274 Bidder's Qualifications

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BIDDER'S QUALIFICATIONS
To be submitted in accordance with the provisions set forth in "Notice and
Instructions to Bidders" contained in the bidding documents for the project.
The undersigned Bidder makes the following representations relating to its
proposal to
for (Business name, address and Rural Utilities Service designation)

1. The Bidder maintains a permanent place of business at
,

,

2. The Bidder possesses adequate financial resources as indicated by the
following abbreviated statement:
Financial condition at close of business
20
ASSETS:
(a)
(b)
(c)
(d)
(e)
(f)

$

Cash in bank and on hand
Receivable -- notes, open accounts and interest
Stock and bonds
Real estate, furniture and fixtures, materials
Equipment
Other assets (name)
TOTAL ASSETS

LIABILITIES:
(a) Payable--notes, open accounts and interest
(b) Real estate encumbrances
(c) Other encumbrances (name)

$
$

Reserves
Capital stock paid up (all classes)
Surplus--net worth
$
TOTAL LIABILITIES
In addition to the foregoing, a complete and detailed financial statement
will be furnished if required.
(d)
(e)
(f)

3.

The following judgments are outstanding against the Bidder:
Judgement Creditors

(a)
(b)

Where Docketed and Date
-

-

-

-

Amount
$

TOTAL JUDGMENTS
4.

Date

In the event the-contract is awarded to the Bidder, a surety bond in a
penal sum not less than the maximum Contract price will be furnished
by:

-

-

RUS Form 274 (Rev. 6-81)

(Surety Company)
(Signed)
Representative of Surety Company

RUS Form 274 (Rev 6-81)

Page 2

5. The Bidder will make available for use in connection with the proposed
construction the following construction plant and equipment:

6. The Bidder has had the following experience on other similar work:

7. If awarded the contract for the construction of the Project, the Bidder will
employ the construction superintendents and supervisors listed hereunder for work
throughout the course of the construction of the Project.

Attached hereto are signed statements of the qualifications of said superintendents and supervisors, including specific experience in supervision of construction
of the type of facilities included in the plans and specifications.
8. The Bidder now has the following bonded jobs under contract:
$

9. The Bidder possesses Contractor's License No.
State of
in which the Project is located, and said license expires on

for the
,20

10. The Bidder hereby represents and warrants that all statements set forth
herein are true and correct. (If the Bidder is a partnership, the partnership name
must be signed, followed by the signature of at least one of the partners. If the
bidder is a corporation, the corporate name must be signed, followed by the signature
of a duly authorized officer and the corporate seal affixed. A typewritten copy of
all such names and signatures shall be appended. No alterations, erasures, corrections or interlineations will be permitted.)

(OFFICIAL SEAL}

-

-

Date
-

Name of Bidder

-

Date

Signature

Title

Signature

Title

.