Unconditional Lien Waiver and Release on Progress 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
Work covered through (date)
Amount of payment received ($)
The Claimant has received a progress payment in the amount shown above for labor, services, equipment and materials furnished to the project described above.
The Claimant unconditionally waives and releases any mechanic’s lien, stop notice, bond or payment right it has on the project for labor, services, equipment and materials furnished through the date shown above, except for the items listed under Exceptions.
This waiver covers a progress payment only. It does not cover retention, pending change orders, extra work, or labor, services, equipment or materials furnished after the date shown above.
Exceptions (amounts or claims NOT waived, e.g. disputed change orders, retention, unpaid prior invoices):
Notice to claimant: this document waives rights unconditionally and states that you have been paid. Do not sign it if you have not been paid. If you have not been paid, use a conditional waiver.
Claimant’s company name
Signature
Printed name and title
Date signed