276 Bidder's Qualifications for Buried Plant Construction

Expires: XX/XX/20XX
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BIDDERS QUALIFICATIONS FOR BURIED PLANT CONSTRUCTION
INSTRUCTIONS - To be submitted in accordance with the provisions set forth in ''Notice and Instructions to Bidders'' contained in the
bidding documents for the project.

The undersigned Bidder makes the following representations relative to its proposal to

for the construction of Rural Utilities Service Project designated

The word ''it'', used herein by way of reference to the undersigned, shall be deemed to mean ''he'' if the Bidder is an
individual and ''they'' if the Bidder is a partnership.
1. It maintains a permanent place of business at
,
or more RUS Borrower(s). List RUS
2. It has completed telephone construction contract(s) for
Borrower(s), if the construction included buried plant of the type comtemplated in the project.
APPROXIMATE NUMBER OF MILES

NAME OF BORROWER

3. if awarded the Construction Contract it will: (Check one)
Perform all construction with it's own forces.
Employ the following subcontractor(s) listed below along with a brief explanation of the construction activities
the subcontractor(s) will perform such as plowing, trenching, or installation of pedestals, terminals, service
wire, telephone instruments, poles, etc:
NAME AND ADDRESS OF SUBCONTRACTOR

CONSTRUCTION ACTIVITY

4. Buried plant construction experience of the Bidder and its subcontractors listed above includes the following:
COMPANY FOR WHICH
WORK WAS DONE

RUS Form 276

REV. 5-59

APPROXLOCATION OF WORK

MILEAGE

OFFICIAL CONFIRMATION OF WORK DONE
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NAME AND ADDRESS OF OFFICIAL

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5. The plow proposed to be used on the Project to perform the buried plant construction is described in the following
information about the design and capabilities of the plow and the work the Bidder or subcontractor has done with
the plow.

6. It will make available the following other equipment for use in plowing, trenching and other operations related to
buried plant.

7. It either owns the plow, and other equipment described in Item 6, or has arranged for equipment as follows: (List
equipment and whether to be bought or leased.)

8. If awarded the Construction Contract the name of the construction superintendent it will place in overall charge of the
proposed construction is
Attached hereto is a signed statement of his experience in telephone construction and in supervision of construction of
the type proposed.
The names of foremen and other key personnel and brief summaries of their experience in the particular operation such
as plowing in which each one will be in charge, are as follows:

9. Listed below are the names of other RUS Borrowers and their Engineers which have found the qualifications of the
Bidder satisfactory for bidding buried plant construction.
OWNER

ENGINEER

10. It now has the following bonded jobs under contract:

S

11. It possesses contractor's license no
for the State of
, 20
in which the Project is located, and said license expires on
12. It hereby represents and warrants that all statements set forth herein are true and correct.
(If the Bidder is a partnership, the partnership must be signed, followed by the signature of at least one of the partners.
If the Bidder is a corporation, the corporate name must be signed, followed by the signature of a duly authorized officer.
A typewritten copy of all such names and signatures shall be appended. No alterations, erasures, corrections or interlineations will be permitted.)

NAME OF BIDDER

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DATE

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TITLE

SIGNATURE

TITLE

DATE

RUS Form 276

SIGNATURE

REV. 5-59