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