281 Tabulation of Materials Furnished by Borrower

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BORROWER DESIGNATION

CONTRACT NO.

U. S. DEPARTMENT OF AGRICULTURE
RURAL UTILITIES SERVICE

TABULATION OF MATERIALS FURNISHED BY BORROWER
(Actual Cost to Borrower and Amount Chargeable to Contractor)
DESCRIPTION OF ITEM
RUS DESIGNATION
1

QUANTITY

ACTUAL COST TO BORROWER
UNIT COST

NAME OF ITEM

2

3

4

EXTENDED COST

AMOUNT CHARGEABLE TO
CONTRACTOR AT CONTRACT PRICE
UNIT PRICE

5

EXTENDED PRICE

6

7

-

TOTAL

The above tabulation is correct to the best of our knowledge and belief.
BORROWER'S ENGINEER

DATE
NAME OF BORROWER

CONTRACTOR

DATE
RUS Form 281( Rev. 5-61)

By

PRESIDENT

DATE

BY

NET
DIFFERENCE

a