Sub-Tier Lien Release Form
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1SUB-TIER LIEN RELEASE
(
)
Interim Lien/Claim Waiver
FROM: ___________________________
CONTRACTOR: ____________________________
CONTACT: ________________________
PROJECT:_________________________________
PHONE: __________________________
ADDRESS: ________________________________
CONDITIONAL RELEASE
UNCONDITIONAL RELEASE
Current Month Due
Cumulative Payments
The undersigned does hereby acknowledge that upon
The undersigned does hereby acknowledge that the
receipt
by
the
undersigned
of
a
check
from
undersigned has been paid and has received progress
__________________________,
in
the
amount
of
payments in the sum of $_____________ for labor,
$_____________ and when the check has been properly
services, equipment, materials furnished to the above-
endorsed and has been paid by the bank upon which it
referenced Project and does hereby release pro tanto any
was drawn, this document shall become effective to
and all claims and rights of lien which the undersigned has
release pro tanto any and all claims and rights of lien which
on the above-referenced Project. This release covers all
the undersigned has on the above-referenced Project.
payment for labor, services, equipment, materials furnished
This release covers a progress payment for labor,
and/or claims to the above referenced Project through
services, equipment, materials furnished and/or claims
____________ and does not cover any retainage or items
through ___________ only and does not cover any
furnished after that date.
The undersigned further
retainage or items furnished after that date.
The
represents and warrants that full payment has been made,
undersigned further represents and warrants that full
or will be made, out of proceeds of progress payment to all
payment has been made, or will be made, out of progress
suppliers of labor and materials (subcontractors). The
payment made herewith to all suppliers of labor and
undersigned shall and does hereby indemnify, save and
materials (subcontractors).
Before any recipient of this
hold PDG Construction Services, Inc. and Owner harmless
document relies on it, said party should verify evidence of
from any and all claims, damages, liens, or losses,
payment to the undersigned.
expenses, including all costs, professional fees, and
attorney’s fees, which contractor and owner may suffer or
incur by reason of the filing of any claims, notices, liens
I CERTIFY UNDER PENALTY OF PERJURY UNDER
encumbrances, suits against PDG Construction Services,
THE LAWS OF THE STATE OF OREGON THAT THE
Inc., the Owner and Property, upon 10 days written notice
ABOVE IS A TRUE AND CORRECT STATEMENT.
and the failure of the undersigned to obtain cancellation
discharge thereof.
______________________________________
Signature of Authorized Corporate Officer/Partner/Owner
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
Title
SIGN IT, EVEN IF YOU HAVE NOT BEEN PAID. IF YOU
HAVE NOT BEEN PAID, USE THE CONDITIONAL
RELEASE FORM.
Dated this ________ day of ______________, 20________ at
_________________________, ____________.
I CERTIFY UNDER PENALTY OF PERJURY UNDER THE
LAWS OF THE STATE OF OREGON THAT THE ABOVE
IS A TRUE AND CORRECT STATEMENT.
_______________________________________________
Signature of Authorized Corporate Officer/Partner/Owner
___________________________________________
Title
Dated this ________ day of ______________, 20________ at
_________________________, ____________.
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