Conditional Waiver And Release Upon Final Payment Form printable pdf download

Conditional Waiver And Release Upon Final Payment Form

CONDITIONAL WAIVER AND RELEASE

UPON FINAL PAYMENT

Property Name:

Property Location:

Undersigned’s Customer:

Invoice/Payment Application Number:

Payment Amount:

Payment Period:

Amount of Disputed Claims:

Upon receipt by the undersigned of a check in the above referenced Payment Amount payable to the

undersigned, and when the check has been properly endorsed and has been paid by the bank on which it is

drawn, this document becomes effective to release and the undersigned shall be deemed to waive any

notice of lien, any private bond right, any claim for payment and any rights under any similar ordinance,

rule or statute related to payment rights that the undersigned has on the above described Property to the

following extent:

This release covers the final payment to the undersigned for all work, materials or equipment furnished

by the undersigned to the Property or to the Undersigned’s Customer and does not cover payment for

Disputed Claims, if any. Before any recipient of this document relies on it, he should verify evidence of

payment to the undersigned. The undersigned warrants that he either has already paid or will use the

money he receives from the final payment promptly to pay in full all his laborers, subcontractors,

materialmen and suppliers for all work, materials or equipment that are the subject of this waiver and

release.

Dated: _____________________

(Company Name)

By: ______________________________

Title: ____________________________

Conditional Waiver And Release Upon Final Payment Form