Contractor Release Form
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 THE RIGHTS INDICATED BEFORE. 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
Claimant Name
First Name Last Name
Customer Name
First Name Last Name
Owner
First Name Last Name
Through Date
Month Day Year
Date
Job Address
Street Address
Street Address Line 2
City State / Province
Postal / Zip Code
Please check one.
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 Exceptions below. 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.
Amount
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
Signature Date
Month Day Year
Claimant's Title
Claimant's Signature
Clear
Should be Empty:

Contractor Release Form

Identifying Information

Exceptions

Signature