B08_Attachment_7_Form_DI-137_Release_of_Claims.pdf

PDF 36 KB Posted

Attached to
CERC A3 Single Phase Electrical Panel Upgrade Federal contract opportunity
Solicitation number
140G0125Q0052
Issued by
Department of the Interior US Geological Survey Office of Acquisitions and Grants

About this file

This is Form DI-137 "Release of Claims" from the Department of the Interior (March 2017 version), which is a standard form used by contractors to release the United States government from any claims before receiving final payment under a contract.

The form appears to be a template that contractors must complete to acknowledge receipt of final payment and release the government from any further claims or liabilities related to the contract, except those specifically noted as exceptions. The form includes fields for the contract number, date, contractor information (with checkboxes to indicate if the contractor is a corporation, partnership, joint venture, or individual), and signature blocks. It contains a special section at the bottom that must be completed only if the contractor is a corporation, requiring certification from a corporate officer that the person signing has the authority to bind the corporation.

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Text version

Contract Number

Date

UNITED STATES

DEPARTMENT OF THE INTERIOR

RELEASE OF CLAIMS

DI-137

(March 2017)

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 , 20 .

(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 .