92330A-ORCF Contractor's Certificate of Actual Cost

Comprehensive Listing of Transactional Documents for Mortgagors, Mortgagees and Contractors

92330a_orcf

Transactional Documents for Mortgagees and Contractors

OMB: 2502-0605

Document [docx]
Download: docx | pdf





Contractor’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:      

Building Number:      

Project Address:      

Borrower Name:      

Contractor Name:      


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

Rough Carpentry

4

6

Finish Carpentry

5

7

Waterproofing

6

7

Insulation

7

7

Roofing

8

7

Sheet Metal

9

8

Doors

10

8

Windows

11

8

Glass

12

9

Lath and Plaster

13

9

Drywall

14

9

Tile Work

15

9

Acoustical

16

9

Wood Flooring

17

9

Resilient Flooring

18

9

Painting and Decorating

19

10

Specialties

20

11

Special Equipment

21

11

Cabinets

22

11

Appliances

23

12

Blinds and Shades, Artwork

24

12

Carpets

25

13

Special Construction

26

14

Elevators

27

15

Plumbing and Hot Water

28

15

Heat and Ventilation

29

15

Air Conditioning

30

16

Electrical

31

Subtotal (Structures)

32

Accessory Structures

33

Total (Structures)








Div.

Trade Item

Paid in Cash

To be Paid Cash

Total

Name of Subcontractor or Payee

Line

2

Earth Work

35

2

Site Utilities

36

2

Roads and Walks

37

2

Site Improvements

38

2

Lawns and Planting

39

2

Unusual Site Conditions

40

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 HUD-92330-A-ORCF worksheets 3 and 4.

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 giving the information indicated.

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 general contractor on the one hand and any subcontractor, material supplier or equipment lessor on the other.

The accompaniment contains a statement fully describing any identities of interest. 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 services or engineering services other than those of a surveyor, general superintendent, or engineer employed by a general contract 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 exist 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 HUD.

All amounts shown have been reduced to give effect to the amount(s) of any kickbacks, rebates, adjustments, discounts, or any other devices which had the effect of reducing the actual cost, 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 as required for Form HUD-93305-ORCF.




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


Signature:

Date:


Div.

Trade Item

Paid in Cash

To Be Paid In Cash

Total

Name of Subcontractor or Payee

3

Concrete





















4

Masonry



















5

Metals













6

Rough Carpentry













6

Finish Carpentry













7

Waterproofing













7

Insulation













7

Roofing













7

Sheet Metal













8

Doors













8

Windows













8

Glass













9

Lath and Plaster













9

Drywall













9

Tile Work













9

Acoustical














Div.

Trade Item

Paid in Cash

To Be Paid In Cash

Total

Name of Subcontractor or Payee

9 Wood Flooring

9 Resilient Flooring

Wood Flooring

















9 Painting and Decorating

Resilient Flooring

















9

Painting and Decorating













10

Specialties













11

Special Equipment













11

Cabinets













11

Appliances













12

Blinds and Shades, Artwork













12

Carpets













13

Special Construction













14

Elevators













15

Plumbing and Hot Water













15

Heat and Ventilation













15

Air Conditioning













16

Electrical













2

Earth Work

















2

Site Utilities



















2

Roads and Walks












2

Site Improvements














2

Lawns and Planting

















2

Unusual Site Conditions


















Previous versions obsolete Page 10 of 42 Form HUD-92330A-ORCF (06/2019)

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File Modified0000-00-00
File Created0000-00-00

© 2024 OMB.report | Privacy Policy