Contractors Release Form DOT F 4220.4.doc
DOC document 40 KB Posted
- Solicitation number
- 6973GH-25-R-00100
About this file
This is a standard Department of Transportation Contractor's Release Form (DOT F 4220.4) that contractors must complete to release the government from liabilities and obligations upon contract completion and final payment. The form requires contractors to specify the contract number, total amounts paid and payable, and any excluded claims or exceptions. For corporate contractors, it must be signed by an authorized representative and certified by the corporate secretary. The form includes spaces for entering payment amounts, exceptions/claims, witness signatures, and execution date.
The related contract opportunity is an FAA solicitation (6973GH-25-R-00100) for refurbishing the cafeteria at the ZSU Combined EnRoute and Approach Control facility in San Juan, PR. This is a 100% small business set-aside for a firm-fixed-price contract, with proposals due March 13, 2025 at 4:00 PM CT. A site visit is scheduled for March 5, 2025. Offerors must submit completed SIR documentation with pricing and certifications, plus an Organizational Experience Questionnaire showing relevant HVAC and roofing projects valued over $50,000 within the past 5 years. Award will be made to the lowest-priced, technically acceptable offer. Questions are due by March 7, 2025 to Stephen.N.Branch@faa.gov.
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Text version
DEPARTMENT OF TRANSPORTATION
CONTRACTOR'S RELEASE
CONTRACTOR (Name and Address)
CONTRACT NO.
ENTER SUM OF TOTAL OF AMOUNTS PAID AND PAYABLE
$________ (PAID)
$________ (PAYABLE)
Pursuant to the terms of the above numbered contract and in consideration of the sum stated above, which has been paid or is to be paid to the Contractor, or its assignees, the Contractor, upon payment of the said sum by the UNITED STATES OF AMERICA (hereinafter called the Government), does remise, release, and discharge the Government, its officers, agents, and employees, of and from all liabilities, obligations, claims, and demands whatsoever under or arising from the said contract, except:
1. Specified claims in stated amounts or in estimated amounts where the amounts are not susceptible of exact statement by the Contractor, as follows: (or state "None")
2. Claims, together with reasonable expenses incidental thereto, based upon the liabilities of the Contractor to third parties arising out of the performance of this contract, which are not known to the Contractor on the date of the execution of this release and of which the Contractor gives notice in writing to the Contracting Officer within the period specified in the said contract; and
3. Claims for reimbursement of costs (other than expenses of the Contractor by reason of his indemnification of the Government against patent liability) including reasonable expenses incidental thereto, incurred by the Contractor under any provisions of the said contract relating to patents.
The Contractor agrees, in connection with patent matters and with claims which are not released as set forth above, that it will comply with all provisions of the said contract, provisions of the said contract, including without limitation those provisions relating to notification to the Contracting Officer and relating to the defense or prosecution of litigation.
IN WITNESSES WHEREOF, this release has been executed this _______ day of ___________________, 19 ___.
| WITNESSES |
| _______________________ |
(Contractor)
| BY |
| _______________________ |
| ____________________________________ |
| TITLE |
| _______________________ |
NOTE: In the case of a corporation, witnesses are not required but the below statement must be completed.
I, (name) _________________________________, am the _______________________ secretary of the corporation named as Contractor in the foregoing release; that (name)_____________________ who signed said release on behalf of the Contractor was then (title)______________________ of said corporation; release was duly signed for and in behalf of said corporation by authority of its governing body and is within the scope of its corporate powers.
Signature
Form DOT F 4220.4 (Rev. 5/05) (word)
PREVIOUS EDITION OBSOLETE
AUTHORIZED FOR LOCAL REPRODUCTION
File details come from the government source that posted it. Updated .