Instructions for RUS Form 158 (10-77)

CERTIFICATION OF CONTRACT OR FORCE ACCOUNT PROPOSAL APPROVAL

This form is used by Rural Utilities Service ( RUS) telecommunications borrowers participating in the Construction Certification Program depicted in 7 CFR 1753, Subpart J. Borrowers need to submit form 158 along with RUS Form 481 on the first request for funds for a contract or proposal or the first request after the approval of an amendment.

Submit the original of the completed form with RUS Form 481 to the respective RUS Engineering Branch Chief.

RUS borrowers or their consulting engineers must complete the following items:

 

Field Name
or Item No.

Project Identification

System Designation

Enter the RUS borrower's number designation consisting of the two‑letter state initial, the three digit number, and the letter identifying the loan, such as WI 533-N.

Name of the Borrower

Enter the legal name of the company.

 

 

Part A . Engineering & Architectural Service

 

Item No.

Instructions for Part A. Engineering and Architectural Service

1. Contract Form

Check the contract form used to secure engineering or architectural services.

2. Name & Address

Enter the name and mailing address of the engineer or architect

3. Contract Amount

Enter the total amount of the contract using numbers, e.g., $45,000.25

4. Contract Date

Enter the date of the contract using the format dd/mm/yy, e.g., 04/15/01.

5. Contract Number

Enter the number the borrower assigns to the contract.

6. Force Account Engineering

Enter the amount for force-account engineering. This blank needs to be filled by RUS borrowers performing engineering on a force account basis for major construction.

7. Force Account Description

Briefly describe the construction projects covered as to make possible the identification of these projects in the RUS approval of force account engineering. RUS approval of force account engineering for major construction is granted for specific purposes named in the notice of approval.

 

 

Part B . Contract Construction

 

Fld Name /
Item No.

Instructions for Part B. Contract Construction

1. Contract form

Check to indicate the Standard Contract Form used in the contract documents. If other is checked, indicate under remark the contract form used.

2. Method of award

Check one to indicate the method of procurement. If the project was competitively bid, check competitive. If the project was negotiated, check n egotiated.

3. Name and address

Enter name of the contractor and its address.

4. Amount

Enter the total amount of the contract or amendment, as appropriate, using numbers, e.g., $300,109.33.

5. Date

Enter the date of the contract using the format mm/dd/yy, e.g., 5/01/01. The date of the contract is the acceptance date of the contract.

6. Contract number

Enter the number the borrower assigns to the contract.

7. Type of construction and location

Enter the name of the exchanges where the construction will take place and briefly describe construction

 

 

Part C . Force Account Construction

 

Fld Name /
Item No.

Instructions for Part C. Force Account Construction

1. Amount

Enter the dollar amount of the proposal using numbers , e.g., $103,345.20

2. Date

Enter the date of the proposal. This is the acceptance date of the contract form.

3. Proposal number

Enter the proposal number assigned by the borrower. You may call the respective RUS Engineering Branch or the RUS Field Representative to obtain a number or leave it blank and a number will be assigned by RUS.

4. Type of project and location

Briefly describe the construction and list the exchanges where the construction will take place. If more space is needed, continue under remarks.

Remarks

You may indicate the date of the RUS letter approving force account construction. Also use this space to provide any additional information that could not be provided above. If you do this, please ensure that you indicate the item for which the information is associated.

 

Fld Name /
Item No.

CERTIFICATION

Signature

This blank is for the signature of the company's Certifying Officer.

Title

Enter the title of the signer above.

Address

Enter the telecommunications company’s address.

Date

Enter the date this certification is signed.