91124-ORCF Design Architect’s Certification

Design Architect’s Certification 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)

Re: Project Name:_________________________

Project Number:________________________

Borrower:____________________________

I, the undersigned Design Architect, to the best of my knowledge, belief and professional judgment, I hereby certify that the proposed construction/substantial rehabilitation when constructed in accordance with the working drawings and specifications, which we prepared for the subject Project:

1. will be consistent with HUD approved permits, drawings and specifications submitted to the local and/or State jurisdiction and such construction/substantial rehabilitation will be permissible under the applicable zoning, building, housing, and other codes, ordinances and/or regulations, as modified by any and all waivers obtained from appropriate officials;

2. incorporates foundation designs that reflect site soils limitations and design recommendations included in the foundation soils report as specified in the geotechnical report;

3. complies with the HUD Minimum Property Standards; all applicable accessibility laws for persons with disabilities, including the Fair Housing Act, 42 U.S.C. §§ 3601-19; Section 504 of the Rehabilitation Act of 1973; and the Americans with Disabilities Act; including the applicable accessibility requirements (e.g., the Uniform Federal Accessibility Standards (UFAS), ADA Standards, and Fair Housing Accessibility Guidelines);; and all other applicable HUD guidelines and criteria;

4. Meets or exceeds the HUD minimum energy codes which are the International Energy Conservation Code (IEEC 2009), or for any buildings greater than 3 stories above grade, the American Society of Heating, Refrigerating and Air Conditioning Engineers Standard 90.1 (ASHRAE 90.1, 2007) or as updated and published by HUD; ;

5. includes the following Energy Efficient Design considerations (list):

6. N/A for Substantial Rehabilitation, all structures in seismic zones 3 and 4 meet three fourths (3/4) of the seismic force level resistance contained in ASCE 41-13, Seismic Evaluation and Retrofit of Existing Buildings, American Society of Civil Engineers, as determined by a registered engineer familiar with lateral force design;

7. N/A incorporates noise attenuation measures which are sufficient to mitigate interior noise levels to an “Acceptable” level and complies with the recommendations of the Noise Engineer; and

8. Waivers of codes, etc., were obtained as identified below:

I further certify that the working drawings and specifications submitted to HUD are identical to the approved permit drawings submitted to the local and/or state jurisdictions.

I am licensed by the state in which the captioned Project is located to render services in the design of buildings.

This certification is made, presented and delivered to influence an official action of HUD, and may be relied upon by HUD as a true statement of the facts contained herein.

Design Architect’s Name: _________________________________________________

Signed: ____________________________________ Date: ____________________

License Number: ________________________________________________________

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).

For the Office of Residential Care Facilities (ORCF) Green MIP Projects, also certify to, and provide the applicable information below.

Energy Professionals Certifications

Project Architect’s Certification for New Construction and Substantial Rehabilitation

You have informed me that the project will be designed to achieve a green building certification consistent with ORCFs Program Guidance. Provide the following information:

Name of Certification: ____________________________________

Standard-keeper’s Name:­­­___________________________________

Address of Standard-keeper: _______________________________

Name of Standard-keeper’s Verifier: _________________________

Address of Verifier: ______________________________________

Proposed Level of Achievement¹: ___________________________

Point Score for Energy²:________________ ­­­­­­­out of a possible: _________________

Is this certification a HUD recognized green building certification? (See Program Guidance)

Yes _____, or No ______, (check one).

If no, the following description of the certification must be true:

The certification and energy conservation measures requires the project design to achieve 25% or greater reduction in energy use, and 10% in water reduction (not energy or water costs) when compared to the same project designed to meet the applicable HUD or local energy code (whichever is more stringent). For an existing property with benchmarked energy consumption history, a 15% reduction in energy use and a 10% water reduction (not energy or water costs) is required compared to benchmarked use; and

The certification requires independent verification of energy conservation measures and sustainable products and methods by the verifier’s review of plans and specifications at the conclusion of design, by the verifier’s onsite inspection of all construction completed prior to closing cavity walls, and by the verifier’s onsite inspection of construction after completion; and

The standard-keeper provides or requires the verifier to provide you and to the Borrower timely written documentation of results or conclusions resulting from the verifier’s review of plans and specifications and each on-site inspection leading to and including the final award (or denial) of the certification.

