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Conditional Waiver and Release on Progress Payment
Arizona A.R.S. § 33-1008
Identifying Information
- Project Name:
- ________________
- Job Number / Invoice:
- ________________
- Claimant:
- ________________
- Customer:
- ________________
- Owner:
- ________________
- Job Location:
- ________________
- Payment Amount:
- $__________
- Through Date:
- ________________
Waiver and Release
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 claim or payment rights for persons in the undersigned's position that the undersigned has on the above referenced project to the following extent.
This release covers a progress payment for all labor, services, equipment or materials furnished to the jobsite or to the customer through the Through Date shown above, except for retention, pending modifications and changes or other items furnished.
Before any recipient of this document relies on it, that person should verify evidence of payment to the undersigned.
The undersigned warrants that the undersigned either has already paid or will use the money the undersigned receives from this progress payment promptly to pay in full all of the undersigned's laborers, subcontractors, materialmen and suppliers for all work, materials, equipment or services provided for or to the above referenced project in regard to the attached statement(s) or progress payment request(s).
Signature
Claimant's Signature — ________
Date of Signature: ________