GSA Civilian Board of Contract Appeals Subpoena, and Forms 4 and 5 (Certificates of Finality)

Form 4

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Contract/Solicitation No.
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CBCA ______________

GOVERNMENT CERTIFICATE OF FINALITY
A. Date claim(s) filed with the contracting officer:
B. Amount to be paid: $ __________________.
C. Agency address (regional office if other than central office):
D. Agency Certification

_____________________________________________________ hereby certifies that:
(1)

it has not initiated and will not initiate any proceeding at the Board for the
reconsideration of, or relief from, this award;

(2)

it has not initiated and will not initiate any appeal of this award to the United States
Court of Appeals for the Federal Circuit.

Government Agency

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Date

By _____________________________________
Signature and Title

Note: This format shall be used only as a guide for individual preparation.