ARIZONA

CONDITIONAL WAIVER AND RELEASE ON FINAL PAYMENT

PROJECT: _________________________________________________________
JOB NO: _________________________________________________________
On receipt by the undersigned of a check from   ____________(maker of check) _____ in the amount of $______(amount) __________ payable to ______________(payee or payees of check) _____ and when the check has been properly endorsed and has been paid by the bank on which it is drawn, this document becomes effective to release any mechanic's lien, any state or federal statutory bond right, any private bond right, any claim for payment and any rights under any similar ordinance, rule or statute related private bond right, any claim for payment and any rights under any similar ordinance, rule or statute related to claim or payment rights for persons in the undersigned's position, the undersigned has on the job of  ____________(owner) _____ located at ____________(job description) _____.  This release covers the final payment to the undersigned for all labor, services, equipment or materials furnished to the job site or to ____________(person with whom undersigned contracted) _____, except for disputed claims in the amount of $________________.  Before any recipient of this document relies on it, the person should verify evidence of payment to the undersigned.

The undersigned warrants that he either has already paid or will use the monies he received from this final payment to promptly pay in full all of his laborers, subcontractors, materialmen and suppliers for all work, materials, equipment or services provided for or to the above referenced project up to the date of this waiver.

Date: _________________                     _________(Company Name) ___________________                                                           By _________(Signature) ________________________                                                                __________(Title)_____________________

 

                                                                

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