Fill and Sign the Conditional Waiver 497427487 Form

Prepared by, recording requested by and return to: ----------------------Above this Line for Official Use Only---------------------Name: _____________________ Company: _____________________ Address: _______________________ City: ____________________ State: _____ Zip: _________ Phone: _________________ Fax: _________________ Nature of Document: Conditional Waiver and Release Upon Progress Payment CONDITIONAL WAIVER AND RELEASE UPON PROGRESS PAYMENT- INDIVIDUAL (Utah Code Ann. §38-1-39(4)(b)) COMES NOW, __________________________________ , as a lien claimant who is required to execute a waiver and release in exchange for or to induce the payment of a progress billing, and would state the following: Property Name: ________________________________________________________________________ Property Location and Description: ________________________________________________________________________ Undersigned's Customer: __________________________________ Invoice/Payment Application Number: __________________________________ Payment Amount: ________________ Payment Period: __________________________________ To the extent provided below, this document becomes effective to release and the undersigned is considered to waive any notice of lien or right under Utah Code Ann., Title 38, Chapter 1, Mechanics' Liens, or any bond right under Utah Code Ann., Title 14, Contractors' Bonds, or Section 63G-6-505 related to payment rights the undersigned has on the above described property once the undersigned endorses a check in the above referenced payment amount payable to the undersigned, and the check is paid by the depository institution on which it is drawn. Conditional Waiver and Release Upon Progress Payment Page 1 of 2 This waiver and release applies to a progress payment for the work, materials, equipment, or a combination of work, materials, and equipment furnished by the undersigned to the property or to the undersigned's customer which are the subject of the invoice or payment application, but only to the extent of the payment amount. This waiver and release does not apply to any retention withheld; any items, modifications, or changes pending approval; disputed items and claims; or items furnished or invoiced after the payment period. 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 the undersigned's laborers, subcontractors, materialmen, and suppliers for all work, materials, equipment, or combination of work, materials, and equipment that are the subject of this waiver and release. This the _____ day of _______________ , 20 ______ . ______________________________ Company Name _____ _________________________ By _____ _________________________ Its _____ _________________________ Type or Print Name Acknowledgment of Individual State of Utah County of __________________ On the ______ day of __________________ , 20 ______ , personally appeared before me ______________________________ , the signer of the foregoing instrument, who duly acknowledged to me that he/she executed the same. (Seal) Notary Public My commission expires:             Type or Print Name Residing at:       Conditional Waiver and Release Upon Progress Payment Page 2 of 2