PROJECT DESIGNATION U.S. DEPARTMENT OF AGRICULTURE

RURAL UTILITIES SERVICE

DATE FINAL STATEMENT OF COST FOR ARCHITECTURAL SERVICE

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)

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 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.

- -
CERTIFICATE OF ARCHITECT

certifies that he is the TITLE

of , the Architect, in a contract entered into

NAME OF ARCHITECT (FIRM)

between the Architect and the Owner 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

By DATE

TELEPHONE PROGRAM ONLY

RECOMMENDED BY

DATE FIELD ENGINEER

APPROVED BY

DATE CHIEF. ENGINEERING BRANCH

- -

- -

- -

RUS Form 284 (Rev. 4-72)