Form 187 Certificate of COmpletion Contract Construction

OMB Collection
Expiration Date
MM/DD/YYYY

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
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U.S. Department of Agriculture
Rural Utilities Service

CERTIFICATE OF COMPLETION

- CONTRACT CONSTRUCTION

I, the undersigned Architect or Engineer of the following Rural Utilities Service project, do hereby certify that:
,

1. The construction provided for pursuant to Construction Contract No.
, 20

dated

, including all approved amendments, between
(''Owner'')

, RUS designation
and

(''Contractor'')

, 20

has been completed as of

, and is in compliance with the

provisions of the Construction Contract, including all plans, specifications, maps, and drawings and all
modifications thereof.
2. Payment in full has been made to all persons who have furnished labor for the Project.
3. The Contractor has obtained valid releases of lien from all manufacturers, material suppliers, and
subcontractors furnishing services or materials which were employed by the Contractor in the performance of
the Construction Contract, and that such releases have been delivered by the Contractor to the Owner.
4. If applicable, the Final Inventory attached hereto and made a part hereof is a complete and accurate summary
of all units of construction in the project and of all work performed in accordance with the Construction
Contract.
5. If applicable, the staking sheets and tabulation of staking sheets upon which the Final Inventory is based show
the accurate location, number, and kind of all units of construction of the project and show all work performed
in accordance with the Construction Contract.
6. All defects in workmanship and materials reported during the period of construction of the project have been
corrected.
7. The total cost of the project as completed is

cents ($

dollars and

Dated this

).
.

,20

day of

Name of Architect or Engineer
By
Date
Title

RUS FORM 187 (Rev. 4-10)

CERTIFICATE OF COMPLETION
CONTRACT CONSTRUCTION
(continued)

We. the undersigned Owner and Contractor, do hereby certify that:
1. The Project has been completed in accordance with the provisions of the Construction Contract, dated
, provided, however, that acceptance of the project by the
, 20
Owner shall not be deemed to relieve the Contractor of its obligations contained in the Construction Contract
with respect to defective workmanship or, materials discovered within one year after the date of completion.
2. If applicable. the Final Inventory attached hereto and made a part hereof is a complete and accurate summary
of all units of construction in the Project and of work performed in accordance with the Construction Contract.

Owner
By
President

Date

Name of Contractor
By
Date
Title

RUS Form 187 (Rev. 4-10)