740G Application for Headquarters Facilities

U.S. DEPARTMENT OF AGRICULTURE
RURAL UTILITIES SERVICE

Form Approved
0572-0032
BORROWER DESIGNATION

APPLICATION FOR HEADQUARTERS FACILITIES

NAME OF BORROWER

INSTRUCTIONS - Submit to RUS an original and four (4) copies and applicable
supporting data. See reverse for detailed instructions.

1. PURPOSE OF PROJECT (Purchase, remodel or construct, main or branch facilities)
BORROWER’S
ESTIMATED COST

2.

a.

PURCHASE PRICE OF PROPERTY (exclude

b.

OFFICE PORTION (Construction

c.

OFFICE PORTION (Remodeling) .............................................................................................................................................................................................................................................................................................................................................

d.

SERVICE PORTION (Construction

e.

SERVICE PORTION (Remodeling).............................................................................................................

f.

AIR CONDITIONING..........................................................................................................................................................................................................................................................................................................................................................................................................

g.

SITE DEVELOPMENT (Grading,

h.

FENCE

i

WATER SUPPLY (Well,

j.

SEWAGE DISPOSAL (Disposal

value of land and show in Item p)....................................................

$

$

$

$

$

$

Per Sq. Ft.)....................................

Sq. Ft. @

Per Sq. Ft.)....................................

Sq. Ft. @

roads, drainage structures, etc.)...............................................................................................................................................................................................
LINEAR FT. @

PER FT. (Height

Ft.).................................................

well house, pump, long connection to main, water treatment, etc.)............................................................
System, long connection to main, etc.)....................................................................................................................................................................

k.

......................................................................................................................................................

l.

......................................................................................................................................................

m.

CONTINGENCIES................................................................................................................................................................................................................................................................................................................................................................................................................

n.

SUBTOTAL............................................................................................................................................................................................................................................................................................................................................................................

o.

ARCHITECTURAL SERVICES..................................................................................................................................................................................................................................................................................................................................................................................

p.

LAND........................................................................................................................................................................................................................................................................................................................................................................................................................................

q.

LEGAL EXPENSES..........................................................................................................................................................................................................................................................................................................................................................................................................

r.

TOTAL......................................................................................................................................................................................................................................................................................................................................................................................

3.

INVESTMENT GUIDELINES (See Paragraph III, RUS Bulletin 86-3, Headquarters Facilities for Electric Borrowers):
*a.

TOTAL DISTRIBUTION PLANT (RUS

Form 7a, Part A, Item 12).......................................................................................................................................................................................................................

b.

TOTAL ESTIMATED HEADQUARTERS COST LESS LAND

c.

CURRENT INVESTMENT IN HEADQUARTERS FACILITIES TO BE RETAINED

d.

TOTAL ESTIMATED INVESTMENT IN HEADQUARTERS FACILITIES

$

(Item 2r minus 2p above) ........................................................................................................................................................................................

(RUS Account 390,
Structures and Improvements) .................................................................................................................................................................................................................................................................................................
(Item 3b plus 3c)......................................................................................................................................................................................................

* e.

SEVEN PERCENT OF ITEM 3a..............................................................................................................................................................................................................................................................................................................................................................................

*f.

ITEM 3d MINUS 3e (Explain

*Does
4a .

RUS USE ONLY

ESTIMATED COST OF PROJECT:

need for funds in excess of zero under "Remarks" below) ........................................................................................

$

not apply to power type borrowers

NO. OF EMPLOYEES REQUIRING DESK
SPACE

5a . DID ARCHITECT ASSIST IN PREP. OF COST ESTIMATE?

4b . NO. OF VEHICLES TO BE
GARAGED
YES

6. METHOD OF FINANCING
a. RUS LOAN....................................................................................
b. GENERAL FUNDS....................................................................

$

c. OTHER (Specify)

NO

5b . NAME OF ARCHITECT

d.

TOTAL

$

REMARKS

These data approved in accordance with a resolution adopted by the Board of Directors on
, 20
.
The facilities described on this application will be designed and constructed to comply with the minimum standards contained in the American National
Standards No. A117.1-1961, to insure that the facilities will be made accessible to and usable by the physically handicapped as required by Public Law
90-480 (42 U.S.C. 4151). The following portions of the project need not be made accessible to, or usable by the public or the physically handicapped
because of their intended use:
(Insert "None" or describe fully with the supporting data).
SIGNATURE OF MANAGER

DATE

SIGNATURE OF PRESIDENT

DATE

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The
valid OMB control number for this information collection is 0572-0032. The time required to complete this information collection is estimated to average 3 hours per response, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information

RUS Form 740g (Rev. 3-72)

This page should be copied onto the backside of RUS Form 740g (the first page of this document)
INSTRUCTIONS
See RUS Bulletin 86-3 (Electric) for RUS policy and procedure for obtaining headquarters facilities, and the methods of financing.
Submit to RUS an original and four (4) copies of this form and applicable supporting data, as set forth below.
The cost of items 2(b) and (d) may be determined by multiplying the number of square feet by an appropriate cost per square foot.
Include the cost of all mechanical work except air conditioning.
The cost of other construction (except fence) is to be estimated on a lump-sum basis.
Describe any exceptions to the compliance with Public Law 90-480 (42 U.S.C. 4151).
SUPPORTING DATA REQUIRED FOR ELECTRIC BORROWERS
A.

If New Construction, furnish:
1.

A justification for the need of the proposed facilities. Include a brief description of all presently used facilities.
Show the approximate number of square feet of space used for office, garage, and warehouse purposes in the
main building and at each branch. State whether they are owned or rented and their present adequacy. Make
known also any plans for future additions, adequacy. Make known also any plans for future additions,
relocations, replacements, disposal or abandonment of any of the facilities.

2.

A description of the site, including:
(a)
(b)
(c)
(d)

B.

A summary statement, indicating general location of site and information on its availability, adequacy,
accessibility, desirability, etc.
A plot plan showing size, streets, roads, alleys, existing and proposed structures, distance to nearest
town, and other pertinent information.
A legal description of the property.
Information as to cost of land and evidence of title clearance in accordance with RUS Bulletin 20-8.

3.

A floor plan. Show dimensions and identify the rooms.

4.

A brief outline of the specifications.

5.

An estimate of the annual taxes and insurance costs.

If Purchase, furnish:
Same as 1, 2, and 5 of paragraph A.
A floor plan of the facilities to be purchased; inside and outside photographs; and a description of the general condition
and type of construction of walls, floors, roof, ceiling, and plumbing, electric and heating systems.

C.

If Remodeling, furnish:
A description of the proposed alterations. Where extensive remodeling is planned, furnish plans and specifications similar
to 3 and 4, of paragraph A.

RUS Form 740g (Rev. 12-93 - Automated Version 3-95)
ITEM#21.DOC

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