Form Hud 92448 – Fill Out and Use This PDF

Contractor's Requisition	U.S. Department of Housing	OMB Approval No. 2502-0028 (exp. 10/31/2013)
	and Urban Development
Project Mortgages
	Office of Housing
To be submitted to mortgagee in quadruplicate	Federal Housing Commissioner

This information is used to verify program benefits consisting of distribution of insured mortgage proceeds when construction costs are involved. The information regarding completed work items is used by HUD to ensure that payments from mortgage proceeds are made for work actu ally completed in

a satisfactory manner. This information is a requirement under Section 207(b) of the National Housing Act (Public Law 479, 48 Stat. 1246, 12 U.S.C. 1701 et. seq) authorizing the Secretary of HUD to insure mortgages. The information collection does not contain information of a sensitive nature.

Public reporting burden for this collection of information is estimated to average 6 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 agency may not collect this information, and you are not required to complete this form, unless it displays a currently valid OMB control number.

In accordance with the provision of the Construction Contract dated ________________ and Contractor's and/or Mortgagor's Cost

Breakdown (Schedule of Values) attached thereto, this requisition is submitted for the amount of $ __________________ due for work

performed up to the ____________ day of ______________ and as itemized below by the trades listed in the Schedule of Values.

					Enter Amounts to Nearest Even Dollar
DIV	Trade Item		Cost as per Cost Breakdown		Amounts Complete	For HUD-FHA Use
			(A)		(B)	(C)
3	Concrete	$	$			$

4Masonry

5Metals

6Rough Carpentry

6Finish Carpentry

7Waterproofing

7Insulation

7Roofing

7Sheet Metal

8Doors

8Windows

8Glass

9Lath and Plaster

9Drywall

9Tile Work

9Acoustical

9Wood Flooring

9Resilient Flooring

9Painting and Decorating

10Specialties

11Special Equipment

11Cabinets

11Appliances

12Blinds and Shades, Artwork

12Carpets

13Special Construction

14Elevators

15Plumbing and Hot Water

15Heat and Ventilation

15Air Conditioning

16Electrical Accessory Buildings

	2	Earth Work
	2	Site Utilities
	2	Roads and Walks
	2	Site Improvement
	2	Lawns and Planting
	2	Unusual Site Conditions
	1	General Requirements
	1	Bond Premium ($	)
Previous editions are obsolete.				Page 1 of 2	form HUD-92448 (1/91)

							Enter Amounts to Nearest Even Dollar
		Trade Item		Cost as per Cost Breakdown		Amounts Complete			For HUD-FHA Use
DIV				(A)			(B)			(C)
1	Other Fees	($	)
(1)	Subtotal of Breakdown Items			$	*	%	$	**	%	$
(2)	Builder's Overhead			$		%	$		%	$
(3)	Builder's Profit			$		%	$		%	$
(4)	Total of Cost Breakdown Items			$			$			$
(5)	Inventory of Materials Stored On-site (See Note Below)						$			$
(6)	Inventory of Materials Stored Off-Site (See Note Below)						$			$
(7)	Sum of Cost Breakdown Items Plus Inventories of Materials						$			$
(8)	Less Net Decrease in Cost as a Result of Approved Changes						$			$
(9)	Total After Adjusting for Net Decrease to Approved Changes						$			$
(10)	Less Retained 10%						$			$
(11)	Bal.: Total Amount Due to Date on Account of Construction Contract						$			$
(12)	Less Previous Payments						$			$
(13)	Net Amount of This Requisition						$			$

I certify that the Work covered by this requisition has been completed in accordance with the Contract Documents, and that I have actually received

$		for Work performed and materials purchased up to the ______________ day of ____________ (date of previous requisition).
Date			Contractor

* Percentage derived from subtotal of Breakdown Items (col. B divided by col. A) Note: Attached inventory of materials item ized as to quantities and costs. ** (col. C divided by col. A) Exclusive of Bond Premium

For Use of HUD-Federal Housing Commissioner

Date		Net Amount Approved for Payment		Column C Completed by
				(Mortgage Credit Examiner)
Reviewed and Approved by	(Chief, Mortgage Credit)		Director, Housing Development

Architect's Certificate I certify, based on my on-site observations (or those of my authorized representative) and the data comprising this requisition, that the Work has progressed to the point indicated; that to the best of my knowledge, information and belief the Work is in accordance with the Contract Documents; and that the Contractor is entitled to payment of the amount certified.

Inspector's Certificate

Amount Modified

No Modification

I certify that I have visited the site on this date ______________________________, observed the Work, and monitored the log and reports of the

Architect (if an architect is administering the Construction Contract); that to the best of my knowledge, information and belief the amount certified represents acceptable Work; and that I have no personal interest, present or prospective, in the property, applicant or proceeds of the mortgage.

Contractor's Prevailing Wage Certificate (For use under all sections of the National Housing Act requiring certification as to payment of prevailing wages. To be completed with each request for insurance of advance of mortgage proceeds which includes a payment on account of construction cost, or at the time the mortgage is presented for insurance pursuant to a commitment to insure upon completion.)

To	Date	Advance No.
Manager	Project Name
Field Office	Project Number

The undersigned, as principal contractor in connection with the construction of the above project, states that he/she is fully familiar with applicable wage determination decision of the Secretary of Labor and certifies that:

a. A copy of the applicable wage determination decision is posted in a conspicuous place at the site of the work and he/she has required each subcontractor as a part of his/her contract, to agree to pay wages at rates not less than those contained in the decision.

b. All laborers and mechanics employed in the construction of the project have been, to the date hereof, paid for such employment at wage rates not less than those contained in the applicable wage determination decision of the Secretary of Labor and no deductions or rebates have been made, either directly or indirectly, from the full weekly wages earned by any person, other than permissible deductions as defined in Regulations of the Secretary of Labor, Part 3 (29 CFR Part 3).

c. He/She has fulfilled his/her obligations, to the date hereof, under The Labor Standards Provisions of the Supplementary Conditions of the Contract for Construction and has included said conditions in all subcontracts.

This certificate is executed by the undersigned for the purpose of inducing the Commissioner to approve for insurance that certain mortgage loan, or an advance thereof, made or to be made by the mortgagee in connection with the construction of the project, and with the intent that the Commissioner rely upon this certification to establish compliance with the provisions of Section 212 of the National Housing Act, which provides in part: The Commissioner shall not insure ... unless the principal contractor files a certificate ... certifying that the laborers and mechanics ... have not been paid not less than the wages prevailing ... as determined by the Secretary of Labor...”

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).

Contractor	By		Date:
	X
Previous editions are obsolete.	Page 2 of 2	form HUD-92448 (1/91)