J08 Release of Claims.docx
DOCX document 14 KB Posted
- Attached to
- Rosebud Lift Station Construction
- Solicitation number
- 75H70126R00018
About this file
This is a Final Release of Claims form template used to document the contractor's release of all liabilities, obligations, claims, and demands against the United States Government upon receipt of contract payment. The form serves as a settlement document for the specified contract, with provisions for the contractor to list any other specific claims in stated or estimated amounts that are excluded from the general release. The document requires execution by authorized representatives of the contractor, including signature, printed name, title, and address. For corporate contractors, a corporate officer must certify the signatory's authority and the release's authorization by the corporation's governing body, with the corporate seal affixed.
This template is associated with the Rosebud Lift Station Construction project (Solicitation 75H70126R00018), a pre-solicitation issued by the Department of Health and Human Services Indian Health Service for the Rosebud Sioux Tribe in Rosebud, South Dakota. The project involves full removal and replacement of an aging lift station serving the hospital complex, with a construction magnitude between $500,000 and $1,000,000 under a firm-fixed-price contract type with a 120-calendar-day performance period. TERO (Tribal Employment Rights Ordinance) requirements apply. The new lift station will include increased capacity to accommodate facility expansion, upgraded chopper pumps to handle debris, a new dry well and wet well, and an enhanced control system for monitoring operations.
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Text version
FINAL RELEASE OF CLAIMS
Pursuant to the terms of Contract No: __________________________________and in consideration of the monies, which have been or are to be paid under the said contract to _________________ (hereinafter called the Contractor) or its assignees, if any, 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 arising out of or under this contract, subject only to specified claims in stated amounts, or in estimated amounts where the amounts are not susceptible of exact statement by the contractor, as follows:
1. Other Specific Claims ________________________
All other terms and conditions of the above-mentioned contract remain in full force and effect.
IN WITNESS WHEREOF, this release has been duly executed this __________ day of _____________________________, 202___.
Witness: Contractor:
Signature Signature
Printed Name and Title Printed Name and Title
Address
(Note in the case of a corporation. Witnesses are not required, but the certificate below must be completed.)
Certificate
I ____________________________, certify that I am the ______________________________ of the corporation names as Contractor in the foregoing release: that ______________________, who signed said release on behalf of the Contractor was the ________________ of said Corporation; that said release was duly signed for and in behalf of aid corporation by authority of its governing body and is within the scope of its corporate powers.
Signature Corporate Seal
File details come from the government source that posted it. Updated .