J08 Release of Claims iHouse.docx
DOCX document 14 KB Posted
- Attached to
- iHouse Apartment Construction
- Solicitation number
- 75H70126R00026
About this file
This document is a Final Release of Claims form template for use upon contract completion and payment. The release serves as a legal instrument through which a contractor acknowledges receipt of payment from the United States Government and releases the government, its officers, agents, and employees from all liabilities, obligations, claims, and demands arising from the contract. The form includes spaces for the contract number, contractor name, execution date, and signature blocks for both the contractor and witnesses, along with a corporate certificate section for use when the contractor is a corporation, which specifies that the signatory was authorized by the corporation's governing body to execute the release on its behalf.
This template applies to the iHouse Apartment Construction solicitation (75H70126R00026), a firm-fixed-price Request for Proposals issued by the Department of Health and Human Services Indian Health Service for construction of a 19-unit apartment building to be relocated to Indian Route 6290, Tonalea, Arizona, in Coconino County. The project carries an estimated value between $5,000,000 and $10,000,000, with a performance period of 365 calendar days, and is designated as an ISBEE set-aside under NAICS code 236220 (Commercial and Institutional Building Construction). The release of claims form would be executed as a condition of final payment upon contract closure.
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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 .