Get USDA RUS 771a 1975-2024

U.S. USDA Form usda-rus-771a 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. This certification is in accordance with acceptable engineering practice. NAME OF INSPECTION FIRM INSPECTION PERFORMED BY SIGNATURE OF LICENSED ENGINEER ACCOUNTING VERIFICATION RUS USE ONLY RUS FORM 771a 10-75 LICENSE NUMBER SIGNATURE OF BORROWER S STAFF ENGINEER. The valid OMB control number for this information collection is 0572-0059. The time required to complete this information is estimated to average 30 minutes 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 SUMMARY OF -WORK ORDERS Inspection By Licensed Engineer Or Borrower s Staff Engineer SYSTEM DESIGNATION INSTRUCTIONS-Prepare 4 copies. Original 1 copy to be forwarded to the SUMMARY NUMBER RUS Field Engineer after the construction has been inspected and certified* For detailed instructions see RUS Bulletin 382-2 Appendix B. APPROVAL IS REQUESTED FOR THE ENCUMBRANCE OF LOAN FUNDS AS SHOWN IN COLUMN h FOR COMPLETE CONSTRUCTION OF SYSTEM IMPROVEMENTS AND EXTENSIONS FOR PURCHASES OF STATION APPARATUS AND EXEMPT MATERIALS* LESS ADVANCES NOT REQUIRED COST OF CONSTRUCTION NET WORK REUSABLE STATION OTHER ADVANCES LABOR AND ORDER MATERIALS APPARATUS Explain TOTAL COST REQUIRED NO. SALVAGED EXEMPT MAT L g d c a e b f h TOTAL CERTIFICATION I certify that 1 the total costs and net requirements for the construction included above are the actual costs and net requirements for loan funds reflected in the permanent records of this organization 2 construction if any which did not conform to the ACD or SLP approved by RUS has received RUS approval 3 construction of extensions if any to serve subscribers in areas not included in existing loans has been approved by RUS 4 all the required acceptance tests have been made on the construction and the results were satisfactory 5 any corrections required on the portions of construction that were field-inspected have been made on all the construction included in the summary and 6 the used in the construction* I further certify regulatory body and other approvals required for this construction have been obtained and that there have been no previous requests for approval of the net advance required for the construction covered hereby. - AUTHORIZED SIGNATURE AND TITLE DATE NAME OF BORROWER INSPECTION - CERTIFICATION I hereby certify that sufficient inspection has been made of the construction reported by this summary to give me reasonable assurance that the construction complies with applicable specifications and standards and meets appropriate code requirements as to strength and safety. The valid OMB control number for this information collection is 0572-0059. The time required to complete this information is estimated to average 30 minutes 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 SUMMARY OF -WORK ORDERS Inspection By Licensed Engineer Or Borrower s Staff Engineer SYSTEM DESIGNATION INSTRUCTIONS-Prepare 4 copies. Original 1 copy to be forwarded to the SUMMARY NUMBER RUS Field Engineer after the construction has been inspected and certified* For detailed instructions see RUS Bulletin 382-2 Appendix B. .