CONDITIONAL WAIVER AND RELEASE ON PROGRESS PAYMENT

IMPORTANT STATUTORY NOTICE

WARNING: Twelve (12) states currently mandate specific statutory lien waiver forms: Arizona, California, Florida, Georgia, Massachusetts, Michigan, Mississippi, Missouri, Nevada, Texas, Utah, and Wyoming. In those jurisdictions, a lien waiver that does not substantially comply with the prescribed statutory form is unenforceable and void. Before using this template, confirm whether your state requires a statutory form and, if so, use the state-prescribed form instead. This universal template is designed for jurisdictions that do not prescribe a mandatory form, or as a reference and drafting guide for customization by licensed counsel.

NOTICE TO ALL PARTIES

THIS DOCUMENT WAIVES THE CLAIMANT'S LIEN, STOP PAYMENT NOTICE, AND PAYMENT BOND RIGHTS EFFECTIVE ON RECEIPT OF PAYMENT. A PERSON SHOULD NOT RELY ON THIS DOCUMENT UNLESS SATISFIED THAT THE CLAIMANT HAS RECEIVED PAYMENT.

THIS IS A CONDITIONAL WAIVER. IT DOES NOT BECOME EFFECTIVE UNTIL THE CLAIMANT ACTUALLY RECEIVES PAYMENT AND THE PAYMENT INSTRUMENT HAS BEEN HONORED BY THE FINANCIAL INSTITUTION ON WHICH IT IS DRAWN. IF THE PAYMENT IS NOT RECEIVED OR THE INSTRUMENT IS DISHONORED, THIS WAIVER IS VOID AND ALL LIEN, STOP PAYMENT NOTICE, AND BOND RIGHTS ARE FULLY PRESERVED.

SECTION 1: WAIVER TYPE SELECTION

Select the type of conditional waiver being executed:

☐ Conditional Waiver and Release on Progress Payment (claimant has NOT yet been paid; waiver becomes effective only upon receipt and clearance of payment)

☐ Conditional Waiver and Release on Final Payment (if final payment, use a separate Final Payment waiver form)

Note: If the claimant HAS already been paid, an Unconditional Waiver and Release should be used instead of this Conditional form. The four standard types of construction lien waivers are:

SECTION 2: PROJECT IDENTIFICATION

SECTION 3: CLAIMANT IDENTIFICATION

SECTION 4: CUSTOMER / HIRING PARTY IDENTIFICATION

SECTION 5: PROGRESS PAYMENT INFORMATION

SECTION 6: CONDITIONAL WAIVER AND RELEASE

6.1 Conditional Waiver Language

Upon receipt of payment in the amount of $ [________________________________] (the "Payment Amount"), the undersigned Claimant hereby waives and releases any and all lien rights, stop payment notice rights, payment bond rights, and any and all other rights or claims the Claimant has or may have against the property, the Owner, the General Contractor, the construction lender, and/or the surety on any payment bond, to the extent of the Payment Amount, for all labor, services, equipment, and/or materials furnished by the Claimant to the above-referenced project through the Through Date of [__/__/____].

6.2 Condition Precedent to Effectiveness

This waiver and release is expressly conditioned upon, and shall not become effective until, ALL of the following conditions are satisfied:

(a) The Claimant has received the payment described in this document;

(b) The payment instrument (check, draft, electronic fund transfer, or other form of payment) has been finally honored, cleared, and irrevocably credited to the Claimant's account by the financial institution on which it is drawn or through which it is processed;

(c) The payment has not been reversed, stopped, charged back, or otherwise dishonored.

If any of these conditions are not satisfied, this waiver and release is automatically null and void, and the Claimant retains all lien, stop payment notice, bond, and claim rights as if this document had never been executed.

