Conditional and Unconditional Waiver and Release Forms
Conditional Waiver and Release Upon Final Payment
Use this form when the claimant is required to execute a waiver and release in exchange for or in order to induce the
payment of a final payment and the claimant has not been paid. This release is only binding if there is evidence of
payment to the claimant. Evidence of payment may be demonstrated by:
• the claimant’s endorsement on a single check or a joint payee check which has been paid by the bank upon which
it was drawn; or
• written acknowledgment of payment given by the claimant.
CONDITIONAL WAIVER AND RELEASE UPON FINAL PAYMENT
Civil Code Section 3262(d)(3)
Upon receipt by the undersigned of a check from________________________________________
in the sum of $____________________ payable to _____________________________________
and when the check has been properly endorsed and has been paid by the bank upon which it is
drawn, this document shall become effective to release any mechanic’ s lien, stop notice, or bond right
the undersigned has on the job of ____________________________________________________
located at_______________________________________________________________________ .
This release covers the final payment to the undersigned for all labor , services, equipment, or material
furnished on the job, except for disputed claims for additional work in the amount of $ ___________ .
Before any recipient of this document relies on it, the party should verify evidence of payment to the
undersigned.
Dated: ________________________ ______________________________________________
By ____________________________________________
MAKER OF CHECK
AMOUNT OF CHECK
PAYEE OR PAYEES OF CHECK
OWNER
COMPANY NAME
TITLE
JOB DESCRIPTION
7/04
NOTE: This form of release complies with the requirements of Civil Code Section 3262(d)(3). It is not effective until the check that constitutes final
payment has been properly endorsed and has cleared the bank.
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