Attachment 12 Contractors Final Affidavit.pdf

CONTRACTOR’S AFFIDAVIT OF RELEASE UNDER CONTRACT

AND

PAYMENT OF DEBTS AND CLAIMS

(Final Progress Payment Submission Attachment))

INVOICE NUMBER:

TO Department of the Army FROM:

Mission and Installation Contracting Command

ATTN: Contracting Officer

Fort Drum, NY 13602-5220

Contract Number:

Project Description:

Pursuant to the terms of said Contract Number, and in consideration of the total contract price of Dollars, $ ______________________ which has been or is to be paid under the said contract to said contractor or it’s assignees, if any, the contractor, upon payment of the said sum by the United States of America (hereinafter called the Government), does remiss, 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

EXCEPTIONS: If none, check “None”. If any amounts claimed, so indicate)

None Exceptions are attached

In witness Whereof, this release has been subscribed and sworn to me this day of

BY

(Contractor’s Signature)

Notary Public

My Commission Expires