Fill and Sign the Unconditional Release Nevada Form

UNCONDITIONAL WAIVER AND RELEASE UPON PROGRESS PAYMENT- CORPORATION Property Name: __________________________________ Property Location: _______________________________________________________ Undersigned's Customer: __________________________________ Invoice/Payment Application Number: _____________________________ Payment Amount: ________________________ The undersigned has been paid and has received a progress payment in the above-referenced Payment Amount for all work, materials and equipment the undersigned furnished to the undersigned’s Customer for the above-described Property and does hereby waive and release any notice of lien, any private bond right, any claim for payment and any rights under any similar ordinance, rule or statute related to payment rights that the undersigned has on the above — described Property to the following extent: ________________________________________________________________________ _______________________________________________________________________ . This release covers a progress payment for the 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 or such portion of the Payment Amount as the undersigned is actually paid, and does not cover any retention withheld, any items, modifications or changes pending approval, disputed items and claims, or items furnished that are not paid. 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 or equipment that are the subject of this waiver and release. This the _____ day of _______________ , 20 ______ . ______________________________ (Company Name) By: __________________________ _____ _________________________ Type or Print Name Its: __________________________ Unconditional Waiver and Release Upon Progress Payment Page 1 of 2 Notice: This document waives rights unconditionally and states that you have been paid for giving up those rights. This document is enforceable against you if you sign it to the extent of the Payment Amount or the amount received. If you have not been paid, use a conditional releasee form. This the _____ day of _______________ , 20 ______ . ______________________________ Signature _____ _________________________ Type or Print Name State of Nevada County of _________________ This instrument was acknowledged before me on _____________ by _________________________________ as (type of authority, e.g., officer, trustee, etc.) ___________________________________ of (name of party on behalf of whom instrument was executed) _________________________________ . ___________________________ (Signature of notarial officer) (Seal, if any) ___________________________ (Title and rank (optional)) (My commission expires (optional): ___________ ) Certificate of Delivery I, _____________________________________, hereby certify that I have delivered this day a true and correct copy of the foregoing to ___________________________________ by: ( ) Personal Service ( ) Mailing a true and correct copy of same by certified U.S. mail, postage prepaid, return receipt requested to _____________________________________. So certified this the ______ day of ___________________, 20____. ________________________ Signature Unconditional Waiver and Release Upon Progress Payment Page 2 of 2