Conditional Waiver and Release Upon Progress Payment
Use this form when the claimant is required to execute a waiver and release in exchange for or in order to induce the
payment of a progress payment and the claimant has not been paid. This form is useful when the claimant has not
been paid yet, but will be paid out of a progress payment that is not the final payment. This conditional waiver and
release is only effective if the claimant is
actually paid
. This release does not cover all items. See the “Conditional
Waiver And Release Upon Progress Payment” form for more information.
CONDITIONAL WAIVER AND RELEASE UPON PROGRESS PAYMENT
Civil Code Section 3262(d)(1)
Upon receipt by the undersigned of a check from________________________________________
MAKER OF CHECK
in the sum of $____________________
AMOUNT OF CHECK
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 ____________________________________________________
OWNER
located at_____________________________________________________
JOB DESCRIPTION
to the following extent.
This release covers a progress payment for labor, services, equipment, or material furnished to
_____________________________________________
YOUR CUSTOMER
through __________________________
DATE
only and does not cover any retentions retained before or after the release date; extras furnished
before the release date for which payment has not been received; extras or items furnished after the
release date. Rights based upon work performed or items furnished under a written change order
which has been fully executed by the parties prior to the release date are covered by this release
unless specifically reserved by the claimant in this release. This release of any mechanic’s lien, stop
notice, or bond right shall not otherwise affect the contract rights, including rights between parties to
the contract based upon a rescission, abandonment, or breach of the contract, or the right of the
undersigned to recover compensation for furnished labor, services, equipment, or material covered by
this release if that furnished labor, services, equipment, or material was not compensated by the progress
payment.
Before any recipient of this document relies on it, said party should verify evidence of payment to the
undersigned.
Dated: ________________________ ______________________________________________
COMPANY NAME
By ____________________________________________
TITLE
7/04
NOTE: This form complies with the requirements of Civil Code Section 3262(d)(1). It is to be used by a party who applies for a progress payment when
the progress check has not yet cleared the bank. This release only becomes effective when the check, properly endorsed, has cleared the bank.