Washington State Lien Waiver Form

Company Letterhead

{{company_name}}

{{company_address}}

Phone: {{phone}}

Email: {{email}}

Website: {{website}}

CONDITIONAL WAIVER AND RELEASE OF LIEN UPON PROGRESS PAYMENT

Upon receipt by the undersigned of a check in the amount of {{payment_amount}} U.S. Dollars (US$) payable to {{payee_name}}, and when the check has been properly endorsed and paid by the bank upon which it is drawn, this document shall become effective to release any mechanics’ lien, stop notice, or bond right the undersigned has on the job of {{property_owner_name}}, located at {{project_address}}, to the following extent.

ACKNOWLEDGMENT OF PAYMENT

The undersigned acknowledges receipt of a progress payment for labor, services, equipment, or materials furnished to the project through {{through_date}} only, and this waiver and release do not cover any retention or items furnished after the date, or extras for which the undersigned has not received payment.

DESCRIPTION OF WORK/MATERIALS

This waiver and release specifically applies to the following work performed or materials supplied:

{{description_of_work_materials}}

LIEN RELEASE

This waiver and release is conditional upon receipt of the stated amount and expressly releases the undersigned’s mechanics’ lien, stop notice, or bond claim rights against the above-described property and parties to the extent of the payment received. This waives all claims for labor, materials, or services furnished up to and including the 'through date' specified above.

REPRESENTATIONS AND WARRANTIES

The undersigned warrants that it has not assigned any claim or demand for payment, and that it has the right to execute this waiver and release.

The undersigned further warrants that all laborers, subcontractors, and materialmen employed by it on the project have been paid in full for all labor, materials, and services furnished by them through the date of this waiver, except for amounts for which payment is not yet due or which have been specifically excluded from this waiver in writing.

INDEMNIFICATION

The undersigned agrees to indemnify and hold harmless {{property_owner_name}} and {{general_contractor_name}} from any and all claims, demands, or causes of action arising from the undersigned’s failure to comply with the terms of this waiver.

NO WAIVER OF FUTURE RIGHTS

This document does not waive any right of the undersigned to assert claims for extra work, delay, or any other changes to the contract for which written change orders or other written approvals have been executed, and for which payment has not been received.

Signature Block

IN WITNESS WHEREOF, the undersigned has executed this Conditional Waiver and Release of Lien upon Progress Payment on the date set forth below.

_____________________________

Signature

Name: {{signer_name}}

Title: {{signer_title}}

Company: {{company_name}}

Date: {{date}}

STATE OF WASHINGTON

COUNTY OF {{county}}

On this {{day}} day of {{month}}, {{year}}, before me, the undersigned, a Notary Public in and for the said State, personally appeared {{signer_name}}, known to me to be the person who executed the within instrument, and acknowledged to me that he/she executed the same for the purposes therein stated.

_____________________________

Notary Public

Printed Name: {{notary_name}}

My Commission Expires: {{commission_expiration_date}}