159 Summary of Completed Construction

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 0572-0059. The time required to complete this information collection is estimated to average 6 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.

''No further benefits may be paid out under this program unless
this report is completed and filed as required (7 USC 901 et seq.)''
SYSTEM DESIGNATION

USDA - RUS
SUMMARY OF COMPLETED CONSTRUCTION
INSTRUCTIONS - Prepare 3 copies. Original copy to be submitted to Area Office with the
Financial Requirement Statement, RUS Form 481. One copy should be sent to the RUS
General Field Representative. For detailed instructions, see 7 CFR 1753.

SUMMARY NUMBER

APPROVAL IS REQUESTED FOR THE ENCUMBRANCE OF LOAN FUNDS AS SHOWN IN COLUMN "f" FOR THE COMPLETED CONSTRUCTION
DESCRIBED BELOW:
LESS ADVANCES NOT REQUIRED
TOTAL COST
CONSTRUCTION

DESCRIPTION OF CONSTRUCTION
(a)

(b)

TOTAL

0.00

REUSABLE
MATERIALS
SAVAGED
(c)

0.00

STATION
APPARATUS &
EXEMPT MAT.
(d)

0.00

NET
ADVANCES

OTHER
(EXPLAIN)
(e)

0.00

(f)

0.00

CERTIFICATION
We certify that (1) the total costs and net requirements for the construction included above are the actual costs and net requirements for loan funds
reflected in the permanent records of this organization, (2) construction was in accordance with the system design or system layout as approved by RUS
and deviations, if any, did receive RUS approval, (3) construction was for purposes included in the loan commitment and deviations, if any, have received
RUS approval, (4) construction was in accordance with RUS specifications using RUS acceptable materials, (5) the requirements for compliance with the
"Buy American" provision of 1938, as amended, have been met where any nondomestic materials or products were used in construction, (6) the Equal
Employment opportunity provisions of the RUS loan agreement have been satisfied, and (7) all loan agreement and mortgage provisions have been met.
We further certify that regulatory body and other approvals required for this construction have been obtained and that there have been no previous
requests for approval of the net advance required for the construction covered hereby.

SIGNATURE
DATE
SIGNATURE OF BORROWER'S CHIEF ENGINEER

DATE

TITLE (AUTHORIZED CORPORATE OFFICER OR MGR)
NAME OF BORROWER

INSPECTION - CERTIFICATION
(For Use Where Consulting Engineer Is Employed)
I hereby certify that sufficient inspection has been made of the construction reported by this summary to give me a reasonable assurance that the
construction complies with applicable specifications and standards and meets appropriate code requirements as to strength and safety. This certification is in
accordance with acceptable engineering practice.
INSPECTION PERFORMED BY
NAME OF INSPECTION FIRM
DATE
ACCOUNTING VERIFICATION (RUS USE ONLY)

RUS FORM 159

10-77

SIGNATURE OF LICENSED ENGINEER
LICENSE NUMBER