WAIVER
AND
RELEASE
ON
PROGRESS
PAYMENT
NOTICE TO CLAIMANT: THIS DOCUMENT MAY WAIVE AND RELEASE THE LIEN,
STOP PAYMENT NOTICE, AND ANY PAYMENT BOND RIGHTS CONDITIONALLY
OR 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,
CHECK THE CONDITIONAL WAIVER AND RELEASE CLAUSE.
Identifying Information
Name of Claimant:
Name of Customer:
Job Location:
Owner:
Through Date:
☐ Unconditional Waiver and Release - This document waives and releases lien, stop payment notice,
and payment bond rights the claimant has for labor and service provided, and equipment and material
delivered, to the customer on this job through the Through Date of this document. Rights based upon labor
or service provided, or equipment or material delivered, pursuant to a written change order that has been
fully executed by the parties prior to the date that this document is signed by the claimant, are waived and
released by this document, unless listed as an Exception below. The claimant has received the following
progress payment.
$___________________________________
Exceptions
This document does not affect any of the following:
(1) Retentions.
(2) Extras for which the claimant has not received payment.
(3) Contract rights, including (A) a right based on rescission, abandonment, or breach of
contract, and (B) the right to recover compensation for work not compensated by the payment.
Signature
Claimant's Signature:
Claimant's Title:
Date of Signature:
☐ Conditional Waiver and Release - This document waives and releases lien, stop payment notice, and
payment bond rights the claimant has for labor and service provided, and equipment and material
delivered, to the customer on this job through the Through Date of this document. Rights based upon labor
or service provided, or equipment or material delivered, pursuant to a written change order that has been
fully executed by the parties prior to the date that this document is signed by the claimant, are waived and
released by this document, unless listed as an Exception below. This document is effective only on the
claimant's receipt of payment from the financial institution on which the following check is drawn:
PLEASE CHECK ONE (1)
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