Georgia Lien Waiver Form

{{company_name}}

{{company_address}}

Phone: {{phone}} | Email: {{email}} | Web: {{website}}

Georgia Lien Waiver Form

Georgia Lien Waiver Form

LIEN WAIVER AND RELEASE UPON PROGRESS PAYMENT

The undersigned, in consideration of the sum of {{payment_amount}} ({{currency}}) and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, does hereby waive and release any and all liens or claims of lien, stop notices, payment bond rights, and any other similar rights to payment that the undersigned has or may hereafter have upon the real property described below for labor, services, equipment, or materials furnished to {{project_name}} located at {{project_address}} for improvements to the real property, up to and including the date of this waiver, for the amount of {{payment_amount}}.

PROPERTY INFORMATION

Project Name: {{project_name}}

Property Address: {{project_address}}

Owner: {{owner_name}}

WAIVER TERMS AND CONDITIONS

This waiver and release is conditioned upon the actual receipt of the aforementioned payment. In the event that payment is not actually received, this waiver and release shall be null and void.

This waiver and release does not cover any retainage, extras for which the undersigned has not received payment, or contract rights, including rights to amounts withheld for disputed work, for which the undersigned has not received payment.

This waiver and release is provided in accordance with O.C.G.A. § 44-14-366.

AFFIRMATION

The undersigned affirms that all laborers, subcontractors, and materialmen employed by the undersigned on the described project have been paid in full for all labor, services, equipment, or materials furnished by them to the described project up to and including the date of this waiver, or that the undersigned has provided for such payment.

SIGNATURE

IN WITNESS WHEREOF, the undersigned has executed this Lien Waiver and Release upon Progress Payment on this {{date}}.

Contractor/Subcontractor/Supplier Name: {{company_name}}

By: _______________________________

Name: {{signer_name}}

Title: {{signer_title}}