RUS Form 792b Certificate of Contractor and Indemnity Agreement

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB
control number. The valid OMB control number for this information collection is 0572-0107. The time required to complete this information collection is estimated to average 1 minute per response,
including the lime for reviewing instructions, searching, existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

U.S. Department of Agriculture
Rural Utilities Service

CERTIFICATE OF CONTRACTOR AND INDEMNITY AGREEMENT
(Line Extensions)

certifies that he or she is the
of
TITLE

NAME OF CONTRACTOR

the Contractor, in a Construction Contract No.

,

dated

,20

, entered into between the Contractor and
, RUS designation

,

NAME OF RUS BORROWER

the Owner, and that he or she is authorized to and does make this Certificate and Indemnity Agreement on behalf of
said Contractor in order to induce the Owner to make payment to the Contractor, in accordance with the provisions
of the said contract.
The undersigned further says that all persons who have furnished labor in connection with the Section of the project
represented by the inventory dated

,20

, in the

amount Of $
, have been
paid in full; that all manufacturers, material suppliers, and subcontractors which furnished any materials or services, or
both, for the said Section of 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.
The undersigned further says that if the Owner pays the Contractor the contract price for the said Section of the
project the Contractor will indemnify and hold harmless and does hereby undertake and agree to indemnity and hold
harmless the Owner from any claim or lien arising out of the negligence or other fault of the Contractor in respect of
the performance of the contract which may have been or may be filed against the Owner.

By
Date

President

This Certificate must be signed with the full name of the Contractor. If the Contractor is a partnership, this Certificate
must be signed in the partnership name by a partner. If the Contractor is a corporation, this Certificate must be signed
in the corporate name by a duly authorized officer.

RUS FORM 792b (Rev. 2-04)