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Attachment 3 <br />Final Release <br />Definitions: As used in this release "Funding Agreement" refers to that certain State of California Department of Public <br />Health Funding Agreement identified in paragraph 2 below; "final invoice" refers to "final claim" as used in said <br />Funding Agreement and "Supplier" refers to the party identified as "Supplier" in said Funding Agreement. <br />Instructions to Supplier: <br />With your final invoice(s) submit one (1) original and one (1) copy. The original must bear the original signature of a <br />person authorized to bind Supplier. The additional copy may bear photocopied signatures. <br />2. Submission of Final Invoice <br />Pursuant to Funding Agreement number entered into between the State of California <br />Department of Public Health (CDPH) and the Supplier (identified below), the Supplier does acknowledge that final payment has <br />been requested via invoice number in the amount of $ _and dated <br />3. Release of all Obligations <br />By signing this form, and upon receipt of the amount specified in the invoice number referenced above, Supplier does hereby <br />release and discharge the State, its officers, agents and employees of and from any and all liabilities, obligations, claims, and <br />demands whatsoever arising from the above referenced Agreement. <br />4. Repayments Due to Audit Exceptions 1 Record Retention <br />By signing this form, Supplier acknowledges that expenses authorized for reimbursement does not guarantee final allowability <br />of said expenses. Supplier agrees that the amount of any sustained audit exceptions resulting from any subsequent audit <br />made after final payment will be refunded to the State. <br />All expense and accounting records related to the above referenced Agreement must be maintained for audit purposes for no <br />less than three years beyond the date of final payment, unless a longer term Is stated in said Funding Agreeement. <br />5. Other Issues <br />By signing this form, Supplier further agrees, in connection with any claims that are not specifically released as set forth above, <br />that it will comply with all of the provisions contained in the above referenced Funding Agreement, including, but not limited to; <br />those provisions relating to notification to the State and related to resolution of disputes and the defense or prosecution of <br />litigation. <br />ONLY SIGN AND DATE THIS DOCUMENT WHEN ATTACHING TO THE FINAL INVOICE <br />Supplier's Legal Name (as on Agreement) <br />Signature of Supplier <br />Printed Namerritle of Person Signing <br />Date: <br />CDPH Distribution: Accounting (Original) Program(Copy): Division of Drinking Water and Environmental Management <br />55A-44