The undersigned has been paid and has received a progress
payment in the sum of $___________(dollar amount)
___ for all labor, services, equipment or material furnished to the job site or to
_______(person with whom undersigned contracted)________
on the job of _______(owner)________
located at _________(job description)________
and does hereby 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 to claim or payment rights for persons in the undersigned's
position that the undersigned has on the above referenced project to the following extent.
This release covers a progress payment for all labor, services, equipment or
materials furnished to the job site or to ___(person with whom undersigned contracted)___________
through ______(date)______ only and
does not cover any retention, pending modifications, and changes or items furnished after
that date.The undersigned warrants that he either has already paid or
will use the monies he received from this progress 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)_______________________
(Each unconditional waiver shall contain the following language in type at least
as large as the largest type otherwise on the document:)
NOTICE
THIS DOCUMENT WAIVES RIGHTS UNCONDITIONALLY AND STATES THAT YOU HAVE BEEN PAID
FOR GIVING UP THOSE RIGHTS. THIS DOCUMENT IS ENFORCEABLE AGAINST YOU IF YOU SIGN IT,
EVEN IF YOU HAVE NOT BEEN PAID. IF YOU HAVE NOT BEEN PAID, USE A CONDITIONAL RELEASE
FORM.