Encl. 1 - Attachment 5 Release of Claims dated

PROCUREMENT AND PROPERTY MANAGEMENT DIVISION

Form No. AMS-FORM-031
Revision No. 2.0

BROOKHAVEN NATIONAL LABORATORY

Effective Date: June 7, 2024

Managed by Brookhaven Science Associates, LLC,
under contract to the U.S. Department of Energy

APPROVED BY:

ACQUISITION MANAGEMENT SYSTEM FORM

Sergio Martinez / 6/7/24

FINAL RELEASE OF CLAIM

CONTRACT NO:

Contractor:
Address:

PRIME CONTRACT NO.:

DE-SC0012704

The work under the said contract between the above-named Contractor and Brookhaven Science Associates, LLC (BSA), has been completed. In consideration of the total payment on the Contract account in the sum of ($
) made by BSA, the undersigned
Contractor hereby releases Brookhaven Science Associates, LLC, its officers, agents, and employees, and the Government of the United States, its agents, and employees, of and from all liabilities, obligation, claims, and demands whatsoever under or arising from the said contract or in connection with the work required to be performed thereunder, and hereby agrees to indemnify BSA and the Government of the United States against, and to hold each of them harmless from, any claims by any person arising out of or in any way connected with the Contract or the work hereunder. The following are excepted from the foregoing release and agreement:

THIS RELEASE has been executed on

, 20
Signature:
Typed Name:
Title:

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