If a claimant or potential claimant is required to execute a waiver and release in exchange for or to induce the payment of a progress payment and is not paid in exchange for the waiver and release, or if a single payee check or joint payee check is given in exchange for the waiver and release, the waiver and release must substantially comply with the form below, described in Texas Property Code section 53.284(b). See Tex. Prop. Code § 53.284(a), (b).
Conditional Waiver and Release on Progress Payment
(Pursuant to Tex. Prop. Code § 53.284)
Project
Job No.
On receipt by the signer of this document of a check from ________________ (maker of check) in the sum of $__________ payable to _____________________ (payee or payees of check) and when the check has been properly endorsed and has been paid by the bank on which it is drawn, this document becomes effective to release any mechanic’s lien right, any right arising from a payment bond that complies with a state or federal statute, any common law payment 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 signer’s position that the signer has on the property of ________________ (owner) located at
______________________ (location) to the following extent:
(job description).
This release covers a progress payment for all labor, services, equipment, or materials furnished to the property or to __________________ (person with whom signer contracted) as indicated in the attached statement(s) or progress payment request(s), except for unpaid retention, pending modifications and changes, or other items furnished.
Before any recipient of this document relies on this document, the recipient should verify evidence of payment to the signer.
The signer warrants that the signer has already paid or will use the funds received from this progress payment to promptly pay in full all of the signer’s laborers, subcontractors, materialmen, and suppliers for all work, materials, equipment, or services provided for or to the above referenced project in regard to the attached statement(s) or progress payment request(s).
Date ____________________________
_________________________________ (Company name)
By ______________________________ (Signature)
_________________________________ (Title)
State of Texas)
County of)
This instrument was ACKNOWLEDGED before me, the undersigned Notary Public, by ___________________________________ (signer’s name), as ________________ (title) of ________________ (company) known to me to be the person whose name is subscribed to the foregoing instrument, who after being duly sworn acknowledged to me that the same was the act of ________________ (company) and that he/she executed same as an act of such company for the purposes and consideration stated therein and further swore that the foregoing was true and correct.
SUBSCRIBED AND SWORN TO on this the ______ day of ____________, 20____.
NOTARY PUBLIC, STATE OF TEXAS