Form 284 - Certificate of Architect

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U.S. DEPARTMENT OF AGRICULTURE
RURAL UTILITIES SERVICE

FINAL STATEMENT OF COST FOR ARCHITECTURAL SERVICE

PROJECT DESIGNATION

DATE

-

-

Before submitting this statement to the Owner, the Architect shall either prepare or obtain and deliver, or determine that:
1. The Owner has been given the bonds, warrantees, guarantees, service and operating manuals and other documents required
of the Contractor by the construction contract.
2. All adjustments in the Contract Price, including adjustments required by the Construction Contract, have been agreed upon
and the Construction Contract amended accordingly, including a Contractor's Bond extension, if required.
3. The Owner has been given a set of ''as-built'' plans and specifications, or state that no substantial changes were made,
and that they will not be required to locate service facilities.
COMPUTATION OF COST

1. Final Construction Contract Price (Include all amendments)

$

2. Cost of labor and materials supplied by other than the Contractor in respect of which architectural services were performed

$

3. Sum of Items I and 2 (This is the ''Cost of Construction of the Project'' as defined in Article
IV, Section I of the Architectural Services Contract)

$

4. Compensation for Architectural Services computed in accordance with Article IV of Architectural Services Contract (Explain under ''Remarks'' or on a separate sheet)

$

5. Compensation for extra services computed m accordance with Article IV, Section 3 of Architectural Services Contract (Explain under ''Remarks'' or on separate sheet

S

6. Sum of Items 4 and 5 (This is the total compensation for Architectural Services)

$

7. Sum of all payments made to date for Architectural Services

$

8. Difference between Items 6 and 7 (Final payment due Architect)

S

REMARKS

RUS Form 284 (Rev. 4-72)

CERTIFICATE OF ARCHITECT

certifies that he is the
of

, the Architect, in a contract entered into

NAME OF ARCHITECT (FIRM)

between the Architect and the Owner

TITLE

for architectural

NAME OF RUS BORROWER

services on a Project which bears the Rural Utilities Service Project Designation
and that this is a true and correct statement of the compensation due under the terms of
the Architectural Services Contract and that all persons employed by the Architect in connection with the Project
have been paid in full and that all other obligations which might become a lien upon the Project have been paid.

SIGNATURE

THIS STATEMENT AND CERTIFICATE IS HEREBY APPROVED

OWNER

-

DATE

By

TELEPHONE PROGRAM ONLY
RECOMMENDED BY

-

FIELD ENGINEER

DATE

APPROVED BY

-

DATE

RUS Form 284 (Rev. 4-72)

CHIEF. ENGINEERING BRANCH