The instructions for submitting this form (if required) are included in 7 CFR 1726, Electric System Construction Policies and Procedures.
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Fld Name / |
Instruction |
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First Blank |
Enter name of the person making the certification. |
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Second Blank |
Enter title of the person making the certification. |
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Third Blank |
Enter name of contractor. |
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Fourth Blank |
Enter the number of contract. |
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Fifth and Sixth Blanks |
Enter the date of the original contract. |
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Seventh Blank |
Enter name of RUS Borrower (Owner). |
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Eighth Blank |
Enter Borrower’s (Owner’s) RUS designation (e.g., AL001) |
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Ninth and Subsequent Blanks |
Enter name of the manufacturer, material supplier, or subcontractor and the material or services provided. |
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Signature Block |
Enter date prepared. (Sign printed copy.) |