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OMe Control No. 2104-0417
DEPARTMENT OF TRANSPORTATION
Expiration Date: N30097
Wie repenting burden for this collection of information is estimated to everage 1 hour per responsa, including the time for reviewing instructions searching existing data
a consideration of the sum stated above, which has been paid or is to be paid to the Contractor, or his assignees, the Contractor, upon wyment of the said by the UNITED STATES OF AMERICA (hereinafter called the Government), does remise, release, and discharge 1 be Goverament, its officers, agents, and employees, of and from all liabilities, obligations, claims, and demands whatsoever under or rising 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:
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 Governemnt against patent liability), including reasonable expenses incidental thereto, incurred by the Contractor under any provisions of the said contract relating to patents.
he Centractor agrees, in connection with patent matters and with claims which are not released as set forth above, that he will comply with all revisions of the said contract, including without limitation those provisions relating to notification to the Contracting Officer and relating to Le defense or prosecution of litigation.
In the case of a corporation, witnesses are not required but the certification below must be completed.
certify that I am the
secretary of the corporation named as Contractor in be foregoing release; that
who signed said release on behalf of the Contractor was then 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 cope of its corporate powers.
OMB Control No 2105-6517
DEPARTMENT OF TRANSPORTATION
Expiration Date: 13091
Public reporting burden for this collection of information is estimated to everage 1 hour per response, including the time for reviewing instructions searching existing data source gathering and maintaining the data needed, and completing and reviewing the collection of information Send comments regarding this burden estimate or any repect of this collection of Information, including suggestions for reducing this burdon, to the FAR Secretariat (VRS). Office of Federal Acquisition and Regulatory Policy. GSA Washington, DC 20404, and te the Office of Management and Budget, Paperwort Reduction Project (3105-0617). Washington, D.C. 20503
This claim constitutes the total amount claimed due and unpaid for the period of employment indicated.
ADDRESS OF EMPLOYEE
SIGNATURE OF EMPLOYEE
For DOT # 43201 REV. 1ON EXCEL)
PREVIOUS EDITION OOSOLETE
AUTNORREDOR LOCAL REPRODUCTION
biceporting turden for this collection of information to estimated to avenge 1 hour per response, including the time for reviewing instructions searching existing data
401, and to the Orice of Management and Budget, Paperwork Reduction Project (2106-0817), Washington, D.C. 20803.
OTE: This report shall include all Government property (.... property furnished by the Government, or acquired or fabricated by
e Typed Name of Contractor Property Administrator
11. Signature and Date
PREVOUS EDITION OBSOLETE
AUTHORVED FOR LOCAL REPRODUCTION
INSTRUCTIONS FOR COMPLETING CONTRACT PRICING SUMMARY Oferons e instructed to prepare their cost proposals in sufficient detail to permit thorough and complete evaluation by the Govemment. A separate DOT F 220 44 is required for the basic and each option period (if applicable). The supporting data for the DOT F 4220.4 shall be as follows. (NOTE: The DOT F *220.44 shall be used to implement the requirements of the SF 1411 and does not relieve offerors from complying with FAR 18 8046 requirements.) (a) The basis for all proposed rutes (including a copy of the indirect cost pool and a computational trail used to arrive the proposed rake shall be clearly identified when the proposed rates are not approved by Government audit agency for use in proposals, or approved by the Government audit agency, but the approval is 12 months or more old. State rather on approved (within 12 months) Government audit agency rate was used.
*) The information below clarifies FAR 15.804-6 requirements for specific cost elements. The cost elements listed below shall be supported, ss minimum, with the following:
1. DIRECT MATERIAL
A Durchased Parts Provide a consolidated priced summary of individual material quantities included in the various tasks, orders, or contract line items being proposed and the basis for pricing (vendor quotes, invoices prices, etc.) Give details on an attached schedule.
B. Subcontracted liams Show the total cost of subcontract effort and provide a separate SF 1911 and supporting DOT F 4220.44 for each Subcontractor or written quotations from the prospective subcontractor in accordance with FAR 15.806-2.
(1) Roe Material: Consists of material in a form or state that requires further processing Provide priced quantities of items required for the proposal. Show lotal cost and give details on w attached schedule.
2) Sundard Commercialiems: Consists of items that the offeror normally fabricates, in whole or in part, and that are generally stocked in inventory. Provide a sopropriate explanation of the basis for pricing If price is based on cost, provide a cost breakdown, if priced at other than cost, provide justification for exemption from submission of cost or pricing dais, as required by FAR 15.804-3e). Show lotal cost and give details on a Kuached schedule
2 MATERIAL OVERHEAR.
Show cost here only if your accounting system provides for such cost segregation and only if this cost is not computed as part of labor overhead (item 4) or General and Administrative (G&A) (item 6).
3. DIRECT LABOR
Show the hourly rate and the soul hours for each individual (if known) and discipline of direct labor proposed. Indicate whether actual rates or escalated rates are used if escalation is included state the degree (percent) and rationale used
4. LABOR OVERHEAD
See paragraph (1) above
S. OTHER DIRECT COSTS
(A) Special Tooling Equipment Identify and support specific equipment and unit prices. Use a separate schedule if necessary
(B) Irel Identify and suppon each trip proposed and the persons (or disciplines) designated to make each trip. Identify and support transportation and per diem rates
(C) Individual Consultant Services. Identify and support the proposed contemplated consultants. Slate the amount of service estimated to be required and the consultant's quoted daily or hourly rate
(D) Other Costs List all other direct charge costs not otherwise included in the categories described above (c.8. services of specialized wades, computer services, preservation, packaging and packing, leasing of equipment) and provide bases for pricing
6. GENERAL AND ADMINISTRATIVE EXPENSE. See paragraph (8) above and bese approved by a Government audit agency for use in proposals.
If more than $250. provide the following information on a separate page for each separate royalty or license fee, name and address of licensor, date of license agreement, patent numbers, patent application serial numbers, or other basis on which the royalty is payable, brief description (including any part of model numbers of each contract item or component on which the royalty is payable). percentage or dollar rate of royalty per unit, unit price of contract item, number of units, and total dollar amount of royalties. In addition, if specifically requested by the Contracting Officer, provide a copy of the current license agreement and identification of applicable claims of specific patents. (See FAR 29 204 and 31 205-37)
1 SUBTOTAL ESTIMATED COSI
Enter the total of wil direct and indirect costs excluding Contract Facilities Capital and Cost of Money and Fee or Profit
9. CONTRACT FACILITIES CAPITAL AND COST OF MONEY Show total cost on line 9 and arrach supporting calculations on the CASB-CMF forms. (See FAR 31.205-10).
10 SUBTOTAL ESTIMATED COSI Enter the total of all proposed costs excluding Fee or Profit and insert this amount in Section 6.A. of SF 1411.
11. SFF OR PROFIT
Enter this proposed Fee or Profit and insent this amount in Section 6.B. of SF 1411,
12. TOTAL ESTIMATED COST AND FEE OR PROFIT Enter the total estimated cost including Fee or Profit (c) Under the column entitled, "Reference," identify the attachment where information supporting the specific cost element may be found.
Farm DOT F 4220.44 (REV 109XWORD)
PREVIOUS EDMON OBSOLETE
AUTHORIZED FOR LOCAL REPRODUCTION