B08_SOL_Attachment_5_DOI_Release_of_Claims.pdf

PDF 36 KB Posted

Attached to
Army Design-Build & Design-Bid-Build Construction Federal contract opportunity
Solicitation number
140D0426R0010
Issued by
Department of the Interior Departmental Offices Interior Business Center

About this file

This is a Release of Claims form used by the United States Department of the Interior as a standard federal contracting document. The form is completed by contractors upon completion of all work and prior to receiving final payment under a contract with the Department of the Interior.

The release requires the contractor to remit, release, and discharge the United States government, including its officers, agents, and employees, from all debts, dues, liabilities, obligations, accounts, claims, and demands arising under or by virtue of the contract, in exchange for final payment of the amount due. The form accommodates various contractor entity types—including corporations, partnerships, joint ventures, and individuals—and requires the contractor's authorized representative to execute the document with signature, name, title, and address information. For corporate contractors, an officer must provide separate certification confirming the signatory's authority and that the release was executed with proper governing body authorization. The form includes fields for the contract number, date of execution, payment amount, and the specific date the release is executed.

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Text version

Contract Number

Date

UNITED STATES

DEPARTMENT OF THE INTERIOR

RELEASE OF CLAIMS

WHERE AS, by terms of the above contract for

, entered into by the United States of America, hereinafter also referred to as the

United States, and the contractor

, it is provided that after completion of all work, and prior to final payment, the contractor will furnish the United States with a release of all claims;

NOW, THEREFORE, in consideration of the above premises and the payment by the United States to the contractor of the amount now due under the contract, to wit, the sum of dollars

) , the contractor hereby remises, releases, and forever discharges the United States, its officers, agents,($ and employees, of and from all manner of debts, dues, liabilities, obligations, accounts, claims, and demands whatsoever, in law and in equity, under or by virtue of the said contract except:

IN WITNESS WHEREOF, the contractor has executed this release this day of , 20 .

(Contractor) (Signature)

By

(Name)

Corporation

Partnership

Joint Venture

Individual

(Street Number or R.F.D.)

(City) (State) (Zip Code)

(Title)

COMPLETE ONLY IF CONTRACTOR IS A CORPORATION

I, CERTIFY That I am the of the corporation named as contractor herein; that , who signed this release on behalf of the corporation, was then of said corporation; and that said release was duly signed for and on behalf of said corporation by authority of its governing body.

(Signature)

Contractor:
Corporation: Off
Partnership: Off
Joint Venture: Off
Individual: Off
Street Number or RFD:
City:
State:
Zip Code:
Title:
Contract Number:
Date:
Sum:
Dollars:
Day:
month:
year:
Name:
Text1:
Text2:
Text3:
Text4:
Name2:
Text5:
Text6:
Text7:

File details come from the government source that posted it. Updated .