BIDDERS QUALIFICATIONS FOR BURIED PLANT CONSTRUCTION

INSTRUCTIONS - To be submitted in accordance with the provisions set forth in ''Notice and Instructions to Bidders'' contained in the

bidding documents for the project.

The undersigned Bidder makes the following representations relative to its proposal to

for the construction of Rural Utilities Service Project designated

The word ''it'', used herein by way of reference to the undersigned, shall be deemed to mean ''he'' if the Bidder is an

individual and ''they'' if the Bidder is a partnership.

1. It maintains a permanent place of business at

,

2. It has completed telephone construction contract(s) for or more RUS Borrower(s). List RUS

Borrower(s), if the construction included buried plant of the type comtemplated in the project.

NAME OF BORROWER APPROXIMATE NUMBER OF MILES

3. if awarded the Construction Contract it will: (Check one)

Perform all construction with it's own forces.

Employ the following subcontractor(s) listed below along with a brief explanation of the construction activities

the subcontractor(s) will perform such as plowing, trenching, or installation of pedestals, terminals, service

wire, telephone instruments, poles, etc:

NAME AND ADDRESS OF SUBCONTRACTOR CONSTRUCTION ACTIVITY

4. Buried plant construction experience of the Bidder and its subcontractors listed above includes the following:

COMPANY FOR WHICH OFFICIAL CONFIRMATION OF WORK DONE

WORK WAS DONE

APPROXLOCATION OF WORK MILEAGE NAME AND ADDRESS OF OFFICIAL TEL. NORUS Form 276 REV. 5-59

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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. The valid OMB control number for this information collection is 0572-0059. The time required to complete this 

information is estimated to average 1 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.
5. The plow proposed to be used on the Project to perform the buried plant construction is described in the following

information about the design and capabilities of the plow and the work the Bidder or subcontractor has done with

the plow.

6. It will make available the following other equipment for use in plowing, trenching and other operations related to

buried plant.

7. It either owns the plow, and other equipment described in Item 6, or has arranged for equipment as follows: (List

equipment and whether to be bought or leased.)

8. If awarded the Construction Contract the name of the construction superintendent it will place in overall charge of the

proposed construction is

Attached hereto is a signed statement of his experience in telephone construction and in supervision of construction of 

the type proposed.

The names of foremen and other key personnel and brief summaries of their experience in the particular operation such

as plowing in which each one will be in charge, are as follows:

9. Listed below are the names of other RUS Borrowers and their Engineers which have found the qualifications of the

Bidder satisfactory for bidding buried plant construction. OWNER

10. It now has the following bonded jobs under contract:

S

11. It possesses contractor's license no for the State of

in which the Project is located, and said license expires on , 20

12. It hereby represents and warrants that all statements set forth herein are true and correct.

(If the Bidder is a partnership, the partnership must be signed, followed by the signature of at least one of the partners.

If the Bidder is a corporation, the corporate name must be signed, followed by the signature of a duly authorized officer.

A typewritten copy of all such names and signatures shall be appended. No alterations, erasures, corrections or interlineations will be permitted.)

NAME OF BIDDER

DATE SIGNATURE TITLE

DATE SIGNATURE TITLE

RUS Form 276 REV. 5-59

ENGINEER

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