Fill and Sign the Agreement to Furnish Insurance Policy PDF Form

Contract Number DI-137 (July 1996) UNITED STATES DEPARTMENT OF THE INTERIOR Date RELEASE OF CLAIMS WHERE AS, by terms of the above contract for , entered into by the United States of America, hereinafter also referred to as the United States, and the contractor , it is provided that after completion of all work, and prior to final payment, the contractor will furnish the United States with a release of all claims; NOW, THEREFORE, in consideration of the above premises and the payment by the United States to the contractor of the amount now due under the contract, to wit, the sum of dollars ($ ) , the contractor hereby remises, releases, and forever discharges the United States, its officers, agents, and employees, of and from all manner of debts, dues, liabilities, obligations, accounts, claims, and demands whatsoever, in law and in equity, under or by virtue of the said contract except: IN WITNESS WHEREOF, the contractor has executed this release this day of , 19 . By (Contractor) Corporation Joint Venture Partnership (Signature) Individual (Name) (Street Number or R.F.D.) (City) (State) (Title) (Zip Code) COMPLETE ONLY IF CONTRACTOR IS A CORPORATION I, CERTIFY That I am the of the corporation named as contractor herein; that , who signed this release on behalf of the corporation, was then of said corporation; and that said release was duly signed for and on behalf of said corporation by authority of its governing body. [SEAL] (Signature) This form was electronically produced by Elite Federal Forms, Inc.