Appendix O - Landowner Release of Claims Forms.pdf
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- 89503625RSW000052
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This document is an Appendix containing Landowner Release of Claims and Release of Claims Denial forms from the U.S. Department of Energy's Southwestern Power Administration. The forms are designed to document a landowner's acceptance or rejection of property conditions after a transmission line or infrastructure project has been completed.
The Release of Claims form allows landowners to confirm that their property has been restored to their satisfaction and that they have no further claims against the Southwestern Power Administration, its agents, or the construction contractor. The Release of Claims Denial form provides a mechanism for landowners to formally document their reasons for not signing the release, with spaces for both the landowner and contractor to record details about the project and the reasons for non-acceptance. Both forms require project information such as project name, contract number, transmission line number, and transmission structure number, as well as contact details for the construction contractor and landowner.
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Text version
APPENDIX O
LANDOWNER RELEASE OF CLAIMS AND RELEASE OF CLAIMS DENIAL FORMS
See section 1.3.1 Rights-of-Way in the technical specifications for more information.
LANDOWNER RELEASE OF CLAIMS FORM
SWPA
(Rev. 6/23)
U.S. Department of Energy Southwestern Power Administration
LANDOWNER RELEASE OF CLAIMS
Project Information
Project Name: _________________________________________
Contract Number: _________________________________________
Transmission Line Number: _________________________________________
Transmission Structures Number: _________________________________________
Construction Contractor Information
Company Name: _________________________________________
Point of Contact Name: _________________________________________
Phone Number: _________________________________________
Email Address: _________________________________________
Landowner Information
Landowner Name: _________________________________________
Physical Address: _________________________________________
Mailing Address: _________________________________________
Phone Number: _________________________________________
Email Address: _________________________________________
Release of Claims
Landowner hereby accepts the conditions of their property after completion of the above-referenced project. The signature below confirms that their property has been restored, they are satisfied with and accept the conditions of the property as-is, and no further action is necessary on the part of the Southwestern Power Administration, its agents, and/or the Contractor identified above.
Landowner Signature: _________________________________________
Landowner Printed Name: _________________________________________
Date: _________________________________________
LANDOWNER RELEASE OF CLAIMS DENIAL FORM
U.S. Department of Energy Southwestern Power Administration
LANDOWNER RELEASE OF CLAIMS DENIAL
Project Information
Project Name: _________________________________________
Contract Number: _________________________________________
Transmission Line Number: _________________________________________
Transmission Structures Number: _________________________________________
Construction Contractor Information (Contractor)
Company Name: _________________________________________
Point of Contact Name: _________________________________________
Phone Number: _________________________________________
Email Address: _________________________________________
Landowner Information (Landowner)
Landowner Name: _________________________________________
Physical Address: _________________________________________
Mailing Address: _________________________________________
Phone Number: _________________________________________
Email Address: _________________________________________
Release of Claims Denial
Landowner hereby declines to sign the presented Release of Claims presented by Contractor in reference to the project identified above. The specific reasons for, rationale of, and/or circumstances resulting in Landowner’s declination are outlined below:
Landowner Signature: _________________________________________
Landowner Printed Name: _________________________________________
U.S. Department of Energy Southwestern Power Administration
LANDOWNER RELEASE OF CLAIMS DENIAL
Refusal of Landowner to Sign Release of Claims or a Release of Claims Denial
This is to certify that attempts were made to have Landowner sign a Release of Claims or a Release of Claims Denial for the above referenced project. However, Landowner expressly declines to sign either form. The specific reasons for, rationale of, and/or circumstances resulting in Landowner’s declination, to the extent known by Contractor or asserted by Landowner, are outlined below:
Contractor Signature: _________________________________________
Contractor Printed Name: _________________________________________
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