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Conditional Waiver And Release On Progress Payment Form

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CIVIL CODE SECTION 8132

CONDITIONAL WAIVER AND RELEASE ON PROGRESS PAYMENT

NOTICE: THIS DOCUMENT WAIVES THE CLAIMANT’S LIEN, STOP PAYMENT

NOTICE, AND PAYMENT BOND RIGHTS EFFECTIVE ON RECEIPT OF PAYMENT. A

PERSON SHOULD NOT RELY ON THIS DOCUMENT UNLESS SATISFIED THAT THE

CLAIMANT HAS RECEIVED PAYMENT.

Identifying Information

Name of Claimant: _________________________________________________

Names of Customer: _______________________________________________

Job Location: _____________________________________________________

Owner: __________________________________________________________

Through Date: ____________________________________________________

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:

Maker of Check: ____________________________________________________

Amount of Check: $ _________________________________________________

Check Payable to: ___________________________________________________

Exceptions

This document does not affect any of the following:

(1) Retentions.

(2) Extras for which the claimant has not received payment.

(3) The following progress payments for which the claimant has previously given a

conditional waiver and release but has not received payment:

Date(s) of waiver and release: ___________________________________________

Amount(s) of unpaid progress payment(s): $ _______________________________

(4) 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 On Progress Payment Form

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