n/a/ CERTIFICATION TO RUS (contract)

Attachment 1

CERTIFICATION TO RUS (contract)

(Certification in lieu of submittal of actual RUS Form of Contract executed OR in lieu of using the applicable RUS Form of Contract all identified required provisions were contained in the contract) (This certification cannot be used if ALL identified essential provisions identified below are not contained in contract)

I, ___________________________________________________________________________,

Name and Title

On behalf of

Borrower Name

RE:

____________________________________________________________________________,

Party to Contract (other than Borrower) (“Contract”)

_____________________________________________________________________________,

Amount of Contract

____________________________________________________________________________,

____________________________________________________________________________,

Date of Contract/Contract #

____________________________________________________________________________,

Contract Type ex. Construction, Equipment, Engineering

(NOTE: Certification NOT available for EPC contracts (engineering, construction & procurement contracts) for RUS financed projects

___________________________________________________________________________,

RUS Form # ex. #200, #198, #830, #790

Hereby certify, to the best of my knowledge, to the Rural Utilities Service (RUS)

To the following (check appropriate box).

• The Contract specifically cited above is the RUS Form of Contract that was executed and used for the facilities financed by RUS

OR

• The Contract specifically cited above is NOT the RUS Form of Contract, however, the executed Contract contains all of the essential and identical provisions of the RUS Form of Contract cited below:

• Buy American provision of the Rural Electrification Act of 1938.

• Patent Infringement hold harmless provision.

• Bid Bond

• Contractor’s Bond

• Compliance with all federal, state and local laws, rules and regulations provisions.

• Equal Opportunity provisions.

• Warranty provision.

• Environmental Protection provision.

• Insurance provision.

• Materials and equipment provisions for RUS accepted materials and equipment

• Liquidated Damages provision.

• Non-Assignment of Contract provision.

• Successors and Assigns provision.

• Remedies provisions.

• Payment and release of liens provisions

• The procurement procedures used for the Contract were in accordance with the applicable procurement procedures specified in 7 C.F.R. part 1726.

• The above named Borrower received a copy of the Debarment Certification in the form attached to the RUS Contract Form. It is attached hereto and made a part hereof.

On behalf of the Borrower, I acknowledge and agree that RUS is entitled to inspect the above described RUS Form of Contract or Borrower Contract at any time during normal business hours.

I acknowledge and understand that RUS, an agency of the United States Department of Agriculture, is relying on this certification. I understand that any materially false, fictitious or factual statement or representation may be punishable by fine or imprisonment under 18 U.S.C. § 1001.

BY

Date