Field Name or Item No. |
Instruction |
System Designation |
Enter the borrower designation as assigned by RUS. |
Summary Number |
Enter the borrower assigned sequential summary number. |
Work Order No. (a) |
Enter the borrower assigned sequential work order number. |
Labor and Other (b) |
Enter the actual cost for labor and other costs associated with the work order construction. |
Material (c) |
Enter the cost of materials used on the project. |
Total Cost (d) |
Enter the sum of labor and materials for the completed work order: Columns b+c. |
Reusable Materials Salvaged (e) |
Enter the cost of salvaged reusable materials. |
Station Apparatus & Exempt Mat’l (f) |
Enter the cost of station apparatus and exempt materials. |
Other (g) |
Enter any other costs for which an advance will not be required and provide an explanation of such costs. |
Net Advances Required (h) |
Enter the net advance required for each work order: cost of construction less advances not required. |
Total |
Enter the sum of the items in Columns b, c, d, e, f, g, and h. |
An authorized official of the borrower must sign and date the form. Enter the title of the authorized official and the legal name of the organization.
If the inspection is performed by a licensed engineer, the licensed engineer must sign and date the form. Enter the name of engineering firm, the name of the engineer that performed the inspection, and the license number.
If the inspection is performed by a borrower’s staff engineer, the staff engineer must sign and date the form.