Attachment 5 Release of Claims.pdf
PDF 218 KB Posted
- Attached to
- Georgeville Well Drilling
- Solicitation number
- 75H70125Q00027
About this file
This file is a Release of Claims form from the Department of Health & Human Services Indian Health Service Division of Engineering Services. The form is designed to formally release the U.S. Government from liabilities and claims related to a specific contract, with provisions for contractors to note any excepted claims. The form requires the contractor to either write "NONE" or specifically detail any retained claims, including dollar amounts, nature of claims, and descriptions consistent with FAR Clause 52.233-1 on Disputes. The document provides space for the contractor's signature, title, and date of execution, with an option to attach additional pages if more claim details are needed.
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Text version
DEPARTMENT OF HEALTH & HUMAN SERVICES
Indian Health Service
Division of Engineering Services
RELEASE OF CLAIMS
Contract No. ___________________________
Task Order No. _________________________
Name and Address of Contractor:
Number, Name and Location of Project:
Project No. _________________________
Pursuant to the terms of the above numbered contract, but subject to any claims as may be specifically excepted below, the Government of the United States, its officers, agents and employees, are hereby released and discharged from all liabilities, demand, obligations, and claims arising under or by virtue of said contract.
EXCEPTED CLAIMS*
SIGNATURE TITLE
DATE
* Write NONE or (a) state the dollar amount of each excepted claim, (b) describe specifically the nature of each excepted claim, and (c) describe the claim in the same manner in which a “claim” is defined in FAR Clause 52.233-1, Disputes. (Attach additional pages if necessary.)
OES-03 (12/15)
File details come from the government source that posted it. Updated .