Exhibit_C_-_Partial_Release_Form.pdf

Project: ELSO CRP & LTS SGE500-11-R-0010 ATTACHMENT D, page 1 of 2

CONTRACTOR'S PARTIAL RELEASE STATEMENT

REF: Contract No.: SGE500-11-D-……..

Pursuant to the terms of the above Contract No. and in consideration of the sum of US$ __________________ (total of amounts paid and payable), which has been paid or is to be paid under the said contract to

(hereinafter called the Contractor) or his assignees, if any, the Contractor upon payment of the said sum by the UNITED STATES OF AMERICA (hereinafter called the Government), does hereby remise, release, and discharge the Government, its officers, agents, and employees of and from all liabilities, obligations, claims, and demands whatsoever under or arising from the said contract, except:

Specified claims in stated amounts or in estimated amounts where the amounts are not susceptible of exact statement by the Contractor, as follows (if none, so state):

IN WITNESS WHEREOF, this release has been executed this day of , 20...

WITNESSES

____________ BY ___________________________________

____________ TITLE ________________________________

Project: ELSO CRP & LTS SGE500-11-R-0010 ATTACHMENT D, page 2 of 2

CERTIFICATE

I, _______________________________________________________ , certify that I am the

(Official Title) of the corporation named as Contractor in the foregoing release; that who signed said release on behalf of the Contractor was then

(Official Title) of said corporation;

that said release was duly signed for and in behalf of said corporation by authority of its governing body and is within the scope of its corporate powers.

(CORPORATE SEAL)