Form DHS 700-2 DHS 700-2 Contractors Assignment of Refunds, Rebates, Credits, and

DEPARTMENT OF HOMELAND SECURITY

OMB Control No. 1600-0002

CONTRACTOR'S ASSIGNMENT OF REFUNDS,
REBATES, CREDITS, AND OTHER AMOUNTS

Expiration Date: 02/28/2011

PRA Burden Statement: This collection of information is mandatory and will be used to fulfill the requirements of the
Homeland Security Acquisition Regulation (HSAR). Public reporting burden 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 other
aspect of this collection of information, including suggestions for reducing this burden, to the Office of the Chief
Procurement Officer, Acquistions Policy and Legislation, Department of Homeland Security, Washington, DC 20528.
Please note that an agency may not conduct or sponsor, and a person is not required to respond to, a collection of
information unless it displays a currently valid OMB control number. The OMB control number for this collection is
1600-0002 and it expires 02/28/2011.
Pursuant to the terms of Contract No.

and in consideration of the reimbursement of costs and payment

of fee, as provided in the said contract and any assignment thereunder,
(hereinafter called the Contractor) does hereby:
1. Assign, transfer, set over the release to the UNITED STATES OF AMERICA (hereinafter called the Government), all
rights, title and interest to all refunds, rebates, credits or other amounts (including any interest thereon) arising out of the
performance of the said contract, together with all the rights of action accrued or which may hereafter accrue thereunder.
2. Agree to take whatever action may be necessary to effect prompt collection of all refunds, rebates, credits or other
amounts (including any interest thereon) due or which may become due, and to promptly forward to the UNITED STATES
TREASURER checks (made payable to the Treasurer of the United States) for any proceeds so collected. The reasonable
costs of any such action to effect collection shall constitute allowable costs when approved by the Contracting Officer as
stated in the said contract and may be applied to reduce any amounts otherwise payable to the Government under the
terms hereof.
3. Agree to cooperate fully with the Government as to any claim or suit in connection with refunds, rebates, credits or other
amounts due (including any interest thereon); to execute any protest, pleading, application, power of attorney or other
papers in connection with; and to permit the Government to represent it at any hearing, trial, or other proceeding arising out
of such claim or suit.
IN WITNESS WHEREOF, this assignment has been executed this

day of

,

BY:
(Contractor)

By signature hereon, I

, declare that I am the
of the corporation named as Contractor in the foregoing assignment; that

(Official Title)

signed said assignment on behalf of the Contractor was then
of said corporation by authority of its governing body and is within the scope of
(Official Title)

its corporate powers.
(CORPORATE SEAL)
(Signature)

DHS Form 700-2 (12/07)

Authorized for Local Reproduction

.