6.3 Payment Instrument Information

6.4 Scope of Waiver

This conditional waiver and release covers only the following:

(a) Labor, services, equipment, and materials furnished by the Claimant to the above-referenced project through the Through Date specified in Section 5;

(b) Rights based upon labor or service provided, or equipment or material delivered, pursuant to a written change order that has been fully executed by all parties prior to the date of this document, unless listed as an Exception in Section 7 below;

(c) Only the specific Payment Amount stated herein -- this waiver does not release or waive any amount in excess of the Payment Amount.

6.5 Rights NOT Waived

This conditional waiver and release expressly does NOT waive, release, or affect any of the following, regardless of whether listed as Exceptions in Section 7:

(a) Any rights or claims arising from work, labor, services, equipment, or materials furnished after the Through Date;

(b) Any retention or retainage amounts withheld from any payment;

(c) Any rights or claims under any pending, unapproved, or disputed change orders;

(d) Any claims for delay damages, acceleration costs, impact damages, or loss of productivity;

(e) Any claims for breach of contract, warranty claims, or indemnification rights;

(f) Any rights arising under any other contract or project between the parties;

(g) Any previously submitted conditional waivers for which the Claimant has not yet received payment;

(h) Any rights or claims relating to stored materials not yet incorporated into the project (unless specifically included in the Payment Amount);

(i) Any statutory rights that cannot be waived as a matter of law in the applicable jurisdiction.

SECTION 7: EXCEPTIONS TO THIS WAIVER

The Claimant expressly reserves the following rights, claims, and amounts, which are NOT released or waived by this document:

7.1 Retention/Retainage

☐ Retention is withheld on this project.

☐ No retention is withheld on this project.

7.2 Disputed Claims

☐ The following disputed claims are expressly excluded from this waiver:

☐ No disputed claims exist as of the date of this waiver.

7.3 Pending Change Orders

☐ The following pending or unapproved change orders are expressly excluded from this waiver:

☐ No pending change orders exist as of the date of this waiver.

7.4 Extras and Additional Work

☐ The following claims for extra or additional work not covered by this payment are expressly excluded:

☐ No claims for extras or additional work exist as of the date of this waiver.

7.5 Prior Unpaid Conditional Waivers

☐ The following prior conditional waivers have been submitted but payment has NOT yet been received or cleared:

☐ All prior conditional waivers have been satisfied by receipt of payment.

7.6 Delay, Impact, and Other Claims

☐ The following additional claims are expressly excluded from this waiver:

☐ No delay, impact, or other claims exist as of the date of this waiver.

7.7 Other Exceptions

☐ The following additional exceptions apply:

[________________________________]

[________________________________]

☐ No other exceptions apply.

SECTION 8: CLAIMANT'S CERTIFICATIONS AND WARRANTIES

The undersigned Claimant hereby certifies and warrants as follows:

8.1 The Claimant has furnished or caused to be furnished the labor, services, equipment, and/or materials described herein to the above-referenced project through the Through Date.

8.2 The Progress Payment Amount stated in this document accurately represents the amount due and owing for work performed through the Through Date, subject to the Exceptions listed in Section 7.

8.3 The Claimant has paid, or will use the funds received from this progress payment to promptly pay in full, all of the Claimant's laborers, subcontractors, sub-subcontractors, materialmen, and suppliers for all work, materials, equipment, and services provided for the above-referenced project through the Through Date, except for any amounts listed as Exceptions.

8.4 The Claimant has no knowledge of any unpaid claims of any person or entity furnishing labor, services, equipment, or materials through the Claimant for the above-referenced project, except as specifically disclosed in the Exceptions.

8.5 The undersigned individual is duly authorized to execute this waiver and release on behalf of the Claimant and has the legal authority to bind the Claimant.

8.6 All information provided in this document is true, correct, and complete to the best of the Claimant's knowledge and belief.

8.7 The Claimant has complied with all applicable preliminary notice, notice to owner, and other statutory notice requirements necessary to preserve lien and bond rights in connection with this project.

SECTION 9: LOWER-TIER WAIVER STATUS

☐ Not Applicable -- Claimant has no lower-tier subcontractors or suppliers on this project.

