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)
