92330-ORCF Mortgagor's Certificate of Actual Cost

Borrower’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. 11/30/2022)

Public reporting burden for this collection of information is estimated to average 8 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).

Project Name:      	FHA Project Number:      
Project Address:      

This Certificate is made pursuant to the provisions of that Agreement and Certification of Borrower dated MM/DD/YYYY and in order to induce you to finally endorse the mortgage for insurance.

The actual cost to the owner of labor and materials and necessary services for construction of the physical improvements in connection with the subject project, after deduction of all kickbacks, rebates, adjustments, discounts, promotional or advertising recoupment made or to be made to the borrower, sponsor or any corporation, trust, partnership, joint venture or other legal entity in which they or any of them hold any interests set forth below, the cost of construction is (is not) supported by Form HUD-92330-A-ORCF, Contractor Certificate of Actual Cost. (Form HUD-92330-A-ORCF must be submitted when there is an identity of interest between borrower and general contractor and when a Cost Plus Contract is required in nonprofit projects.)

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 or handbooks.

The undersigned hereby certifies that, except as noted below, there has not been and is not now any identity of interest between borrower and general contractor and/or any subcontractor, material supplier, or equipment lessor. It is further certified that, except as noted, there are not and have not been any such relationships between sponsor(s) of this project and general contractor and/or subcontractor, material supplier and equipment lessor.

All references to "Identity of Interest" herein made are made in the context of the definition printed below, which has been read by the undersigned.

Identity of Interest between the borrower and/or sponsor as parties of the first part and general contractors, subcontractors, mate­rial suppliers, or equipment lessors as parties of the second part will be construed as existing under any of the following conditions:

When there is any financial interest of the party of the first part in the party of the second part; when one or more officers, directors or stockholders of the party 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 party 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 his or 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 comes into being any side deals, agreements, contracts or undertaking en­tered into or contemplated, thereby altering, amending, or cancel­ling any of the required closing documents except as approved by the commissioner; when any relationship (e.g. family) existing which would give the borrower or general contractor control or influence over the price of the contract or the price paid to the subcontractor, material supplier or lessor of equipment.

The following identities of interest exist:      . If none, so state.

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

Borrower Name:      	Title:      
Signature:	Date:      

Item * Attach itemized schedules and copies of bills and receipts where applicable	Column A Paid in Cash	Column B To be paid in cash within 45 days after final endorsement	Column C Total
Amount due under terms of Lump-Sum Construction Contract (as adjusted)
Amount due under terms of Cost-Plus Construction Contract (as adjusted and exclusive of Builder's Profit)
* 1 c. Allowable Builder's Profit (Use only if 1b is used)
Architect's Fee - Design
Architect's Fee - Supervision
* 2c. Architect's Fee - Additional Services
Interest During Construction
Taxes During Construction
Property Insurance
Mortgage Insurance Premium (MIP)
FHA Examination Fee
FHA Inspection Fee
Title and Recording Fees
* 10a. Initial Financing Fee
* 10b. Permanent Placement fee
* 10c. Discounts
* 10d. Other Approved Financing Expenses
* 11a. Legal
* 11b. Organization
* 11c. Borrower’s Cost Certification Audit Fee
* 12. Other (exclusive of items required by the Construction Contract)
Subtotal
13a. Consultant's Fee
* 13b. Major Moveable Equipment
* 13c. Offsite and Demolition
* 13d. Other
Subtotal
* 14a. Reduction (if any) resulting from Operating Statement Attached
* 14b. Reduction (if any) resulting from Grants / Loans
Total

Previous versions obsolete Page 9 of 9 Form HUD-92330-ORCF (06/2019)