UNCONDITIONAL WAIVER AND RELEASE ON PROGRESS

UNCONDITIONAL WAIVER AND RELEASE ON PROGRESS PAYMENT

STATE OF ARIZONA

(Pursuant to Arizona Revised Statutes §33-1008)

Project: ___________________________

___________________________

Job No: ___________________________

The undersigned has been paid and has received a progress payment in the sum of $_____________

(Amount of check)

for all labor, services, equipment or material furnished to the jobsite or to:

_________________________________________________________________________________

(Person with whom undersigned contracted)

on the job of ______________________________________________________________________

(Owner)

located at ________________________________________________________________________

(Job Description)

and does hereby release any mechanic's lien, any state or federal statutory bond right, any private

bond right, any claim for payment and any rights under any similar ordinance, rule or statute related to

claim or payment rights for persons in the undersigned's position that the undersigned has on the

above-referenced project to the following extent. This release covers a progress payment for all labor,

services, equipment or materials furnished to the jobsite or to:

_________________________________________________________________________________

(Person with whom undersigned contracted)

through ______________________ only and does not cover any retention, pending modifications and

(Date)

changes or items furnished after that date.

The undersigned warrants that he either has already paid or will use the monies he receives from this

progress payment to promptly pay in full all of his laborers, subcontractors, materialmen and suppliers

for all work, materials, equipment or services provided for or to the above-referenced project up to the

DATED on _______________, 20_____ _________________________________________

(Claimant name)

By: ___________________________________

Its: ___________________________________

Address:____________________________

___________________________________

Phone: ____________________________

Fax: _______________________________

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, EVEN IF YOU HAVE NOT BEEN PAID. IF YOU HAVE NOT BEEN

PAID, USE A CONDITIONAL RELEASE FORM.