158 Certification of Contractor or Force Account Proposal Ap

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USDA - RUS
CERTIFICATION OF CONTRACT OR FORCE
ACCOUNT PROPOSAL APPROVAL

SYSTEM DESIGNATION

INSTRUCTIONS- Prepare 3 copies. Original copy to be submitted to Area Office
with the Financial Requirement Statement, RUS Form 481. One copy should be
sent to the RUS Field Engineer. "For detailed instructions, see 7 CFR 1753."

NAME OF BORROWER

This certification of contract or force account proposal is submitted to support a request for funds in the amount(s) specified therefor on a financial requirement statement,
RUS Form 481, where the borrower has received RUS approval to administer engineering and construction procedures in accordance with RUS Bulletin 320-23.

PART A. ENGINEERING & ARCHITECTURAL SERVICE (COMPLETE APPLICABLE PORTIONS)
1. INDICATE RUS
CONTRACT FORM
220

217

245

Other

2. NAME & ADDRESS OF ENGINEER OR ARCH.

3. AMT. OF CONTRACT

4. DATE

5. CONTRACT NO. ASSIGNED
BY BORROWER

6. AMT. FOR FA ENGINEERING 7. DESCRIBE BRIEFLY WHAT FA ENGINEERING WILL COVER:
(MAJOR CONSTRUCTION)

PART B. CONTRACT CONSTRUCTION
2. METHOD OF AWARD

1. INDICATE RUS CONTRACT FORM
257
545

397

238
398
OR AMEND. FORM

525
526

4. AMOUNT OF CONTRACT OR AMENDMENT

3. NAME & ADDRESS OF CONTRACTOR

COMPETITIVE
NEGOTIATED
6. CONTRACT NO. ASSIGNED BY BORROWER

5. DATE

7. DESCRIBE BRIEFLY THE CONSTRUCTION & LOCATION BY EXCHANGE:

PART C. FORCE ACCOUNT CONSTRUCTION

1. AMT. OF PROPOSAL 2. DATE

3. PROPOSAL NUMBER . 4. DESCRIBE BRIEFLY THE CONSTRUCTION & LOCATION BY EXCH.
ASSIGNED BY BORR.

REMARKS

CERTIFICATION
I certify that (1) the information shown above is correct, (2) the construction indicated above is based on plans and specifications prepared in
accordance with a design approved by RUS and is for purposes for which funds are included in the loan approved or guaranteed by RUS, (3) the
performance bond requirements, if any, applicable to the form of contract used, have been satisfied, (4) the RUS requirements for compliance with the
"Buy American" provision of RE Act of 1938, as amended, have been met where any non-domestic materials or products will be used, and (5) the
Equal Employment Opportunity requirements of the RUS loan agreement and RUS Bulletin 320-15 have been met.

SIGNATURE

TITLE (AUTHORIZED CORPORATE OFFICER OR MANAGER)

DATE
RUS FORM 158

BORROWERS ADDRESS

10-77