J11 Release of Claims.docx
DOCX document 14 KB Posted
- Attached to
- RFP Stephan Booster Station & WM Replace
- Solicitation number
- RFP75H70125R00046
About this file
The document is a Final Release of Claims form designed for use in federal contracting, specifically related to the RFP75H70125R00046 solicitation for the Indian Health Service. The release document provides a standard template for contractors to formally discharge all liabilities, obligations, and claims associated with a specific contract upon final payment, with provisions for potential specific claims to be noted.
The associated federal contract opportunity is for the Stephan Booster Station & Water Main Replacement project, issued by the Department of Health and Human Services Indian Health Service. The solicitation is set aside for Indian Small Business Economic Enterprises (ISBEE) and seeks a contractor to remove and replace an existing booster station and approximately 9,900 linear feet of ductile iron pipe. The contract will be a Firm Fixed-Price (FFP) type, procured as a Request for Proposal (RFP) using Lowest Price Technically Acceptable (LPTA) evaluation criteria. Mandatory requirements include SAM registration and compliance with specific small business size standards.
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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
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