☐ Lower-Tier Waivers Attached -- Conditional waivers from the following lower-tier subcontractors and suppliers are attached hereto:

☐ Lower-Tier Waivers to Follow -- Claimant will provide lower-tier waivers within [____] business days of receipt of payment.

SECTION 10: SIGNATURE AND EXECUTION

10.1 Claimant's Signature Block

10.2 Acknowledgment of Receipt (Optional)

The undersigned acknowledges receipt of this Conditional Waiver and Release on Progress Payment:

SECTION 11: NOTARIZATION (If Required by Contract or Jurisdiction)

☐ Notarization is required by the governing contract.
☐ Notarization is required by the applicable jurisdiction.
☐ Notarization is being provided voluntarily.
☐ Notarization is not required.

STATE OF [________________________________]

COUNTY OF [________________________________]

On this [____] day of [________________], [____], before me, [________________________________], a Notary Public in and for the above-referenced State and County, personally appeared [________________________________], who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.

I certify under PENALTY OF PERJURY under the laws of the State of [________________________________] that the foregoing paragraph is true and correct.

WITNESS my hand and official seal.

[NOTARY SEAL/STAMP]

SECTION 12: STATE-SPECIFIC REQUIREMENTS AND VARIATIONS

STATES WITH MANDATORY STATUTORY FORMS

The following twelve (12) states require the use of specific statutory lien waiver forms. In these states, this universal template may NOT be used in place of the prescribed form. Consult the applicable statute and use the state-mandated form.

CALIFORNIA (Cal. Civ. Code Sections 8130-8138)

Form Requirement: California mandates use of the statutory form prescribed by Civil Code Section 8132 for conditional waivers on progress payments. Any waiver that does not substantially follow the statutory form is unenforceable.

Key Provisions:
- The statutory form covers lien rights, stop payment notice rights, and payment bond rights
- Waiver is effective only upon receipt of payment from the financial institution on which the check is drawn
- "Through Date" establishes the temporal scope of the waiver
- Exceptions automatically preserved include: (a) retention, (b) extras for which claimant has not received payment, and (c) prior conditional waivers for which payment has not been received
- Claimant need not list retention or prior unpaid conditional waivers as separate exceptions -- they are preserved by operation of the statutory form
- Under Cal. Civ. Code Section 8136, an oral or written statement purporting to waive rights under the mechanic's lien law, other than in compliance with Sections 8132-8138, is void and unenforceable

Practice Note: California practitioners must use the exact statutory language from Section 8132. Do NOT modify the statutory form language, as any material deviation may render the waiver unenforceable.

TEXAS (Tex. Prop. Code Sections 53.281-53.287)

Form Requirement: Texas mandates use of statutory forms under Property Code Section 53.284. A waiver that does not substantially comply is unenforceable.

Key Provisions:
- Four statutory forms prescribed: conditional progress, unconditional progress, conditional final, unconditional final
- The conditional progress payment waiver is used when claimant has NOT been paid or has received only a single payee or joint payee check
- Signer warrants that it has already paid or will use the funds to promptly pay all laborers, subcontractors, materialmen, and suppliers
- Waiver is effective only when check has been properly endorsed and paid by the bank on which it is drawn
- Under Section 53.281, a waiver not complying with the statutory form is unenforceable
- Section 53.282 prohibits requiring a claimant to execute a waiver that does not comply with the statutory forms
- The waiver must include specific notice language prescribed by the statute

Practice Note: Texas requires the signer to include a warranty regarding payment to lower-tier parties. Ensure this warranty is accurate, as it may create independent liability.

FLORIDA (Fla. Stat. Section 713.20)

Form Requirement: Effective July 1, 2025, Florida requires lien waiver forms to be identical to the statutory forms (the word "substantially" was removed from the statute by SB 658). Prior to that date, forms needed only to be "substantially similar."

