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

Form 5

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Contract/Solicitation No.
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CBCA ______________

APPELLANT/APPLICANT CERTIFICATE OF FINALITY

A.

Address to which check should be sent (if check is to be sent to counsel, enclose a power
of attorney):

B.

Appellant/Applicant 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; and

(3)

it agrees to accept the amount awarded, plus any interest awarded, in accordance
with the Board's decision in this case, in full and final satisfaction of its case.

Appellant/Applicant

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Date

By _________________________________
Signature and Title

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