The selected certification and level of achievement is applicable to the design and construction methods proposed for the project and complies with ORCF Green MIP program guidance. The project design is consistent with all the requirements of the selected certification at the specified level of achievement and the project is designed to achieve the energy and water reductions (not energy or water costs) and an ENERGY STAR® Score not less than 75 (signed by the Project Architect and Energy Professional, consistent with the Green MIP program guidance).

Waivers were approved and listed in an attachment to this dcoument. Yes _____, or No _____ (check one).

This certification is made, presented and delivered to influence an official action of HUD, and may be relied upon by HUD as a true statement of the facts contained herein.

Architect’s Name: _____________________________________

Business Address: _____________________________________

Architect’s License Number: _____________________

Signed by: ________________________________ Date: ________________

Energy Professional’s Name: _____________________ Green Certification: _______________

Business Address: _____________________________________

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).

Project Architect’s and/or Energy Professional’s Certification for Refinancing

I certify that the project will be designed to achieve a green building certification consistent with ORCFs Green MIP program guidance. Provide the following information:

Name of Certification: ____________________________________

Standard-keeper’s Name:­­­___________________________________

Address of Standard-keeper: _______________________________

Name of Standard-keeper’s Verifier: _________________________

Address of Verifier: ______________________________________

Proposed Level of Achievement³: ___________________________

Point Score for Energy⁴________________ ­­­­­­­out of a possible: _________________

Is this certification a HUD recognized green building certification? (See Program Guidance)

Yes _____, or No ______, (check one).

If no, the following description of the certification must be true:

For existing projects, the certification and energy conservation measures require the project design to achieve 15% or greater reduction in energy use (not energy costs), and 10% in water reduction (not water costs) when compared to the benchmarked use; and (see Program Guidance)

The certification requires independent verification of energy conservation measures and sustainable products and methods by the verifier’s review of plans and specifications at the conclusion of design, by the verifier’s onsite inspection of all construction completed prior to closing any opened cavity walls, and by the verifier’s onsite inspection of construction after completion; and

The standard-keeper provides or requires the verifier to provide you and to the Borrower timely written documentation of results or conclusions resulting from the verifier’s review of plans and specifications and each on-site inspection leading to and including the final award (or denial) of the certification.

The selected certification and level of achievement is applicable to the design and construction methods proposed for the project and complies with ORCF Program Guidance. The project design is consistent with all the requirements of the selected certification at the specified level of achievement and the project repairs or retrofits will earn the specified certification and are designed to achieve the energy and water reductions (not energy or water costs) and an ENERGY STAR® Score not less than 75 (signed by the Project Architect (if applicable)and Energy Professional, consistent with the Green MIP program guidance).

Waivers were approved and listed in an attachment to this dcoument. Yes _____, or No _____(check one).

Architect’s Name: ___________________________________

Business Address: ___________________________________

Architect’s License Number: ___________________________

Signed by: _________________________________________Date: ________________

Energy Professional’s Name: ___________________________

Energy Professional’s License Number: _____________ Green Certification: _______________

Business Address: ___________________________________

Signed by: _________________________________________Date: ________________

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).

1 e.g., bronze, silver, gold, or similar grades of achievement.

2 If applicable, most standard-keepers assign a level of achievement based on numbers of points assigned to design or siting features as part of a scoring system. Typically, categories of features have a total number of points possible for the category. This question asks for the number of points scored for the category of energy use or efficiency and the total number of points possible for that category.

3 e.g., bronze, silver, gold, or similar grades of achievement.

4 If applicable, most standard-keepers assign a level of achievement based on numbers of points assigned to design or siting features as part of a scoring system. Typically, categories of features have a total number of points possible for the category. This question asks for the number of points scored for the category of energy use or efficiency and the total number of points possible for that category.

Previous versions obsolete Page 7 of 7 form HUD-91124-ORCF (06/2019)