756 Contract Closeout Certification

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collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is
0572-0059. The time required to complete this information collection is estimated to average .5 of a hour per response, including the time 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

.

CONTRACT CLOSEOUT CERTIFICATION
(Submit an original and a copy to RUS Area Engineering Branch.)
BORROWER’S NAME:
PROJECT DESIGNATION:
CONTRACT TYPE & NUMBER:
CLOSEOUT AMOUNT:
SALES TAXES (INCLUDED ABOVE):

In connection with the above construction contract, the undersigned certify that:
1. The construction is complete and was done in accordance with the RUS approved system design or
layout or subsequent RUS approved changes;
2. The construction was for loan purposes;
3. Construction used RUS-accepted materials and was in accordance with specifications published by
RUS covering the construction which were in effect when the contract was executed, or in the
absence of such specifications, that it meets other applicable specifications and standards (specify),
and that it meets all applicable national and local code requirements;
4. The construction complies with the ``Buy American'' provision ( 7 U.S.C. 903 note) of the Rural
Electrification Act of 1938 (7 U.S.C. 901 et seq.), as amended;
5. All necessary approvals have been obtained from regulatory bodies and other entities with jurisdiction
over the project;
6. All closeout documents required by this part have been examined and found complete such that the
Contractor has fulfilled all obligations under the contract except for warranty coverage; and
7. The engineer or architect is not affiliated with and does not represent the contractor, vendor, or
manufacturer who is a participant in the contract.

BORROWER

ENGINEER/ARCHITECT

BY:
TITLE:

BY:
TITLE:

DATE:

DATE:
CO.:

RUS Form 756 (01-03)

Expires: XX/XX/20XX