396a Certificate of Completion, Special Equipment Contract (N

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CERTIFICATE OF COMPLETION
SPECIAL EQUIPMENT CONTRACT

(Not 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 Service
Project do hereby certify that:
1. The equipment and materials, provided for pursuant to Contract No.
dated

, including all approved amendments, (herein-

, 20

after called "Equipment") between
(Owner) and
(Contractor) have been delivered and are in all respects in strict compliance with the
provisions of the contract, including specifications, drawings and all modifications thereof.
2. The Equipment has been installed and all acceptance tests have been made on the Equipment and the results were satisfactory.
3. The total cost of the Equipment in accordance to the contract and approved amendments
thereto is
Dollars ($
).
A break down of the total cost by group or central office, 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 AND 2 ABOVE
TITLE

RUS FIELD ENGINEER
RUS FORM

396a

3-64

DATE