Form HUD-92330A-OHF Contractor's Certificate of Actual Cost - Hospitals/Sect

Contractor's Certificate of Actual Cost Section 242

U.S. Department of Housing and Urban Development Office of Hospital Facilities

OMB Approval No. 2502-0602 (Exp. 05/31/2016)

Public reporting burden for this collection of information is average 2 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. This information is required to obtain benefits, HUD may not collect this information, and you are not required to complete this form, unless it displays a currently valid OMB control number.  24 C.F.R. 242.42, authorizes the collection of this information. The information is required for a general contractor when an identity of interest exists between the general contract and the mortgagor or when a mortgagor is a non-profit entity and a cost plus contract has been used. The information is required from the contractor to convey its actual construction cost in a standardized format for cost certification.

Privacy Act Notice. The United States Department of Housing and Urban Development, Federal Housing Administration, is authorized to solicit the information requested in this form by virtue of Title 12, United States Code, Section 1701 et seq., and regulations promulgated thereunder at Title 12, Code of Federal Regulations. While no assurances of confidentiality is pledged to respondents, HUD generally discloses this data only in response to a Freedom of Information request.

Project Number	Building Number	Borrower
Contractor	Name of Project	Location

This Certificate is made pursuant to the provisions of the Construction Contract, entered into by and between us under date of

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)																								34

_____________________ and it is understood and agreed by the undersigned that this Certificate is to be submitted by you to the Federal Housing Commissioner in order to induce the Commissioner to finally endorse the mortgage for insurance. The actual cost incurred in the completion of construction under the above Construction Contract and accepted construction changes is itemized below:

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	$

Itemized Breakdown

The undersigned hereby certifies that: (Check One)

[ ] There has not been and is not now any identity of interest between mortgagor and/or Construction Manager 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 the Commissioner.

All amounts shown include all change orders for the project, 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 Forms HUD-93305.

I hereby certify that all the information stated herein, as well as any information provided in the accompaniment herewith, is true and accurate. Warning: HUD will prosecute false claims and statements. Conviction may result in criminal and/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802)

Signature of Authorized Official:

Date:

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-92330A-OHF worksheets 3 & 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.

Worksheet

Div.	Trade Item			Paid in Cash	To be Paid 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
9	Wood Flooring
9	Resilient Flooring

Div.	Trade Item												Paid in Cash	To be Paid Cash	Total	Name of Subcontractor or Payee
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 1 of 4 form HUD-92330A­OHF

ref. Handbook 4470.1,4470.2, & 4615.1