|
Fld Name / |
Instruction |
|
Borrower’s RUS Designation |
Enter the abbreviation for the state where the telecommunications company is located. Enter the 3 digit RUS identification code that is assigned to the telecommunications company. Example: AL 506. |
|
Contractor |
Enter the complete name of the contractor. Example: Foote Contracting Company, Inc. |
|
Contract No. |
Enter numerical or alphanumerical characters identifying the contract. Example: 123B2 or 456-7. |
|
Contract Date |
Enter the month, day and year (4 digits) that the contract is executed. Example: 6/06/2001. |
|
Contract Amount |
Enter a numerical dollar amount indicating the total cost of the contract. Do not use commas in the dollar amount. Example: 150000.00. |
|
Fld Name / |
Instruction |
|
W.O. Number |
Enter numerical numbers identifying the work order assigned to the construction project in the first (1) blank provided. Example: W.O. Number 56. |
|
Contract Date |
Enter the month and day in the second (2) blank provided. Enter the year (4 digits) in the third (3) blank provided. |
|
Contractor’s Name |
Enter the complete name of the contractor in the fourth (4) blank provided. |
|
Fld Name / |
Instruction |
|
Contractor’s License No. |
Enter a numerical number indicating the license number of the contractor in the fifth (5) blank provided. |
|
Issuance State |
Enter the state or states where the contractor is licensed to do business in the sixth (6) blank provided. |
|
Expiration Date |
Enter the month, day, and year (4 digits) that the contractor’s license expires in the seventh (7) blank provided. |
|
Contractor’s Mailing Address |
Enter the complete mailing address of the contractor in the eighth (8), ninth (9), tenth (10), eleventh (11) blanks provided. Example: 32 Mapledale Road Woodbridge, Virginia, 22193. |
|
Owner |
Enter the complete mane of the telecommunications company. |
|
Fld Name / |
Instruction |
|
Item 1. Description of Work |
In the blanks provided describe the work to be performed under this contract. |
|
Item1. Description of Work - Drawings |
Enter a check mark in the blank associated with “YES” or in the blank associated with “NO” to indicate whether or not drawings, specifications, or other information are to be included as part of the contract. If the “YES” blank is checked, the appropriate drawings, specifications, etc. shall be attached to this contract as addenda. |
|
Item 2. Purpose for Project |
Enter a check mark in the blank associated with “CONSTRUCTION” or in the blank associated with “MAINTENANCE” to indicate whether or not the project is for construction or maintenance. |
|
Item 4. Owner Furnished Materials |
Enter a check mark in the blank associated with “YES” or in the blank associated with “NO” to indicate whether or not the owner will furnish the contractor with the materials necessary to construct the project. If owner furnished materials are to be supplied on the contract, a list of such materials is required to be attached to the contract as an addendum. |
|
Item 5. Owner’s Exchanges |
In the blanks provided indicate the exchange or exchanges of the telecommunications company where construction will be performed by the contractor. Example: Mapledale Exchange. |
|
Item 6. Payment Method Hourly Basis |
Enter a numerical dollar amount for labor only or a numerical dollar amount for labor and materials on an hourly basis. Do not use commas in the dollar amount. Example: Labor Only 15.00/Hour or Labor and Materials 30.00/Hour. |
|
Fld Name / |
Instruction |
|
Item 6. Payment Method Lump-Sum |
Enter a numerical dollar amount indicating the lump-sum payment for labor only or a numerical dollar amount indicating the lump-sum payment for labor and materials. Do not use commas in the dollar amount. Example: Labor Only 15000.00 or Labor and Materials 30000.00. |
|
Item 6. Payment Method Unit Basis |
Enter a numerical dollar amount on an unit cost basis. Do not use commas in the dollar amount. Example: 15.00 per BD Unit. Construction units shall also be described in the blanks provided. |
|
Item 7. Contract Amount |
Enter a numerical dollar amount indicating the total cost of the contract. Do not use commas in the dollar amount. Example: 150000.00. |
|
Item 7. Payment Schedule |
In the blanks provided enter a schedule on when and how the telecommunications company intends to pay the contractor for services rendered. Include the amount of payment and the date payment is due in the schedule. The date should contain the month, day, and year (4 digits). |
|
Item 7. Invoice Submission |
In the blanks provided enter the name of the telecommunications company representative, the representative’s title, and the representative’s complete mailing address where the contractor is to send the invoices for verification and payment. Ms. Janet Foote, Accounts Manager, Prince Telecommunications Company, 655 Forestdale Avenue, Woodbridge, West Virginia 22195 |
|
Item 8. Length of Construction |
In the first blank provided enter the month, day, and year (4 digits) the construction project is to commence. In the second blank provided enter the month, day, and year (4 digits) the construction project is to be completed. Example: Commencement Date: May 09, 2001; Completion Date: August 20, 2001. |
|
Fld Name / |
Instruction |
|
Number of Attachments |
In the blank provided enter a numerical number indicating the number of attachments are included as part of the contract. Example: 15 Attachments. |
|
Contractor’s Name |
Enter the complete name of the contractor in the blank provided. |
|
Contractor’s Signature – “By” Blank |
Enter the signature of the person representing the contractor in the blank provided. |
|
Contractor’s Date |
Enter the month, day, and year (4 digits) to indicate the date that contractor or the contractor’s representative agreed to the Insurance Requirements specified in the RUS 773 Contract. |
|
Contractor’s Title |
Enter the title of the person who signed as the contractor’s representative in the blank provided. Example: Vice President. |
|
Owner’s Name |
Enter the complete name of the telecommunications company in the blank provided. |
|
Owner’s Signature – “By” Blank |
Enter the signature of the person representing the telecommunications company in the blank provided. |
|
Owner’s Date |
Enter the month, day, and year (4 digits) to indicate the date that telecommunication company or the telecommunications company’s representative agreed to the Insurance Requirements specified in the RUS 773 Contract. |
|
Owner’s Title |
Enter the title of the person who signed as the telecommunication company’s representative in the blank provided. Example: Vice President Operations. |