If a claimant or potential claimant is required to execute an unconditional waiver and release to prove the receipt of good and sufficient funds for a progress payment and the claimant or potential claimant asserts in the waiver and release that the claimant or potential claimant has been paid the progress payment, the waiver and release must substantially comply with the form below, described in Texas Property Code section 53.284(c). Tex. Prop. Code § 53.284(a), (c). The notice provision must appear at the top of the document, printed in bold type at least as large as the largest type used in the document, but not smaller than ten-point type. Tex. Prop. Code § 53.284(c)(1).
NOTICE: This document waives rights unconditionally and states that you have been paid for giving up those rights. It is prohibited for a person to require you to sign this document if you have not been paid the payment amount set forth below. If you have not been paid, use a conditional release form.
Unconditional Waiver and Release on Progress Payment
(Pursuant to Tex. Prop. Code § 53.284)
Project
Job No.
The signer of this document has been paid and has received a progress payment in the sum of $___________ for all labor, services, equipment, or materials furnished to the property or to _____________________ (person with whom signer contracted) on the property of _______________________ (owner) located at ______________________ (location) to the following extent: ______________________ (job description). The signer therefore waives and releases 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 above referenced project to the following extent:
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.
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