DEPARTMENT OF TRANSPORTATION OMB Control No. 2105-0517 Polc reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions searching existing data In consideration of the sum stated above, which has been paid or is to be paid to the Contractor, or his assignees, the Contractor, upon payment of the said by the UNITED STATES OF AMERICA (hereinafter called the Government), does remise, release, and discharge t 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: 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. The Contractor agrees, in connection with patent matters and with claims which are not released as set forth above, that he will comply with all 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 NOTE: BY TITLE (Contractor) In the case of a corporation, witnesses are not required but the certification below must be completed. CERTIFICATE certify that 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; 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. 238.4 (REV. 18/19) (EXCEL) (CORPORATE SEAL) PREVIOUS EDITION OBSOLETE AUTHORIZED FOR LOCAL REPRODUCTION DEPARTMENT OF TRANSPORTATION OMB Control No. 2105-0517 Expiration Date: 4/30/97 Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any aspect of this collection of information, including suggestions for reducing this burden, to the FAR Secretariat (VRS), Office of Federal Acquisition and Regulatory Policy, GSA, Washington, D.C. 20408, and to the Office of Management and Budget, Paperwork Reduction Project (2105-0517), 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 Form DOT F 4220.7 (REV.10/94) (EXCEL) PREVIOUS EDITION OBSOLETE AUTHORIZED FOR LOCAL REPRODUCTION CONTRACTOR REPORT OF OMB Control No. 2106-0517 Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing Instructions searching existing data NOTE: This report shall include all Government property (i.e., property furnished by the Government, or acquired or fabricated by 10 Typed Name of Contractor Property Administrator Tome DOT # 4230.43 (10/94) (EXCEL) PREVIOUS EDITION OBSOLETE 11. Signature and Date AUTHORIZED FOR LOCAL REPRODUCTION INSTRUCTIONS FOR COMPLETING CONTRACT PRICING SUMMARY Offerors are instructed to prepare their cost proposals in sufficient detail to permit thorough and complete evaluation by the Government. A separate DOT F 4220 44 is required for the basic and each option period (if applicable). The supporting data for the DOT F 4220.44 shall be as follows. (NOTE: The DOT F 4220.44 shall be used to implement the requirements of the SF 1411 and does not relieve offerors from complying with FAR 15.804-6 requirements.) (a) The basis for all proposed rates (including a copy of the indirect cost pool and a computational trail used to arrive at the proposed rate shall be clearly identified when the proposed rates are not approved by a 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 an approved (within 12 months) Government audit agency rate was used. (b) The information below clarifies FAR 15.804-6 requirements for specific cost elements. The cost elements listed below shall be supported, as a minimum, with the following: 1 DIRECT MATERIAL A. Purchased 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 Items: Show the total cost of subcontract effort and provide a separate SF 1411 and supporting DOT F 4220.44 for each subcontractor or written quotations from the prospective subcontractor in accordance with FAR 15.806-2. C Other (1) Bay Material: Consists of material in a form or state that requires further processing. Provide priced quantities of items required for the proposal. Show total cost and give details on an attached schedule. (2) Standard Commercial Items: Consists of items that the offeror normally fabricates, in whole or in part, and that are generally stocked in inventory. Provide an appropriate 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 data, as required by FAR 15.804-3(e). Show total cost and give details on an attached schedule 2 MATERIAL OVERHEAD. 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 total 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 (a) above 5. OTHER DIRECT COSTS (A) Special Tooling/Equipment. Identify and support specific equipment and unit prices. Use a separate schedule if necessary. (B) Travel Identify and support 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. State 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 (eg, services of specialized trades, computer services, preservation, packaging and packing, leasing of equipment) and provide bases for pricing 6 GENERAL AND ADMINISTRATIVE EXPENSE See paragraph (a) above and base approved by a Government audit agency for use in proposals. 7 ROYALTIES 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 27.204 and 31.205-37) 8. SUBTOTAL ESTIMATED COST Enter the total of all 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 attach supporting calculations on the CASB-CMF forms. (See FAR 31 205-10). 10 SUBTOTAL ESTIMATED COST Enter the total of all proposed costs excluding Fee or Profit and insert this amount in Section 6.A. of SF 1411. 11. FEE OR PROFIT Enter this proposed Fee or Profit and insert 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. Form DOT F 4220 44 (REV 10/94)(WORD) PREVIOUS EDITION OBSOLETE AUTHORIZED FOR LOCAL REPRODUCTION |