Key Provisions:
- Two statutory forms: progress payment and final payment
- Florida permits conditional language to be added to the statutory form, making the waiver effective only upon receipt of actual funds (Fla. Stat. Section 713.20(6))
- The 2025 amendments formally accommodate electronic fund transfers (EFTs) and other verifiable payment systems, in addition to checks
- A person may NOT require a lienor to furnish a waiver different from the statutory forms
- The waiver covers the lienor's lien for labor, services, or materials furnished through the specified date
- Florida requires specification of the property description and the name of the owner

Practice Note: Given the 2025 changes eliminating the "substantially similar" standard, Florida practitioners must ensure exact compliance with the statutory form language. Adding conditional language is permitted under Section 713.20(6) but should follow the statutory framework closely.

NEW YORK (N.Y. Lien Law Section 34)

Form Requirement: New York does NOT prescribe a statutory lien waiver form. Parties have flexibility in drafting waiver language, but waivers must comply with important statutory restrictions.

Key Provisions:
- Under N.Y. Lien Law Section 34, any contract or agreement made in advance of furnishing labor or materials that purports to waive the right to file or enforce a mechanic's lien is void as against public policy
- Lien waivers cannot be executed before the work is performed or materials are delivered
- Waivers may be conditional (effective upon receipt of payment) or unconditional (effective immediately)
- A valid waiver must clearly state the amount being waived and the property to which it applies
- The waiver must demonstrate a clear intention to waive lien rights
- The waiver must be signed by the party waiving lien rights
- New York does not prohibit advance waiver of bond claims -- only lien rights are protected under Section 34

Practice Note: Because New York has no statutory form, this universal template (with appropriate modifications for New York law) may be used. However, ensure the waiver is executed contemporaneously with or after the progress payment, never in advance. Include clear conditional language to protect the claimant until payment is received and cleared.

ADDITIONAL STATE NOTES

SECTION 13: PROTECTIVE GUIDANCE FOR CLAIMANTS

13.1 Before Signing This Waiver

☐ Verify that the Payment Amount accurately reflects the amount you are owed for work through the Through Date.

☐ Confirm that all Exceptions (retention, disputed claims, pending change orders, extras) are properly and completely listed in Section 7.

☐ Ensure the Through Date does not extend beyond the period for which you are actually being paid.

☐ If you have lower-tier subcontractors or suppliers, confirm their payment status and note any outstanding obligations.

☐ Verify that you have complied with all applicable preliminary notice requirements (e.g., California Preliminary 20-Day Notice, Texas notice requirements, Florida Notice to Owner).

☐ Confirm that the check or payment instrument information is accurate and matches the payment you expect to receive.

☐ Review the waiver to ensure it does not contain overly broad release language that goes beyond lien, stop notice, and bond rights (e.g., broad general releases of all claims).

☐ If in a statutory-form state, confirm that the prescribed statutory form is being used rather than this universal template.

☐ Retain a complete copy of the signed waiver and all attachments for your records.

13.2 After Signing This Waiver

☐ Deposit the payment instrument promptly and monitor for clearance.

☐ If the check or payment is dishonored, bounces, or is reversed, immediately notify all parties in writing that the conditional waiver is void and that all lien rights are preserved.

☐ In Georgia: If the interim waiver is signed and payment is NOT received, record an affidavit of nonpayment with the county clerk within 90 days of signing, or lien rights will be lost.

☐ Maintain a log of all conditional waivers submitted and their payment/clearance status.

☐ After payment clears, pay all lower-tier subcontractors and suppliers promptly.

13.3 Common Pitfalls to Avoid

SECTION 14: INSTRUCTIONS FOR COMPLETING THIS FORM

14.1 Step-by-Step Guide

Step 1: Complete Section 2 (Project Identification) with full project details, including legal description if required by your jurisdiction.

Step 2: Complete Section 3 (Claimant Identification) with the claimant's full legal name, address, and contact information.

Step 3: Complete Section 4 (Customer Identification) with the information for the party who directly hired the claimant.

