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Back to Forms for 'Releases and Settlements'.


CONDITIONAL WAIVER AND RELEASE

CONDITIONAL WAIVER AND RELEASE

UPON PROGRESS PAYMENT

(Mechanic's Lien Release)

 

 

Upon receipt by the undersigned of a check from (maker of check): ________________ in the sum of __________________ Dollars ($_________) payable to (payee or payees of check): ___________________________ 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 release any mechanic's lien, stop notice, or bond right the undersigned has on the job of (description of job): _____________________________

_______________________________________ located at: _____________________

to the following extent.

 

This release covers a progress payment for labor, services, equipment or materials furnished to (your customer): ___________________ through: __________________ (month & day), __________ (year) only, and does not cover any retention for items already furnished or items furnished after that date.  Before any recipient of this document relies on it, said party should verify evidence of payment to the undersigned.

 

This document also releases (name of party to be released): ______________________ 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)

 

_________________________________________                   _________________

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

 

 

_________________________________________                   _________________

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

 

 

_________________________________________                   _________________

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

 

_________________________________________                   _________________

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

 

 

_________________________________________                   _________________

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

 



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