FS-2400-72 MRCTA Liaiblity Waiver

USDA Forest Service FS-2400-72 (Rev. 10/2008)

OMB 0596-0212 (12/2011)

Request for Relief and Release of Liability Statement

Market-Related Contract Term Addition

36 CFR 223.52(c)(3)

Timber Sale Name:	     
Contract Number:	     
In accordance with 36 CFR 223.52(c)(3) I,		     	(Purchaser):

(1) Release the United States (acting by and through the U.S. Forest Service) from all liability, including further consideration or compensation, resulting from any relief provided by 36 CFR 223.52(c)(3).

(2) I further release the United States (acting by and through the U.S. Forest Service) from all liability, including further consideration or compensation, resulting from the Forest Service’s decision not to provide the relief under 36 CFR 223.52(c)(3) requested by me.

(3) I acknowledge that the contract for which I have requested relief under 36 CFR 223.52(c)(3) remains in effect until the contract is modified, and that if the requirements for modification are not met, the contract must be performed under the original terms of the contract, including making periodic payments that become due before modification.

		     
[Purchaser]		Date

By:	     
Title:	     

BURDEN AND NONDISCRIMINATION STATEMENTS

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0596-0212. The time required to complete this information collection is estimated to average 30 minutes 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.

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