Step 4: Complete Section 5 (Payment Information) with accurate financial figures. The Through Date should correspond exactly to the billing period covered by the progress payment.

Step 5: Complete Section 6 (Conditional Waiver) with the Payment Amount and payment instrument details. Ensure the Payment Amount matches the net amount of the progress payment after retention.

Step 6: Complete Section 7 (Exceptions) thoroughly. List every reserved claim, disputed item, pending change order, and retained amount. Anything not listed may be deemed waived in some jurisdictions.

Step 7: Review Section 8 (Certifications) and confirm all statements are accurate before signing.

Step 8: Complete Section 9 (Lower-Tier Status) if the claimant has subcontractors or suppliers.

Step 9: Execute the waiver in Section 10. Obtain notarization in Section 11 if required.

Step 10: Deliver the signed waiver to the requesting party and retain a complete copy.

14.2 Document Retention

Maintain copies of all executed conditional waivers, together with proof of payment receipt and clearance, for a minimum of:

SECTION 15: DEFINITIONS

For purposes of this document, the following terms have the meanings set forth below:

SOURCES AND REFERENCES

Statutory Citations

• California Civil Code Sections 8130-8138 -- Waiver and Release provisions for construction claims
• Section 8132: Conditional Waiver and Release Upon Progress Payment (statutory form)
• Section 8134: Unconditional Waiver and Release Upon Progress Payment
• Section 8136: Prohibition on non-statutory waiver forms

• https://leginfo.legislature.ca.gov/faces/codes_displayText.xhtml?lawCode=CIV&division=4.&title=2.&part=6.&chapter=5.&article=

• Texas Property Code Sections 53.281-53.287 -- Waiver and Release of Lien or Payment Bond Claim

• Section 53.284: Forms for Waiver and Release (four statutory forms)

• https://statutes.capitol.texas.gov/Docs/PR/htm/PR.53.htm

• Florida Statutes Section 713.20 -- Waiver or Release of Liens

• Amended effective July 1, 2025 (SB 658) -- forms must now be identical to statutory forms

• https://www.flsenate.gov/Laws/Statutes/2025/713.20

• New York Lien Law Section 34 -- Public policy prohibition on advance lien waivers

• https://www.nysenate.gov/legislation/laws/LIE/34

• Arizona Revised Statutes Section 33-1008 -- Waiver of Lien (statutory forms)

• https://www.azleg.gov/ars/33/01008.htm

• Georgia Code Section 44-14-366 -- Interim and Final Waiver Forms; Affidavit of Nonpayment

• https://law.justia.com/codes/georgia/title-44/chapter-14/article-8/part-3/section-44-14-366/

• Michigan Compiled Laws Section 570.1115 -- Waiver of Lien (statutory forms)

• https://www.legislature.mi.gov/Laws/MCL?objectName=mcl-570-1115

Industry References

• American Institute of Architects (AIA) Document G901-2022: Conditional Waiver and Release on Progress Payment

• https://aiacontracts.com/contract-documents/g901-2022

• Contractors State License Board (CSLB) -- California Conditional and Unconditional Waiver Forms

• https://www.cslb.ca.gov/consumers/legal_issues_for_consumers/mechanics_lien/conditional_and_unconditional_waiver_release_form.aspx

Additional Resources

• National Association of Surety Bond Producers (NASBP) -- Lien Waivers and Releases of Claims: Best Practices

• https://www.nasbp.org/

• Levelset -- Lien Waiver Forms and State-by-State Requirements

• https://www.levelset.com/lien-waivers/

This template is provided for informational and educational purposes only and does not constitute legal advice. Twelve states mandate specific statutory lien waiver forms that must be used in lieu of this template. Laws governing mechanic's liens, stop payment notices, and payment bonds vary significantly by jurisdiction and are subject to change. Consult a qualified construction attorney licensed in your jurisdiction before executing any lien waiver or release. Last updated: 2026-02-17.