Arizona Partial Conditional Lien Waiver



Job No.:

Upon receipt by the undersigned of a check from _________________________________________(Maker of Check) in the sum of $ _________________________________________(Amount of Check) 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 was drawn, this document becomes effective to release any mechanicsʼ lien, and state or federal statutory bond right, any private bond right, any claim for payment, any bonded stop notice, and any rights under any similar ordinance, rule or statue related to claim or payment rights for persons in the undersignedʼs position that the undersigned has on the job of _________________________________________(Owner) located at_________________________________________(Job Description and/or Location) to the following extent. This release covers a progress payment for all labor, services, equipment or materials furnished to the jobsite or to _________________________________________(Person with whom Undersigned Contracted) through _________________________________________(Date) only and does not cover any retention, pending modifications and changes, or other items furnished after that date. Before any recipient of this document relies on it, that person should verify evidence of payment to the undersigned.

The undersigned warrants that he/she either has already paid or will use the monies he/ she receives from this progress payment to promptly pay in full all of his 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.


Company Name:

By: (Signature)


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