91123-ORCF Design Professional’s Certification of Liability Insuran

Design Professional’s Certification of Liability Insurance (Architect, Engineer or Designer) Section 232

U.S. Department of Housing and Urban Development Office of Residential Care Facilities

OMB Approval No. 2502-0605 (exp. 11/30/2022)

Public reporting burden for this collection of information is estimated to average 0.5 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. The information is being collected to obtain the supportive documentation that 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. Response to this request for information is required in order to receive the benefits to be derived from the National Housing Act Section 232 Healthcare Facility Insurance Program. 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. While no assurance of confidentiality is pledged to respondents, HUD generally discloses this data only in response to a Freedom of Information Act request.

Warning: Anyone who knowingly submits a false claim or makes a false statement is subject to criminal and/or civil penalties, including confinement for up to 5 years, fines, and civil and administrative penalties. (18 U.S.C. §§ 287, 1001, 1010, 1012; 31 U.S.C. §3729, 3802).

To: U.S. Department of Housing and Urban Development (HUD) and

Lender:      

Re: Project Name:      

Project Number:      

Borrower:      

__     __, the Design Architect/Engineer/Designer for the above referenced Project, hereby certifies that (i) it maintains Architect and/or Engineers Professional Liability Insurance in an amount not less than $_     _ (Aggregate) and/ $_     _ (per Claim) issued by_     _, Policy Number _     _, per the Certificate of Liability Insurance (ACORD 25) attached as Exhibit A hereto, and (ii) such insurance shall be maintained continuously through the completion of construction of the Project and the 12-month Warranty Inspection period as required by HUD.

This certification is made, presented and delivered in connection with Lender’s application for mortgage insurance pursuant to Section 232 of the National Housing Act and to influence an official action of HUD, and may be relied upon by HUD as a true statement of the facts contained herein.

____________________________,

By:       as of       , 20     

(Name and title of signatory) Date

Exhibit A

Certificate of Liability Insurance

Previous versions obsolete Page 2 of 2 form HUD-91123-ORCF (06/2019)