Form 506 - Statement of Engineering Fees - Telecommunications

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U.S. Department of Agriculture
Rural Utilities Service

STATEMENT OF ENGINEERING FEES
TELECOMMUNICATIONS

PROJECT DESIGNATION

CONTRACT NO.

CONTRACT SECTION
Form 217a - Project Design, Assistance and Coordination
A. Section 1. Project Design
B. Section 2. Assistance to Owner
C. Section 3. Coordination
D. Section 4. Plant Records
Form 217a Subtotal
Form 217b - Central Office Equipment Engineering Services
A. Section 1. Review of Requirements
B. Section 2C. Rebidding
C. Additions, Modifications, Relocations, or Removals
D. Sections 2F, 2H and 2I and Section 3
E. For each new Central Office Equipment contract or Force Account Proposal an amount equal to:
percent (
%) of first $100,000
Plus
percent (
%) of next $300,000
Plus
percent (
%) of the balance
F. For each Installation Only contract:
percent (
%)
Form 217b Subtotal
Form 217c - Transmission Facilities Engineering Services
A. Section 1. Review of Requirements
B. Additions, Modifications, Relocations, or Removals
C. Section 3A. Rebidding
D. Sections 3E, 3F and 3G
E. Section 4. Tests
F. For each new Transmission Facilities contract or Force Account Proposal an amount equal to:
percent (
%) of first $50,000
Plus
percent (
%) of next $150,000
Plus
percent (
%) of the balance
G. For each Installation Only contract:
percent (
%)
Form 217c Subtotal
Form 217d - Building Engineering Services
A. Section 1. Review of Requirements
B. Section 3B. Rebidding
C. Additions, Modifications, Relocations, or Removals
D. Sections 3F and 3G
E. For each new Building contract or Force Account Proposal an amount equal to:
percent (
%) of first $50,000
Plus
percent (
%) of the balance
Form 217d Subtotal
Form 217e - Outside Plant Staking Services
A. Section 1. Review of Requirements
B. Section 2C. Changes
C. Section 2I. Joint Use or Joint Occupancy
D. Replacement of Markers
E. For Staking:
1.
per mile of existing buried plant to be modified
miles at $
2. Plus
miles at $
per mile of new buried plant
3. Plus
per mile of underground cable installed in ducts
miles at $
4. Plus
miles at $
per mile of new aerial plant.
5. Plus
per mile of existing aerial plant to be modified.
miles at $
6. Plus
per mile of new joint use lines
miles at $
7. Plus
miles at $
per mile of existing lines to be removed where no
construction or modification work is to be performed
per service entrance for each new or
8. Plus
service entrances at $
modified service entrance
per subscriber shown on construction sheets
9. Plus
subscribers at $
F. Section 2J. Time and Expense Staking
Form 217e Subtotal

RUS Form 506 (Rev 12-96)

DATE

-

INSTRUCTIONS - See 7 CFR Part 1753.17(f)
ESTIMATED

INVOICED
AND
APPROVED

FINAL

"You are not required to respond to this collection of information unless this form displays the currently valid OMB control number. "

INVOICED

ESTIMATED

CONTRACT SECTION

AND

FINAL

APPROVED
Form 217f - Outside Plant Contract Document Phase Engineering Services
or
A. Sum of $
Sections at $
per section
Plus
Amendments at $
per amendment.
Plus
miles at $
per mile of Project Line
for each approved Force Account Proposal
B. The Sum of $
C. Section 2. Map Tracings and Other Data.
D. Section 3. Schematics, Assignments, and Cut Sheets
E. Section 4B6. Underground Conduit.
F. Section 4C3. Pre-Bid Conference and Rebidding
G. Section 4D3. Changes to Force Account Proposals
Form 217f Subtotal
Form 217g - Outside Plant Construction Phase Engineering Services
A. Section 1. Construction Phase
1. Section 1B. Residents and Inspectors
2. Section 1C. Pre-Construction Conference
3. Section 1F. Joint Use or Joint Occupancy
4. Section 1G. Tests
5. Section 1H. Connecting Companies
6. Section 1I. Reporting
7. Section 1J. Final Inspection
or
B. Section 2. Final Documents: the sum of $
Sections
at $
per section
Plus
miles at $
per mile of line included
Plus
for each service entrance
service entrances at $
installed, replaced or modified
C. Section 3. Plant Records
D. Section 4. Inventory and Appraisal
Form 217g Subtotal
Form 217 Contract SUBTOTAL
TAXES
GRAND TOTAL

CERTIFICATE OF ENGINEER
(Complete for Final Statement Only)

of

, certify that (1) I am the

I,

(Title)

, the Engineer in a contract entered into between the Engineer and the Owner,

(Name of Engineer)

, for engineering services in a rural telecommunications Project, which Project
(Name of Owner)
bears the Rural Utilities Service Project designation
; and that (2)
this is a true and correct statement of the fees due under the terms of the engineering service contract, and that (3) all persons
employed by the Engineer in connection with the engineering on the Project have been paid in full.

(Signature)

THIS STATEMENT AND CERTIFICATE IS HEREBY APPROVED

-

-

By:

(Date)

RECOMMENDED BY:

(0WNER
)

-

(RUS General Field
Representative)

(Date)

APPROVED BY:

-

(Date)

RUS Form 506 (Rev 12-96)

(Chief

Area, Engineering Branch)