CONDITIONAL WAIVER AND RELEASE UPON “FINAL PAYMENT”

Upon receipt by the undersigned of a check from:	Clovis Unified School District

In the sum of $ 	
(Amount of Check)

Payable to: 	
(Payee)

and when the check has been properly endorsed and has been paid by the bank upon which it is drawn, this document shall become effective to release any mechanic’s lien, stop notice, or bond right the undersigned has on Clovis Unified School District project described as follows:

Name & Location : 	

Bid No. or Bid Package No.: 	

This release covers the final payment to the undersigned for all labor, services, equipment, or material furnished on the job, except for disputed claims for additional work in the amount of $ ____________________________.
Before any recipient of this document relies on it, the party should verify evidence of payment to the undersigned.

(Company Name)	(Date)

By:	
(Title)

Exclusions: Listing of Claims, of which Notice has been given:
1. Claim for:	              In the amount of $	
2. Claim for:	              In the amount of $	
3. Claim for:	              In the amount of $	
4. Claim for:	              In the amount of $	
5. Claim for:	              In the amount of $