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U.S. DEPARTMENT OF AGRICULTURE
RURAL UTILITIES SERVICE
SUMMARY OF WORK ORDERS
SYSTEM DESIGNATION
(Inspection By RUS Field Engineer)
INSTRUCTIONS - Prepare 3 copies. Original to be forwarded to Area Office of RUS after RUS Field
Engineer has approved construction. For detailed instructions see RUS Bulletin 382-2,
Appendix B.
SUMMARY NUMBER
APPROVAL IS REQUESTED FOR THE ENCUMBRANCE OF LOAN FUNDS AS SHOWN IN COLUMN "h" FOR COMPLETED CONSTRUCTION OF SYSTEM
IMPROVEMENTS AND EXTENSIONS OR FOR PURCHASES OF STATION APPARATUS AND EXEMPT MATERIALS:
COST OF CONSTRUCTION
WORK
ORDER
NO.
a
LABOR AND
OTHER
MATERIAL
b
LESS ADVANCES NOT REQUIRED
REUSABLE
MATERIALS
SALVAGED
TOTAL COST
c
d
STATION
APPARATUS &
EXEMPT MAT'L.
e
f
OTHER
NET
ADVANCES
(Explain)
REQUIRED
9
h
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
TOTAL
0.00
0.00
0.00
0.00
0.00
0.00
0.00
CERTIFICATION
I 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, if any, which did not conform to the ACD or SLP approved by RUS, has received RUS approval, (3) construction of extensions, if any, to serve subscribers in
areas not included in existing loans, has been approved by RUS, (4) all the required acceptance tests have been made on the construction and the results were satisfactory, (5) any
corrections required on the portions of construction that were field-inspected have been made on all the construction included in the summary, and (6) the requirements of the "'Buy
American" provision have been complied with where any foreign made materials or equipment were used in the construction. I 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.
AUTHORIZED SIGNATURE AND TITLE
-
NAME OF BORROWER
DATE
APPROVAL OF CONSTRUCTION
The above construction or purchase has been reviewed and is approved front an engineering standpoint.
-
RUS FIELD ENGINEER
DATE
ACCOUNTING VERIFICATION (RUS USE ONLY)
RUS Form 771 (Rev.10-75)
Clear Form
| File Type | application/pdf |
| File Title | rus0771.fml |
| Author | MBrooks |
| File Modified | 2003-10-07 |
| File Created | 2003-02-28 |