HUD-53237 Choice Neighborhoods - Extraodinary Site Costs Certifica

OMB Approval No. 2577-0269
(exp. 4/30/2018)

CHOICE NEIGHBORHOODS – EXTRAORDINARY SITE COSTS CERTIFICATION
I hereby certify that:
1.

I am a licensed engineer

architect

(check one).

2.

I am not an employee of the Lead Applicant, Co-Applicant (if any), Principal Team Member
(if any), or unit of local government in which the housing project identified below is located.

3.

Extraordinary site costs may be incurred in the revitalization and demolition of existing
property, as well as in the development of new and rehabilitated units. Examples of
such costs include, but are not limited to: abatement of extraordinary environmental
site hazards; removal or replacement of extensive underground utility systems;
extensive rock and/or soil removal and replacement; removal of hazardous
underground tanks; work to address unusual site conditions such as slopes, terraces,
water catchments, lakes, etc.; and work to address flood plain and other environmental
remediation issues. Costs to abate asbestos and lead-based paint should be included in
normal demolition costs where such items are found within the structures themselves.
An example of extraordinary lead-based paint would be where the lead has leached into
the soil and extraordinary measures are needed to remove the lead.

4.

I have reviewed the attached description of the extraordinary site costs requested by
the Lead Applicant identified below, and affirm that these costs qualify as extraordinary
site costs (as that term is defined in Paragraph 3 above) and that the costs are justified
and reasonable in light of my assessment of the site of the severely distressed project
and the work proposed to be completed at that site.

Name: _____________________________________________

____

_______ __

Signature: _____________________________________________

Date:

_____

License number: _____________

_______ State of Registration: ________

Lead Applicant: _______________________

__________________

_____
________

Name of Targeted Public and/or Assisted Housing Site(s):
_____________________________________

______

Required Attachment: Description and itemized listing of extraordinary site costs.
Warning: HUD will prosecute false claims and statements. Conviction may result in the
imposition of criminal and civil penalties. (18 U.S.C. 1001, 1010, 1012, 31 U.S.C. 3729, 3802)
HUD Form 53237 (04/2015)