The instructions for submitting this form (if required) are included in 7 CFR 1726, Electric System Construction Policies and Procedures.
This form is completed by the Owner/Engineer based on information provided by the Contractor.
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Fld Name / |
Instruction |
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Item 1 |
Enter Owner’s RUS designation (e.g., AL001) |
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Item 2 |
Enter the amendment date |
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Item 3 |
Enter the amendment number. |
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Item 4 |
Enter the contract number. |
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Item 5 |
Indicate if a bond extension is attached. |
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Item 6.a |
Enter the original completion or delivery date. |
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Item 6.a |
Enter the amended completion or delivery date. |
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Item 7 |
Enter the reason(s) for the amendment. |
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Item 8 |
Enter the amount of the original contract price and any subsequent amendments (including this amendment.) |
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Next 2 Blanks |
Enter the amount of the contract amendment in the appropriate blank. |
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Next 2 Blanks |
Indicate whether the amendment requires RUS approval (see 7 CFR 1726 for criteria.) |
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Signature Block |
Enter the names of the Engineer, Contractor, and Owner in the appropriate blanks. (Sign printed copy.) |
Page 2
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Fld Name / |
Instruction |
|
Item 1 |
Enter Owner’s RUS designation (e.g., AL001) |
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Item 2 |
Enter the contract number. |
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Column 1 |
Enter the Item Number. |
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Column 2 |
Enter the amendment number in the heading. Enter the reason(s) and description of the amendment item. |
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Columns 3‑5 |
Enter cost changes in the column(s) indicated. |