Attachment 8 Template C Contractors Release of Claims.pdf

Contractor Release of Claims

Date:

Contractor Name & Address:

Attention:

SUBJECT: Contractor Release of Claims

Contract/Order Number:

Project Title:

The Contractor's performance under the subject contract has been completed and the Contracting Office is currently in the process of closing the subject contract that ended on (completion date).

Please complete this Contractor Release of Claims and return it to the Contracting Officer by

All deliverables including all items, supplies, services and/or reports required under the terms of the contract ( ) have been furnished, ( ) have not been furnished, or ( ) have not been furnished and, if applicable a list of exclusions is attached.

All Contractor badges granting access to Government facilities and equipment ( ) have been returned to the COR/USDA Security Office, ( ) have not been returned to the COR/USDA Security Office, ( ) Not applicable for this contract. If Contractor badges have not been returned to the COR/USDA Security Office, the Contractor must immediately notify the COR and coordinate arrangement for the immediate return of badges.

1. Contract Number: _______________________

2. Last modification number: _______________________

3. Last call or order number, if applicable: _______________________

4. Contractor Name and Telephone:

5. Contractor Contact Name and Email:

6. Dollar amount of excess funds, if any applicable: _______________________

7. Final Invoice Number and Date: __________________________________________

INVOICE # DATE AMOUNT

If there are any outstanding claims (invoices) against the Government, list the invoice number, date, and amount. If none exists, state “NONE.” ___________

INVOICE # DATE AMOUNT

9. Total Amount Awarded Under Contract: $

10. Total Amount Paid Under Contract: $

11. Contractor Performance Assessment Reporting System (CPARS). A CPARS evaluation/assessment is required prior to contract closeout. Past performance reporting is required by Federal Acquisition Regulation (FAR) Part 42.1502 and 42.1503 and Agriculture Acquisition Regulation (AGAR).

Contracting Officers, Purchasing Agents, Contracting Officer’s Representatives (COR), Technical Contact/Representatives and Contractors are required to complete CPARS evaluations at http://www.cpars.gov. The CPARS Evaluation/ Assessment ( ) was completed in CPARS, ( ) was not completed in CPARS, ( ) not applicable below simplified acquisition threshold.

Contractor Release of Claims, page 2

8. Invoices, dates and amounts (attach document if additional space is needed):

http://www.cpars.gov/

CONTRACTOR (or ASSIGNEE) CERTIFICATION:

I certify that I am the official of the corporation named as Contractor in the foregoing Release of Claims to sign said Release of Claims and Contract Completion Statement on behalf of the Contractor and is the Official of said corporation; that said Release of Claims was duly signed for and on behalf of said corporation by authority of its governing body and is within the scope of its corporate powers.

I certify that all services have been performed in accordance with the contract terms and conditions; the contract is now complete and can be closed. All USDA Badges, equipment, property, and documents have been returned to the COR/Technical Contact and all required contract actions have been fully and satisfactorily accomplished.

The Contractor, upon payment of the said sum by the UNITED STATES OF AMERICA (hereafter 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.

(Contractor or Assignee Signature Authority) (Date)

(Printed Name & Title)

(Telephone & Email)

CONTRACTING OFFICER:

(CO Signature) (Date)

(Printed Name) (Agency)

(Telephone & Email)

Contractor Release of Claims, page 3