Conditional Lien Waiver and Release on Final Payment
Generic template for projects in states without a statutory waiver form. Not legal advice.
Claimant (name of the party signing and giving up lien rights)
Customer (party paying the claimant)
Property owner
Project name
Job number / PO / subcontract number
Project address or legal description
Final payment amount ($)
Payment made by (maker of check or payer)
Payable to (payee)
Upon receipt by the Claimant of a final payment from the Customer in the amount shown above, and once that payment has been properly endorsed (if a check) and paid by the bank on which it is drawn or otherwise received in good funds, this document becomes effective to waive and release any mechanic’s lien, stop notice, bond or payment right the Claimant has on the project described above, for all labor, services, equipment and materials furnished to the project.
This is a final waiver. Apart from the items listed under Exceptions, it covers all work the Claimant has furnished to the project, including retention, change orders and extra work.
If the payment is not received, or does not clear, this document has no effect and the Claimant keeps all of its lien and payment rights.
Exceptions (disputed claims NOT waived, with amounts):
Claimant’s company name
Signature
Printed name and title
Date signed