Exhibit_G_-_Contractor_s_Release.docx
DOCX document 32 KB Posted
- Attached to
- Hospital Beds (HBeds) - DGS-OTA
- Solicitation number
- 0000037498
- Issued by
- California
About this file
This is a Contractor's Release form issued by the California Department of Public Health (CDPH) for the Hospital Beds (HBeds) data subscription project. The release form must be submitted with the contractor's final invoice(s) and serves as documentation that final payment has been requested and received. The contract involves a three-year term with two optional one-year extensions for a contractor-hosted Software as a Service (SaaS) solution and hospital onboarding services to support CDPH's compliance with Assembly Bill 177 regarding healthcare bed capacity management statewide.
Upon execution and receipt of final payment, the contractor releases the State of California, its officers, agents, and employees from all liabilities, obligations, claims, and demands arising from the contract. The contractor acknowledges that reimbursable expenses are subject to audit verification for three years beyond final payment, with any sustained audit exceptions requiring refund to the State. The contractor must certify compliance with recycled product use requirements under California Public Contract Code Section 12200 and must return all State equipment upon contract completion unless otherwise approved by CDPH. The contractor further agrees to comply with all contract provisions related to patent matters and litigation defense or prosecution. The form requires original signatures from an authorized contractor representative and must be submitted with supporting documentation as necessary.
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Text version
California Department of Public Health HBEDS Exhibit G – Contractor’s Release
EXHIBIT G – CONTRACTOR’S RELEASE
Instructions to Contractor:
With final invoice(s) submit one (1) original and one (1) copy. The original must bear the original signature of a person authorized to bind the Contractor. The additional copy may bear photocopied signatures.
Submission of Final Invoice Pursuant to contract number entered into between the State of California Department of Public Health
(CDPH) and the Contractor (identified below), the Contractor does acknowledge that final payment has been requested via
| invoice number(s) |
| , in the amount(s) of $ |
| and dated |
If necessary, enter "See Attached" in the appropriate blocks and attach a list of invoice numbers, dollar amounts and invoice dates.
Release of all Obligations By signing this form, and upon receipt of the amount specified in the invoice number(s) referenced above, the Contractor does hereby release and discharge the State, its officers, agents, and employees of and from any and all liabilities, obligations, claims, and demands whatsoever arising from the above referenced contract.
Repayments Due to Audit Exceptions / Record Retention By signing this form, Contractor acknowledges that expenses authorized for reimbursement does not guarantee final allowability of said expenses. Contractor agrees that the amount of any sustained audit exceptions resulting from any subsequent audit made after final payment will be refunded to the State.
All expense and accounting records related to the above referenced contract must be maintained for audit purposes for no less than three years beyond the date of final payment, unless a longer term is stated in said contract.
Recycled Product Use Certification By signing this form, Contractor certifies under penalty of perjury that a minimum of 0% unless otherwise specified in writing of post consumer material, as defined in the Public Contract Code Section 12200, in products, materials, goods, or supplies offered or sold to the State regardless of whether it meets the requirements of Public Contract Code Section 12209. Contractor specifies that printer or duplication cartridges offered or sold to the State comply with the requirements of Section 12156(e).
Reminder to Return State Equipment/Property (If Applicable) (Applies only if equipment was provided by CDPH or purchased with or reimbursed by contract funds) Unless CDPH has approved the continued use and possession of State equipment (as defined in the above referenced contract) for use in connection with another CDPH agreement, Contractor agrees to promptly initiate arrangements to account for and return said equipment to CDPH, at CDPH's expense, if said equipment has not passed its useful life expectancy as defined in the above referenced contract.
Patents / Other Issues By signing this form, Contractor further agrees, in connection with patent matters and with any claims that are not specifically released as set forth above, that it will comply with all of the provisions contained in the above referenced contract, including, but not limited to, those provisions relating to notification to the State and related to the defense or prosecution of litigation.
ONLY SIGN AND DATE THIS DOCUMENT WHEN ATTACHING TO THE FINAL INVOICE
| Contractor’s Legal Name (as on contract): |
Signature of Contractor or Official Designee:
| Date: |
| Printed Name/Title of Person Signing: |
CDPH Distribution: Accounting (Original) Program Confidential - Low
Confidential - Low
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