752a Certificate of Completion Central Office equipment Contr

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 is estimated to average 30 minutes 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.

CERTIFICATE OF COMPLETION CENTRAL
OFFICE EQUIPMENT CONTRACT

(Not Including Installation)

TO:

ADMINISTRATOR
RURAL UTILITIES SERVICE
U. S. DEPARTMENT OF AGRICULTURE
WASHINGTON, D. C. 20250
PROJECT DESIGNATION

I , the undersigned Engineer of the above- designated Rural Utilities Service Project
do hereby certify that:
1. The equipment and materials provided for pursuant to Contract No.
, 20

dated

, including all approved amendments, (herein-

after called ''Equipment'') between
(Owner) and

(Contractor) have been delivered and are in all respects in strict compliance with the provisions
of the contract, including specifications, drawings and all modifications thereof.
2. The Equipment has been installed and all acceptance tests have been made on the Equipment
and the results were satisfactory.
3. The total cost of the Equipment in accordance to the contract and approved amendments
thereto is
Dollars ($
A breakdown of this total cost by central offices is shown on the back of this certificate.
Dated this

day of

20

OWNER

By

NAME OF ENGINEER

By

APPROVED AS TO ITEMS I AND 2 ABOVE
TITLE

RUS FIELD ENGINEER

RUS FORM 752a (Rev. 6-66)

DATE

).

TOTAL COST OF EQUIPMENT BY CENTRAL OFFICES

CENTRAL OFFICE NAME
(By location)

EQUIPMENT AND
MATERIALS COST

COST OF SPARE
PARTS AND
MAINTENANCE TOOLS

AMOUNT FOR TAXES (if any)
PAID BY
CONTRACTOR

TOTAL
RUS FORM 752a (Rev. 5-66)

PAID BY
OWNER

TOTAL COST OF
EQUIPMENT & MATERIALS