CONDITIONAL WAIVER AND RELEASE UPON FINAL PAYMENT

(Mechanic's Lien Release)

Upon receipt by the undersigned of a check from _________________ in the sum of _____________________________ payable to ______________________ and when the check has been properly endorsed and has been paid by the bank upon which it is drawn, this document shall become effective to indicate that the undersigned has been paid in full for all labor, services, equipment or material furnished to ______________ on the job of ____________________ located at: ___________________________and upon those aforesaid conditions being met, this document does hereby release any mechanic’s lien, stop notice, or any right against a labor and material bond on the job, except for disputed claims for extra work in the amount of _____________________.

Before any recipient of this document relies on it, said party should verify evidence of payment to the undersigned. This document also releases _______________________ from liability.

COMPANY NAME: ________________________

DATED: _______________________

______________________________________ ________________

SIGNATURE OF AUTHORIZED PERSON TITLE

THE UNDERSIGNED HAVE PERFORMED LABOR FOR WAGES ON THE PROJECT DESCRIBED ABOVE AND HAVE BEEN PAID IN FULL TO DATE

_________________________________________ _________________

(Signature Of Person Performing Labor For Wages) (Date)

_________________________________________ _________________

(Signature Of Person Performing Labor For Wages) (Date)