If a claimant or potential claimant is required to execute a waiver and release in exchange for or to induce the payment of a final payment and is not paid in good and sufficient funds 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(d). Tex. Prop. Code § 53.284(a), (d).
Conditional Waiver and Release on Final 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 the final payment to the signer for all labor, services, equipment, or materials furnished to the property or to __________________ (person with whom signer contracted).
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 final 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 up to the date of this waiver and release.
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