HUD 51004 Summary of Materials Stored

Summary of Materials Stored

OMB Approval No. 2577-0157
(exp. 3/31/2020)

U.S. Department of Housing
and Urban Development

Office of Public and Indian Housing
Public reporting burden for this collection of information is estimated to average 2.5 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. HUD may not conduct or sponsor,
and an applicant is not required to respond to a collection of information unless it displays a currently valid OMB control number. This information is
collected under the authority of Section 6(c) of the U.S Housing Act of l937 and HUD regulations. HAs are responsible for contract administration to
ensure that the work for project development is done in accordance with State laws and HUD requirements. The contractor/subcontractor reports provide details
and summaries on payments, change orders, and schedule of materials stored for the project The information will be used to ensure that the total development
costs, identified in the ACC, are kept as low as possible and consistent with HUD construction requirements. Responses to the collection are necessary to obtain
a benefit. The information requested does not lend itself to confidentiality.
Instructions: This form is for the Contractor to summarize the value of materials stored at the site (as shown on the schedule, form HUD-51003). Use a
separate line for the contractor and each of his/her subcontractors. Prepare an original and one copy, attach form HUD-51003, and send to the Public
Housing Agency with the Periodic Estimate for Partial Payment, form HUD-51001. Payment Value. No more than 90 percent of the estimated value of the
stored materials will be allowed, and only the net amount will be carried to line 13 on the back of the Periodic Estimate for Partial Payment, form HUD-51001.
Signatures. This form must be signed by those employees of the contractor and of the Public Housing Agency who prepare and check the Schedule of
Materials Stored, form HUD-51003.
Name of Public Housing Agency

Supporting Periodic Estimate
for Partial Payment Number

Period
From (mm/dd/yyyy)

To (mm/dd/yyyy)

Location of Project

Project Number

Name of General Contractor

Contract Number

Name of General Contractor or Subcontractor
General Contractor

$

Subcontractors

$

Prepared by

Amounts

Date (mm/dd/yyyy) Checked by

Total

$

Less 10%

$

Net

$
Date (mm/dd/yyyy)

I certify that I or my authorized representatives have examined and checked in detail the invoices representing the cost of materials set forth
in appended "Schedule of Materials Stored", form HUD-51003, dated (mm/dd/yyyy) __--------------------------------------------------------------submitted by __ --------------------------------------------------------------------------- _____ consisting of _________ sheets with an indicated cost
of $ ______________________ , and find that the net unit prices set forth in the schedule are the same or less than the invoices examined,
and that such materials were suitably stored at the site of the development as of (date)(mm/dd/yyyy) _____________________ .
Name of Owner

By (Authorized Representative)

Title

Date
(mm/dd/yyyy)

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)
Previous editions are obsolete

form HUD-51004 (01/201))