8.9 - Attachment G-9 (HUD-51003).pdf

OMB Approval No. 2577-0157 (exp. 1/301/2027) Schedule of Materials Stored U.S. Department of Housing and Urban Development Office of Public and Indian Housing

Instructions: This form is to be used to support the Periodic Estimate for Partial Payment (form HUD-

Public reporting burden for this collection of information is estimated to average 1.5 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. Comments regarding the accuracy of this burden estimate and any suggestions for reducing this burden can be sent to the Reports Management Officer, Office of Policy Development and Research, REE, Department of Housing and Urban Development, 451 7th St SW, Room 4176, Washington, DC 20410-5000. When providing comments, please refer to OMB Approval No. 2577-0157. 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.

51001). The contractor must prepare a separate schedule for his/her materials and for those of his/her subcontractors. Attach an original (or a copy ) to each copy of the Summary of Materials Stored (form HUD-51004). Enter all identifying data and list materials stored. The listing of materials stored must correspond to the arrangement established on the Schedule of Contract Payments (form HUD-51000) and each item will be keyed by corresponding item number. This form must be signed as noted.

Name of Public Housing Agency Supporting Periodic Estimate for Partial Payment Number

Period

From (mm/dd/yyyy) To (mm/dd/yyyy)

Item Number* Description and Quality Quantity Unit of Measure Unit Price at Site Total Price

Amount Carried Forward $

Total Amount or Amount Carried Forward $ form HUD-51003 (1/2014) As identified in Schedule of Amounts for Contract Payments, form HUD-51000.

I certify that the information provided on this form and in any accompanying documentation is true and accurate. I acknowledge that making, presenting, or submitting a false, fictitious, or fraudulent statement, representation, or certification may result in criminal, civil, and/or administrative sanctions, including fines, penalties, and imprisonment.

Prepared by (Contractor's Representative) Date (mm/dd/yyyy) Checked by (Owner's Representative) Date (mm/dd/yyyy)

Name and Location of Project Project Number

Name of General Contractor Contract Number

Name of Subcontractor Subcontract Number

Previous Editions are Obsolete

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