This form is based on the form found in Tex. Prop. Code § 53.284(b). If a contractor (or other potential lien claimant) is required to execute a waiver and release in exchange for or to induce 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 read as follows.
Conditional Partial Release During Construction
Project:
Job No.:
On receipt by the signer of this document of a check from [name of maker of check] in the sum of $[amount] payable to [name[s] of payee[s] 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 [name of owner] located at [specify location] to the following extent: [specify job description].
This release covers a progress payment for all labor, services, equipment, or materials furnished to the property or to [name of 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
[Name and title]