Fill and Sign the Conditional Waiver Release Payment Form

Conditional Waiver and Release Upon Progress Payment Page 1 of 2 This Instrument Prepared By: Name __________________________ Address __________________________________________ ________ CONDITIONAL WAIVER AND RELEASE UPON PROGRESS PAYMENT (C.R.S. Article 22, Title 38, Mechanics’ Lien) The undersigned, __________________________________ , has been p aid and has received a progress payment in the sum of $ _________________ for labor, services, equipment or material furnished to ________________________ (Your __________________________________ (sub -contractor, agent) on the job of __________________________________ (Contractor or General Contractor) located at the (Customer’s) (Owner’s) property located at _____________________________________________________________________________ , in the City of _________________ , County of ___________ ______ , State of Colorado, and does hereby waive and release (Job Description, such as “roofing materials, plumbing labor and materials, etc.)) any right to a mechanic’s lien, stop notice, or any rig ht against a labor and material bond on the job to the following extent . This release covers a progress payment for labor, services, equipment, or materials furnished to ________________________________ , your customer, through the _____ day of __________________ , 20 _____ only and does not cover any retentions retained before or after the release date; extras furnished before the re lease date for which payment has not been received; extras or items furnished after the release date. Rights based upon work performed or items furnished under a written change order which has been fully executed by the parties prior to the release date ar e covered by this release unless specifically reserved by the claimant in this release. This release of any mechanic’s lien, stop notice, or any right shall not otherwise affect the contract rights, including rights between parties to the contract based up on a rescission, abandonment, or breach of the contract, or the right of the undersigned to recover compensation for furnished labor, services, equipment, or material covered by this release if that furnished labor, services, equipment, or material was not compensated by the progress payment. Before any recipient of this document relies on it, said party should verify evidence of payment to the undersigned. Dated this the _____ day of ________________ , _____ . ____________________________________________ (Company Name) By _________________________________________ Print/Type Name _____ _________________________ Conditional Waiver and Release Upon Progress Payment Page 2 of 2 Title _____ ___________________________________