396 Certificate of Completion, Special Equipment Contract (i

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CERTIFICATE OF COMPLETION
SPECIAL EQUIPMENT CONTRACT
(INCLUDING INSTALLATION)
TO: ADMINISTRATOR
RURAL UTILITIES SERVICE
U. S. DEPARTMENT OF AGRICULTURE
WASHINGTON, D.C. 20250

PROJECT DESIGNATION

I, the undersigned Engineer of the above-designated Rural Utilities Servcie Project. do
hereby certify that:
1. The installation of equipment provided for pursuant to Contract No.
20

dated

, including all approved amendments, (hereinafter called the ''Project'') between
(Owner) and

(Contractor)

has been completed as of
, 20
, and is in all respects in strict compliance
with the provisions of the Loan Contract and the Contract, including specifications, drawings and all modifications
th ereof.
2. The Contractor has delivered to the Owner a Certificate of Contractor and Indemnity Agreement certifying
that all persons who have furnished labor in connection with the Project have been paid in full; that all manufacturers, materialmen and subcontractors which furnished any materials or services, or both, for the Project have
been paid in full; that no lien has been filed against the Project and no person has any right to claim any lien
against the Project.
3. All the required acceptance tests have been made on the equipment; results were satisfactory, and the
Contractor has furnished in writing to the Owner the results of all tests.
4. All defects in workmanship and materials reported during the period of construction of the Project have
been corrected.
5. The total cost of the Project as completed is
Dollars ($
).
A break down of the total cost by group, central office, or location, as applicable, is shown on the back of this
certificate.
Dated this

day of

20

OWNER

By

NAME OF ENGINEER

By
APPROVED AS TO ITEMS 1, 3 AND 4 ABOVE

TITLE

RUS FIELD ENGINEER
RUS FORM

396

DATE

REV. 3-64

=

TOTAL COST OF THE PROJECT
BY GROUP, CENTRAL OFFICE, OR LOCATION
(Complete applicable parts)
YOICE FREQUENCY REPEATERS
TRUNK GROUP

TOTAL
COST

GIVE C.O. NAME OR SYSTEM
.
LAYOUT REFERENCE

BETWEEN CENTRAL

GIVE C.O. NAME OR SYSTEM
OFFICES
.
LAYOUT
REFERENCE
LOCATION(S) WHERE REPEATERS IN THIS GROUP
ARE INSTALLED (List location(s) or system layout
reference(s)
.
NI OR NR
NO. OF REPEATERS IN THIS GROUP
lBY TYPE
V
TOTAL COST OF EQUIPMENT FOR THIS

GROUP BY TYPE

NI OR NR.
V

TOTAL COST OF INSTALLATION FOR
THIS GROUP BY TYPE

NI OR NR
V

TOTAL COST FOR THIS GROUP
SPARE PARTS & MAINTENANCE TOOLS
TEST EQUIPMENT
TRUNK CARRIER
TRUNK GROUP
BETWEEN CENTRAL
OFFICES

GIVE C.O. NAME OR SYSTEM
.
LAYOUT REFERENCE

TOTAL
COST

GIVE C.O. NAME OR SYSTEM
.
LAYOUT
REFERENCE

NUMBER OF CHANNELS IN THIS GROUP
TOTAL COST OF EQUIPMENT FOR THIS GROUP
TOTAL COST OF INSTALLATION FOR THIS GROUP
TOTAL COST FOR THIS GROUP
SPARE PARTS & MAINTENANCE TOOLS
TEST EQUIPMENT
SUBSCRIBER CARRIER
CENTRAL OFFICE WHERE EQUIPMENT WILL BE
INSTALLED

TOTAL
COST

NUMBER OF CHANNELS IN THIS CENTRAL OFFICE
TOTAL COST OF EQUIP> FOR THIS CENTRAL OFFICE
TOTAL COST OF INSTALLATION FOR THIS C.O.
TOTAL COST FOR THIS C.O.
SPARE PARTS & MAINTENANCE TOOLS

POINT-TO-POINT RADIO FACILITIES (Microwave)
LOCATION BY CENTRAL OFFICE (Give name or system

-

TEST EQUIPMENT

TOTAL
COST

layout reference) OR SITE IDENTIFICATION (Give
geographical location or system layout reference)

NUMBER OF VOICE TERMINALS AT THIS
LOCATION
TOTAL COST
OF EQUIPMENT
BY ITEM
FOR THIS
LOCATION

MULTIPLEX
R.F. TERMINALS
ACTIVE R.F. REPEATER
PASSIVE REPEATER
TOWER AND ANTENNA
AUXILIARY POWER

TOTAL COST OF INSTALLATION FOR THIS LOCATION
TOTAL COST FOR THIS LOCATION
SPARE PARTS & MAINTENANCE TOOLS
TEST EQUIPMENT
MOBILE AND FIXED RADIO TELEPHONE
TOTAL
COST

LOCATION BY CENTRAL OFFICE (Give name of
system layout reference) OR SITE IDENTIFICATION
(Give geographical location or system reference)
NUMBER OF MOBILE
AND FIXED
STATIONS (Show only
under associated
base station location)
TOTAL COST
OF EQUIPMENT
BY THIS ITEM
FOR THIS
LOCATION

SINGLE CHANNEL UNITS
MULTI-CHANNEL UNITS
(List under only one base
station location
MOBILE STATIONS
FIXED SUBSCRIBER STATIONS
RADIO BASE STATION
DIAL CONTROL TERMINAL OR
REMOTE CONTROL CONSOLE
TOWER AND ANTENNAS
AUXILIARY POWER

TOTAL COST OF INSTALLATION FOR THIS LOCATION
TOTAL COST FOR THIS LOCATION
SPARE PARTS & MAINTENANCE TOOLS
TEST EQUIPMENT
TOTAL AMOUNT OF TAXES PAID BY CONTRACTOR. . . . .
TOTAL AMOUNT OF TAXES PAID BY OWNER
TOTAL COST OF THE PROJECT
RUS Form 396 (Rev. 3-64)