Form PROC-4100

6/24/03

Rev. 0

Release and Certificate of Final Payment

With reference to Contract No. / dated / , 20
as amended, between the undersigned Subcontractor,
[NAME OF SUBCONTRACTOR]
and / Battelle Energy Alliance, LLC (BEA)
for
[TYPE OF WORK]
at
[LOCATION OF WORK]
The Undersigned certifies that to its best knowledge and belief, each of its lower-tier subcontractors and materialmen has been paid in full for work, labor, services, materials and equipment supplied in connection with the foregoing contract and/or used by them in connection with the Undersigned’s work under said contract and has obtained releases to that effect.
In consideration of $ / as final payment under the contract, the Undersigned
hereby unconditionally releases and forever discharges Battelle Energy Alliance, LLC and the U. S. Department of Energy from all claims, demands, suits, causes of action, losses, costs, expenses, or obligations of every nature, whether known or unknown, including, without limitation, any claims for cumulative impacts, extended overhead or loss of efficiency, arising out of or in connection with the performance of the said contract and all amendments thereto except as set forth below.
(Note: If none, write “None.” in space above. Any claims excepted must be described and the specific amount claimed must be set forth.)
The foregoing shall not relieve the Undersigned of its obligations under the provisions of said contract, as amended, which by their nature survive completion of the Work including, without limitation, warranties, guarantees and indemnities.
Executed this / day of / , 20
______
(SUBCONTRACTOR NAME) / (PRINTED NAME OF AUTHORIZED SUBCONTRACTOR REPRESENTATIVE)
SIGNED (AUTHORIZED SUBCONTRACTOR REPRESENTATIVE) / TITLE