92328-ORCF Contractor's and/or Mortgagor's Cost Breakdown

Contractor's and/or Mortgagor's Cost Breakdown Schedules of Values Section 232

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

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

Public reporting burden for this collection of information is estimated to average 4 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).

Date:      	Sponsor:      
FHA Project Number:      		Building Identification:      
Project Name:      
Project Address:      

This form represents the Contractors and/or Borrowers firm costs and services as a basis for disbursing dollar amounts when insured advances are requested. Detailed instructions for completing this form are included at the end.

Line	Div.	Trade Item	Cost	Trade Description
1	3	Concrete
2	4	Masonry
3	5	Metals
4	6	Rough Carpentry
5	6	Finish Carpentry
6	7	Waterproofing
7	7	Insulation
8	7	Roofing
9	7	Sheet Metal
10	8	Doors
11	8	Windows
12	8	Glass
13	9	Lath and Plaster
14	9	Drywall
15	9	Tile Work
16	9	Acoustical
17	9	Wood Flooring
18	9	Resilient Flooring
19	9	Painting and Decorating
20	10	Specialties
21	11	Special Equipment
22	11	Cabinets
23	11	Appliances
24	12	Blinds and Shades, Artwork
25	12	Carpets
26	13	Special Construction
27	14	Elevators
28	15	Plumbing and Hot Water
29	15	Heat and Ventilation
30	15	Air Conditioning
31	16	Electrical
32		Subtotal (Structures)
33		Accessory Structures
34		Total (Lines 32 and 33)

Line	Div.	Trade Item	Cost	Trade Description
35	2	Earth Work
36	2	Site Utilities
37	2	Roads and Walks
38	2	Site Improvements
39	2	Lawns and Planting
40 41	2	Unusual Site Condition Total Land Improvements		Nonresidential and Special Exterior Land Improvement (costs included in trade item breakdown)		Offsite Costs (costs not included in trade item breakdown)
42		Total Struct. & Land Imprvts.		Description	Est. Cost	Description	Est. Cost
43	1	General Requirements
44		Subtotal (Lines 42 and 43)
45		Builder's Overhead
46		Builder's Profit		Total $
47		Subtotal (Lines 44 thru 46)		Other Fees		Total $
48						Demolition (costs not included in trade item breakdown)
49		Other Fees
50		Bond Premium				Description	Est. Cost
51		Total for All Improvements
52		Builder's Profit Paid by Means Other Than Cash
53		Total for All Improvements Less Line 52
				Total $		Total $

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

Borrower	Signature:	Date:      
Contractor	Signature:	Date:      
ORCF Authorized Agent Date	Signature:	Date:      

Instructions for Completing Form HUD-92328-ORCF

This form is prepared by the contractor and/or borrower as a requirement for the issuance of a firm commitment. The firm replacement cost of the project also serves as a basis for the disbursement of dollar amounts when insured advances are requested. A detailed breakdown of trade items is provided along with spaces to enter dollar amounts and trade descriptions.

Date-Date form was prepared.

Sponsor-Name of sponsor or sponsoring organization.

FHA Project No.-Eight-digit assigned project number.

Building Identification-Number(s) or Letter(s) of each building as designated on plans.

Name of Project-Sponsors designated name of project. Project Location-Street address, city and state.

Division-Division numbers and trade items have been developed from the cost accounting section of the uniform system.

Accessory Structures-This item reflects structures, such as: com­munity, storage, maintenance, mechanical, laundry and project office buildings. Also included are garages and carports or other buildings.

When the amount shown on line 33 is $20,000.00 or 2% of line 32 whichever is the lesser, a separate form HUD-92328-ORCF will be prepared through line 32 for Accessory Structures.

Unusual Site Conditions-This trade item reflects rock excavation, high water table, excessive cut and fill, retaining walls, erosion, poor drainage and other on-site conditions considered unusual.

Cost-Enter the cost being submitted by the Contractor or bids submitted by a qualified subcontractor for each trade item. These costs will include, as a minimum, prevailing wage rates as determined by the Secretary of Labor.

Trade Description-Enter a brief description of the work included in each trade item.

Other Fees-Includable are fees to be paid by the Contractor, such as sewer tap fees not included in the plumbing contract. Fees paid or to be paid by the Mortgagor are not to be included on this form.

Total For All Improvements-This is the sum of lines 1 through 50 and is to include the total builder's profit (line 46).

Line 52-When applicable, enter that portion of the builder's profit (line 46) to be paid by means other than cash and/or any part of the builder's profit to be waived during construction.

Non-Residential and Special Exterior Land Improvement Costs-Describe and enter the cost of each improvement, i.e. on-site parking facilities including individual garages and carports, commercial facili­ties, swimming pools with related facilities and on-site features pro­vided to enhance the environment and livability of the project and the neighborhood. The Design Representative and Cost Analyst shall collaborate with the borrower or their representative in designating the items to be included.

Off-Site Costs-Enter description and dollar amount including fees and bond premium for off-site improvements.

Demolition-Enter description and dollar amount of demolition work necessary to condition site for building improvements including the removal of existing structures, foundations, utilities, etc.

Other Fees-Enter a brief description of item involved and cost estimate for each item.

Signatures-Enter the firm name, signature of authorized officer of the contractor and/or Borrower and date the form was completed.

Previous versions obsolete Page 10 of 13 Form HUD-92328-ORCF (06/2019)