WA Conditional Waiver and Release on Final Payment

The form below is used to create a Conditional Waiver and Release on Final Payment for your use. Please do not print this page. Once you have filled out the form you will be emailed a copy of the final document. To download a PDF of your submitted waiver, go to the My Documents page and click "Download and Print Order".

  • On receipt by the undersigned of a check from
  • In the Sum of
  • Payable to
  • and when the check has been properly endorsed and has been paid by the bank on which it is drawn, this document becomes effective to release any right to a mechanic’s lien, any state or federal statutory bond right, any private bond right, any claim for payment and any rights under any similar ordinance, rule or statute related to claim or payment rights for persons in the undersigned’s position, the undersigned has on the job of
  • located at
  • This release covers the final payment to the undersigned for all labor, services, equipment or materials furnished to the jobsite or to
  • from (date paid through)
  • MM slash DD slash YYYY
  • except for disputed claims in the amount of
  • Before any receipt of this document relies on it, the person should verify evidence of payment to the undersigned.
  • The undersigned warrants that he either has already paid or will use monies received from this payment to promptly pay in full all of his laborers, subcontractors, material men and suppliers for all work, materials, equipment or services provided for or to the above referenced project up to the date of this waiver.
  • MM slash DD slash YYYY