefits to be derived. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Housing and Urban Development, Office of the Chief Data Officer, Attention: Departmental Clearance Officer, 451 7th Street SW. Room, Washington, DC 20410 or email [email protected]. HUD collects this information, pursuant to Section 242 of the National Housing Act and regulations at 24 CFR Part 242, in order to review Section 242 applications to determine eligibility, underwrite insured hospital loans, ensure adequate collateral, process initial/final endorsement, manage FHA’s hospital portfolio, monitor and manage risk, and ensure ongoing compliance with regulations. No confidentiality is assured. 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. Instructions: The information is required from a general contractor when an Identity of Interest exists between the general contractor or construction manager and the Borrower or when a cost plus contract has been used. The information is required from the general contractor to convey its actual construction cost in a standardized format for cost certification. Project Number Name of Project Borrower Contractor Short Project Description Location This Certificate is made pursuant to the provisions of the Construction Contract, entered into by and between _________________ (Borrower) and __________________(General Contractor) under date of____________ and further amended through date of ________. It is understood and agreed by the undersigned that this Certificate is to be submitted by the Borrower to the Federal Housing Commissioner to induce the Commissioner to provide final endorsement of 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: 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 Wood, Plastics, and Composites 4 7 Thermal and Moisture Protection 5 8 Openings 6 9 Finishes 7 10 Specialties 8 11 Equipment 9 12 Furnishings 10 13 Special Construction 11 14 Conveying Equipment 12 13 21 Fire Suppression 14 22 Plumbing 23 Heating, Ventilating, and Air Conditioning 15 16 25 Integrated Automation 17 26 Electrical 18 27 Communications 19 28 Electronic Safety and Security 20 21 Subtotal (Structures) 32 Accessory Structures 33 Total (Structures) 34 Div. Trade Item Paid in Cash To be Paid Cash Total Name of Subcontractor or Payee Line 2 Existing Conditions 35 31 Earthwork 32 Exterior Improvements 37 33 Utilities 38 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 this form, the HUD-92330A-OHF. 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. 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 Construction Manager or general contractor on the one hand and any subcontractor, material supplier or equipment lessor on the other. [ ] ] An Identity of Interest exists and is fully described in an attachment the Contractor shall label as “Attachment A.” 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 or engineering services other than those of a surveyor, general superintendent, or engineer employed by a general contractor 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 exists 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 Federal Housing Commissioner; when any relationship (e.g. family) existing which would give the Borrower, general contractor, or construction manager control or influence over the price of the contract or the price paid to the subcontractor, material supplier or lessor of equipment. 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 if required by HUD regulations, handbooks, commitment, and/or Forms HUD-93305-OHF. 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: Worksheet Div. Trade Item Paid in Cash To be Paid Cash Total Name of Subcontractor or Payee 3 Concrete 4 Masonry 5 Metals 6 Wood, Plastics, and Composites 7 Thermal and Moisture Protection 8 Openings 9 Finishes 10 Specialties 11 Equipment 12 Furnishings 13 Special Construction 14 Conveying Equipment 21 Fire Suppression 22 Plumbing 23 Heating, Ventilating, and Air Conditioning 25 Integrated Automation 26 Electrical 27 Communications 28 Electronic Safety and Security Div. Trade Item Paid in Cash To be Paid Cash Total Name of Subcontractor or Payee 2 Existing Conditions 31 Earthwork 32 Exterior Improvements 33 Utilities