J6_RELEASE_OF_CLAIMS_GSA1142-15a.pdf

RELEASE OF CLAIMS

The undersigned contractor, pursuant to the terms of Contract Number located at hereby release the United States from any and all claims arising under or by virtue of said contract or any modification or change thereof except as follows: (Here list any claims against the Government and the amounts thereof. If none, so state.)

Witness the signature and seal of the undersigned this day of

CONTRACTOR

WITNESS:

(Seal)

(Print or type)

(Signature)

(Official Title)

(Signature)

(Address)

GSA 1142 (REV. 5/2015)

between the United States of America and said contractor for the

GENERAL SERVICES ADMINISTRATION

OMB Control Number: 3090-0080 Expiration Date: 6/30/2018

Paperwork Reduction Act Statement - This information collection meets the requirements of 44 U.S.C. § 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget (OMB) control number. The OMB control number for this collection is 3090-0080. We estimate that it will take 6 minutes to read the instructions, gather the facts, and answer the questions. Send only comments relating to our time estimate, including suggestions for reducing this burden, or any other aspects of this collection of information to: U.S. General Services Administration, Regulatory Secretariat Division (M1V1CB), 1800 F Street, NW, Washington, DC 20405.

RELEASE OF CLAIMS

The undersigned contractor, pursuant to the terms of Contract Number located at hereby release the United States from any and all claims arising under or by virtue of said contract or any modification or change thereof except as follows: (Here list any claims against the Government and the amounts thereof. If none, so state.)

Witness the signature and seal of the undersigned this day of

CONTRACTOR

WITNESS:

(Seal) (Print or type) (Signature) (Official Title) (Signature) (Address)

GSA 1142 (REV. 5/2015)

between the United States of America and said contractor for the

GENERAL SERVICES ADMINISTRATION

OMB Control Number: 3090-0080 Expiration Date: 6/30/2018 Paperwork Reduction Act Statement - This information collection meets the requirements of 44 U.S.C. § 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget (OMB) control number. The OMB control number for this collection is 3090-0080. We estimate that it will take 6 minutes to read the instructions, gather the facts, and answer the questions. Send only comments relating to our time estimate, including suggestions for reducing this burden, or any other aspects of this collection of information to: U.S. General Services Administration, Regulatory Secretariat Division (M1V1CB), 1800 F Street, NW, Washington, DC 20405.