AMOUNT
CLAIMED

AMOUNT ALLOWED

1.  Previous reimbursed costs--Prime and Subs

$

$

2.  Previous unreimbursed costs

$

$

3.  Total cost settlement

$

$

4.  Previous fees paid--Prime

$

$

5.  Previous fees unpaid--Prime

$

$

6.  Total fee settlement

7.  Gross settlement

Less: Deductions not reflected in Items 1-7

a.  Disposal credits                                                           $__________

b.  Other charges against contractor arising from contract  $__________  

8.  Net settlement

Less: Prior payment credits

$_________
$

9.  Net payment

10.  Recapitulation of previous settlements (insert number of previous partial settlements effected on account of this particular termination): Aggregate gross amount of previous settlements Aggregate net amount of previous partial settlements Aggregate net payment provided in previous partial settlements Aggregate amount allowed for prime contractor acquired property taken over by the Government in connection with previous partial settlements

$_________
$_________
$_________


$_________