The instructions for = submitting=20 this form (if required) are included in 7 CFR 1726, Electric = System=20 Construction Policies and Procedures.
This form is = completed by the=20 Owner/Engineer based on information provided by the Contractor.
Fld Name /
Item No.
Instruction
Item 1
Enter Owner=92s RUS designation (e.g., = AL001)
Item 2
Enter the amendment date
Item 3
Enter the amendment number.
Item 4
Enter the contract number.
Item 5
Indicate if a bond extension is = attached.
Item 6.a
Enter the original completion or delivery=20 date.
Item 6.a
Enter the amended completion or delivery=20 date.
Item 7
Enter the reason(s) for the = amendment.
Item 8
Enter the amount of the original contract = price and any=20 subsequent amendments (including this amendment.)
Next 2 Blanks
Enter the amount of the contract amendment in = the=20 appropriate blank.
Next 2 Blanks
Indicate whether the amendment requires RUS = approval=20 (see 7 CFR 1726 for criteria.)
Signature Block
Enter the names of the Engineer, Contractor, = and Owner=20 in the appropriate blanks. (Sign printed=20 copy.)
Page 2
Fld Name /
Item No.
Instruction
Item 1
Enter Owner=92s RUS designation (e.g., = AL001)
Item 2
Enter the contract number.
Column 1
Enter the Item Number.
Column 2
Enter the amendment number in the = heading. Enter=20 the reason(s) and description of the amendment item.
Columns 3‑5
Enter cost changes in the column(s)=20 indicated.