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BIDDER'S QUALIFICATIONS

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 relating to its

proposal to

for (Business name, address and Rural Utilities Service designation)

1. The Bidder maintains a permanent place of business at

,

 2. The Bidder possesses adequate financial resources as indicated by the 

following abbreviated statement:

Financial condition at close of business 20

ASSETS:

(a) Cash in bank and on hand $

(b) Receivable -- notes, open accounts and interest

(c) Stock and bonds

(d) Real estate, furniture and fixtures, materials

(e) Equipment

(f) Other assets (name)

TOTAL ASSETS $

LIABILITIES:

Payable--notes, open accounts and interest $

Real estate encumbrances

Other encumbrances (name)

(d) Reserves

(e) Capital stock paid up (all classes)

(f) Surplus--net worth

TOTAL LIABILITIES $

 In addition to the foregoing, a complete and detailed financial statement 

will be furnished if required.

3. The following judgments are outstanding against the Bidder:

Where Docketed and Date Amount

(a) $

(b)

TOTAL JUDGMENTS

4. In the event the-contract is awarded to the Bidder, a surety bond in a

penal sum not less than the maximum Contract price will be furnished

by:

(Surety Company)

Date (Signed)

Representative of Surety Company

RUS Form 274 (Rev. 6-81)

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.

,

(a)

(c)

(b)

Judgement Creditors
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RUS Form 274 (Rev 6-81) Page 2

 5. The Bidder will make available for use in connection with the proposed 

construction the following construction plant and equipment:

 6. The Bidder has had the following experience on other similar work:

 7. If awarded the contract for the construction of the Project, the Bidder will 

employ the construction superintendents and supervisors listed hereunder for work 

throughout the course of the construction of the Project.

Attached hereto are signed statements of the qualifications of said superintendents and supervisors, including specific experience in supervision of construction 

of the type of facilities included in the plans and specifications.

 8. The Bidder now has the following bonded jobs under contract:

$

 9. The Bidder possesses Contractor's License No. for the

State of

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

 10. The Bidder hereby represents and warrants that all statements set forth 

herein are true and correct. (If the Bidder is a partnership, the partnership name 

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 and the corporate seal affixed. A typewritten copy of 

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

(OFFICIAL SEAL}

Name of Bidder

Date Signature Title

Date Signature Title