Lien Waiver Template
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1Lien Waiver
From:
_______________________________
Project:
______________________________
(Firm giving release)
(Project Name)
(Business Address)
(Project Address)
Contact Person:
_______________
Contact Telephone:
________________
UNCONDITIONAL RELEASE
CONDITIONAL RELEASE
The undersigned does hereby acknowledge that
the undersigned has received progress payments in
The undersigned does hereby acknowledge that
the sum of _______________ for labor, services,
upon receipt by the undersigned of a check from
equipment or materials furnished to the above
________________________
in the sum of
referenced job and does hereby release pro tanto
_____________and when the check has been
any and all claims and rights of lien which
properly endorsed and has been paid by the bank
the undersigned has on the above referenced job,
upon which it was drawn, this document shall
except unsettled claims previously communicated
become effective to release pro tanto any and all
in writing and included on the undersigned's
claims and rights of lien which the undersigned has
Change Estimate Log. Subject to the same
on the above referenced job, except unsettled
exception, this release covers all payment for labor
claims previously communicated in writing and
services, equipment, materials furnished and/or
included on the undersigned's Change Estimate
claims to the above referenced job through
Log. Subject to the same exception, this release
______________ only and does not cover
covers a progress payment for labor, services,
any retention or items furnished after that date.
equipment, materials furnished and/or claims
through _________________ only and does not
NOTICE: THIS DOCUMENT WAIVES RIGHTS
cover any retention or items furnished after that
UNCONDITIONALLY AND STATES THAT YOU HAVE BEEN
PAID FOR GIVING UP THOSE RIGHTS. THIS DOCUMENT IS
date. Before any recipient of this document relies
ENFORCEABLE AGAINST YOU IF YOU SIGN IT, EVEN IF
on it said party should verify evidence of payment to
YOU HAVE NOT BEEN PAID. IF YOU HAVE NOT BEEN PAID,
the undersigned.
USE A CONDITIONAL RELEASE FORM.
I CERTIFY UNDER PENTALY OF PERJURY UNDER LAWS OF
I CERTIFY UNDER PENTALY OF PERJURY UNDER LAWS OF
THE STATE OF COLORADO THAT THE ABOVE IS TRUE AND
THE STATE OF COLORADO THAT THE ABOVE IS TRUE AND
CORRECT STATEMENT.
CORRECT STATEMENT.
Signature:
Signature:
______________________________________
______________________________________
(Authorized Corporate Officer/Partner/Owner)
(Authorized Corporate Officer/Partner/Owner)
(Title)
(Title)
Dated this ___________ day of _____________
Dated this ___________ day of _____________
Subscribed and sworn before me day and year first
Subscribed and sworn before me day and year first
above written:
above written:
By ____________________________________
By ____________________________________
Notary Public for ___________________________
Notary Public for ___________________________
My Commission Expires _____________________
My Commission Expires _____________________
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