Free Conditional Lien Waiver Template
Conditional Lien Waiver
This Document is a Conditional Lien Waiver that becomes effective only upon receipt and clearance of the payment described below. The undersigned, upon receiving such payment, hereby waives and releases any and all liens, claims, and rights it may have to the payment to the extent specified below.
I. PARTIES
Company Name: [YOUR COMPANY NAME]
Lien Claimant: [YOUR NAME]
Project Name/Description: Glendale Community Center Renovation
Property Location: Glendale, AZ 85301
II. PAYMENT INFORMATION
Amount of Payment: $15,000.00
Invoice Number: INV-2053-4567
Date of Invoice: October 15, 2053
III. CONDITIONAL WAIVER AND RELEASE
Upon receipt of the payment specified above and upon the clearance of said payment, [YOUR NAME] ([YOUR COMPANY NAME]) conditionally waives and releases any rights to assert a mechanic’s lien, stop notice, or bond claim for labor, services, equipment, or materials provided for the above-listed project to the extent of the amount paid.
This waiver and release are conditioned upon payment being fully processed and settled. Should the payment fail to clear or be dishonored, this document becomes null and void, and all rights of the undersigned to file a lien, stop notice, or bond claim are restored.
IV. WARRANTIES
No other rights are waived, and this Conditional Lien Waiver does not cover any unpaid or future payments, including retainage, extra work, or other amounts owed that are not specified in the Payment Information section above.
V. SIGNATURE AND DATE
By signing below, the undersigned verifies that the information provided is accurate and acknowledges understanding and agreement to the terms of this Conditional Lien Waiver.
Printed Name: Alanis Durgan
Title: Project Manager
Date: October 18, 2053
This Conditional Lien Waiver is a binding legal document. If there are any questions regarding its contents or intent, consult legal counsel before signing.
