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U.S. Department of Agriculture
Rural Utilities Service
CERTIFICATE OF CONTRACTOR
AND INDEMNITY AGREEMENT
, certifies that
he is the
TITLE OR DESIGNATION
, the Contractor, in
NAME OF CONTRACTOR
entered into between the Contractor
a Contract dated
the Owner, for the
NAME OF RUS BORROWER
construction of a rural telephone Project (hereinafter referred to as Project), which bears the Rural
Utilities Service Project Designation
and that he is authorized
to and does make this Certificate and Indemnity Agreement on behalf of said Contractor in order to
induce the Owner to make payment to the Contractor, in accordance with the provisions of the said
contract and to induce the Rural Utilities Service to advance monies to the Owner for the construction
performed pursuant to the contract.
Undersigned further says that all persons who have furnished labor in connection with of the
Project represented by the Final Invoice dated
have been paid
in full; that all manufactures, materialmen and subcontractors which furnished any materials or service,
or both, for the said Project have been paid in full, that no lien has been filed against the Project and no
person has any right to claim any lien against the Project.
Undersigned further says that if the Owner pays the Contractor the contract price for the said
Project the Contractor will indemnify and hold harmless and does hereby undertake and agree to
indemnify and hold harmless the Owner from any claim or lien arising out of the negligence or other
fault of the Contractor in respect of the performance-of the contract which may have been or may be
filed against the Owner.
SIGNATURE OF CONTRACTOR
President, Vice-President, Partner or Owner, or if signed by other than one of the foregoing,
Power of Attorney signed by one of the foregoing should be attached.
Indicate applicable designation.
RUS Form 743