Tab 16 SIR Attach 3 Contractors Release Form DOT F4220.4.doc
DOC document 53 KB Posted
- Solicitation number
- 6973GH-25-R-00128
About this file
The document is a Department of Transportation Contractor's Release Form (DOT F4220.4) used to formally release the government from liabilities and claims upon contract completion. The form allows a contractor to release the United States government from various contractual obligations after receiving payment, with specific provisions for retaining rights to certain patent-related claims, third-party liabilities, and claims not known at the time of release execution. The form includes spaces for contractor details, contract number, total payment amount, and requires signatures from the contractor and, in the case of a corporate entity, a corporate secretary verification.
This form is associated with a Federal Aviation Administration (FAA) solicitation (6973GH-25-R-00128) for replacing mechanical room flooring at the Guam Combined Center Radar Approach (ZUA) facility in Barrigada, Guam. The competitive solicitation is a firm fixed-price contract set aside exclusively for small businesses, with a site visit scheduled for April 22, 2025, and proposal responses due by May 6, 2025, at 5:00 PM CDT. Proposals will be evaluated based on the lowest-priced quote that is fully responsive and responsible, with the expectation of making an award to a small business contractor.
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Text version
DEPARTMENT OF TRANSPORTATION
CONTRACTOR'S RELEASE
CONTRACTOR (Name and Address)
CONTRACT NO.
ENTER SUM OF TOTAL OF AMOUNTS PAID AND PAYABLE
Pursuant to the terms of the above numbered contract and in consideration of the sum stated above, which has been paid or is to be paid to the Contractor, or its assignees, the Contractor, upon payment of the said sum by the UNITED STATES OF AMERICA (hereinafter 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 under or arising from the said contract, except:
1. Specified claims in stated amounts or in estimated amounts where the amounts are not susceptible of exact statement by the Contractor, as follows: (or state "None")
2. Claims, together with reasonable expenses incidental thereto, based upon the liabilities of the Contractor to third parties arising out of the performance of this contract, which are not known to the Contractor on the date of the execution of this release and of which the Contractor gives notice in writing to the Contracting Officer within the period specified in the said contract; and
3. Claims for reimbursement of costs (other than expenses of the Contractor by reason of his indemnification of the Government against patent liability) including reasonable expenses incidental thereto, incurred by the Contractor under any provisions of the said contract relating to patents.
The Contractor agrees, in connection with patent matters and with claims which are not released as set forth above, that it will comply with all provisions of the said contract, provisions of the said contract, including without limitation those provisions relating to notification to the Contracting Officer and relating to the defense or prosecution of litigation.
IN WITNESSES WHEREOF, this release has been executed this _______ day of ___________________, 19 ___.
| WITNESSES |
| _______________________ |
(Contractor)
| BY |
| _______________________ |
| ____________________________________ |
| TITLE |
| _______________________ |
NOTE: In the case of a corporation, witnesses are not required but the below statement must be completed.
I, _________________________________, am the _______________________ secretary of the corporation named as Contractor in the foregoing release; that _____________________ who signed said release on behalf of the Contractor was then _______________________ of said corporation; 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.
Signature
Form DOT F 4220.4 (Rev. 5/05) (word)
PREVIOUS EDITION OBSOLETE
AUTHORIZED FOR LOCAL REPRODUCTION
File details come from the government source that posted it. Updated .