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No further benefits may be paid out under this program unless this report is completed and filed as required by existing law and regulations (7 U.S.C. et seq.)

U.S. Department of Agriculture 

Rural Utilities Service

PROJECT DESIGNATION

STATEMENT OF ENGINEERING FEES

TELECOMMUNICATIONS CONTRACT NO. DATE

ESTIMATED INVOICED FINAL

AND

APPROVED

Form 217a - Project Design, Assistance and Coordination

A. Section 1. Project Design

B. Section 2. Assistance to Owner

C. Section 3. Coordination

D. Section 4. Plant Records

Form 217a Subtotal

Form 217b - Central Office Equipment Engineering Services

A. Section 1. Review of Requirements

B. Section 2C. Rebidding

C. Additions, Modifications, Relocations, or Removals

D. Sections 2F, 2H and 2I and Section 3

E. For each new Central Office Equipment contract or Force Account Proposal an amount equal to:

percent ( %) of first $100,000

Plus

Plus percent ( %) of the balance

F. For each Installation Only contract: percent ( %)

Form 217b Subtotal

Form 217c - Transmission Facilities Engineering Services

A. Section 1. Review of Requirements

B. Additions, Modifications, Relocations, or Removals

C. Section 3A. Rebidding

D. Sections 3E, 3F and 3G

E. Section 4. Tests

F. For each new Transmission Facilities contract or Force Account Proposal an amount equal to:

Form 217c Subtotal

Form 217d - Building Engineering Services

A. Section 1. Review of Requirements

B. Section 3B. Rebidding

C. Additions, Modifications, Relocations, or Removals

D. Sections 3F and 3G

E. For each new Building contract or Force Account Proposal an amount equal to:

Form 217d Subtotal

Form 217e - Outside Plant Staking Services

A. Section 1. Review of Requirements

B. Section 2C. Changes

C. Section 2I. Joint Use or Joint Occupancy

D. Replacement of Markers

E. For Staking:

1. per mile of existing buried plant to be modified miles at $

2. Plus miles at $ per mile of new buried plant

3. Plus per mile of unde miles at $ rground cable installed in ducts

4. Plus miles at $ per mile of new aerial plant.

5. Plus per mile of existing aerial plant to be modified. miles at $

6. Plus per mile of new joint use lines miles at $

7. Plus miles at $ per mile of existing lines to be removed where no

construction or modification work is to be performed

8. Plus service entrances at $ per service entrance for each new or

modified service entrance

9. Plus subscribers at $ per subscriber shown on construction sheets 

F. Section 2J. Time and Expense Staking

Form 217e Subtotal

RUS Form 506 (Rev 12-96)

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 an average of 6 hours 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.

INSTRUCTIONS - See 7 CFR Part 1753.17(f)

percent ( %) of next $300,000

percent ( %) of first $50,000

Plus

Plus percent ( %) of the balance

G. For each Installation Only contract: percent ( %)

percent ( %) of next $150,000

percent ( %) of first $50,000

Plus percent ( %) of the balance

CONTRACT SECTION
"You are not required to respond to this collection of information unless this form displays the currently valid OMB control number. "

CONTRACT SECTION ESTIMATED INVOICED FINAL

AND

APPROVED

Form 217f - Outside Plant Contract Document Phase Engineering Services

A. Sum of $ Sections at $ per section or

Plus Amendments at $ per amendment.

Plus miles at $ per mile of Project Line

B. The Sum of $ for each approved Force Account Proposal

C. Section 2. Map Tracings and Other Data.

D. Section 3. Schematics, Assignments, and Cut Sheets

E. Section 4B6. Underground Conduit.

F. Section 4C3. Pre-Bid Conference and Rebidding

G. Section 4D3. Changes to Force Account Proposals

Form 217f Subtotal

Form 217g - Outside Plant Construction Phase Engineering Services

A. Section 1. Construction Phase

1. Section 1B. Residents and Inspectors

2. Section 1C. Pre-Construction Conference

3. Section 1F. Joint Use or Joint Occupancy

4. Section 1G. Tests

5. Section 1H. Connecting Companies

6. Section 1I. Reporting

7. Section 1J. Final Inspection

B. Section 2. Final Documents: the sum of $ or Sections

at $ per section

Plus miles at $ per mile of line included

Plus service entrances at $ for each service entrance

installed, replaced or modified

C. Section 3. Plant Records

D. Section 4. Inventory and Appraisal

Form 217g Subtotal

Form 217 Contract SUBTOTAL

TAXES

GRAND TOTAL

CERTIFICATE OF ENGINEER 

 (Complete for Final Statement Only)

I, , certify that (1) I am the of

(Title)

, the Engineer in a contract entered into between the Engineer and the Owner, (Name of Engineer) , for engineering services in a rural telecommunications Project, which Project

(Name of Owner)

bears the Rural Utilities Service Project designation ; and that (2)

this is a true and correct statement of the fees due under the terms of the engineering service contract, and that (3) all persons 

employed by the Engineer in connection with the engineering on the Project have been paid in full.

(Signature)

THIS STATEMENT AND CERTIFICATE IS HEREBY APPROVED

(0WNER

)

By: (Date)

RECOMMENDED BY:

(RUS General Field 

Representative) APPROVED BY:

(Chief Area, Engineering Branch)

(Date)

RUS Form 506 (Rev 12-96)

(Date)

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