Attachment E - DI 137 DOI Release of Claims.pdf

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Attached to
WV-NCTC DIV OF FAC CAMPUS EV CHARGING ST
Solicitation number
140F0920B0004
Issued by

About this file

This document is a release of claims form required by the United States Department of the Interior to be completed by a contractor after all work is finished and prior to final payment on Contract Number Date. The contractor remises, releases, and discharges the United States, its officers, agents, and employees from all debts, obligations, accounts, claims, and demands whatsoever relating to the contract, with the exception of any items explicitly listed. The contractor must be a corporation, partnership, joint venture, or individual with a street address, city, state, and zip code provided. The contractor signs and dates the form, and if a corporation, an officer also certifies the contractor's identity and authority to sign.

The related federal contract opportunity is a solicitation posted by the Department of the Interior Fish and Wildlife Service Region 2. It is for electric vehicle charging stations to be installed in the blue and green parking lots at the West Virginia Northern Community College. No other details are provided regarding response date, award date, pricing terms, set-asides, incumbent contractors, or statement of work requirements.

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Text version

Contract Number

Date

UNITED STATES

DEPARTMENT OF THE INTERIOR

RELEASE OF CLAIMS

DI-137

(July 1996)

WHERE AS, by terms of the above contract for

, entered into by the United States of America, hereinafter also referred to as the

United States, and the contractor

, it is provided that after completion of all work, and prior to final payment, the contractor will furnish the United States with a release of all claims;

NOW, THEREFORE, in consideration of the above premises and the payment by the United States to the contractor of the amount now due under the contract, to wit, the sum of dollars

) , the contractor hereby remises, releases, and forever discharges the United States, its officers, agents,($ and employees, of and from all manner of debts, dues, liabilities, obligations, accounts, claims, and demands whatsoever, in law and in equity, under or by virtue of the said contract except:

IN WITNESS WHEREOF, the contractor has executed this release this day of , 19 .

(Contractor) (Signature)

By

(Name)

Corporation

Partnership

Joint Venture

Individual

(Street Number or R.F.D.)

(City) (State) (Zip Code)

(Title)

COMPLETE ONLY IF CONTRACTOR IS A CORPORATION

I, CERTIFY That I am the of the corporation named as contractor herein; that , who signed this release on behalf of the corporation, was then of said corporation; and that said release was duly signed for and on behalf of said corporation by authority of its governing body.

(Signature)

[SEAL]

This form was electronically produced by Elite Federal Forms, Inc.

Contractor:
Corporation: Off
Partnership: Off
Joint Venture: Off
Individual: Off
Street Number or RFD:
City:
State:
Zip Code:
Title:
Contract Number:
Date:
Sum:
Dollars:
Day:
month:
year:
Name:
Text1:
Text2:
Text3:
Text4:
Name2:
Text5:
Text6:
Text7:

File details come from the government source that posted it. Updated .