Unconditional Waiver & Release on Progress Payment
NOTICE TO CLAIMANT: THIS DOCUMENT WAIVES AND RELEASES LIEN, STOPPAYMENT NOTICE, AND PAYMENT BOND RIGHTS UNCONDITIONALLY ANDSTATES THAT YOU HAVE BEEN PAID FOR GIVING UP THOSE RIGHTS. THISDOCUMENT IS ENFORCEABLE AGAINST YOU IF YOU SIGN IT, EVEN IF YOUHAVE NOT BEEN PAID. IF YOU HAVE NOT BEEN PAID, USE A CONDITIONALWAIVER AND RELEASE FORM.
Identifying Information
Name of Claimant
*
Your company name here
Name of Customer
*
Write CleanSquad, Inc in area above
Job Address Location
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Through Date
*
-
Month
-
Day
Year
This will be the last day of the month work was completed.
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 ormaterial delivered, pursuant to a written change order that has been fully executed by the parties prior tothe date that this document is signed by the claimant, are waived and released by this document, unlesslisted as an Exception below. The claimant has received the following progress payment:
$$$ Amount of Check Below
*
Claimant's Title
*
Your job title in company.
Your Signature
*
Date of Signature
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: