UNCONDITIONAL WAIVER AND RELEASE ON FINAL PAYMENT

STATE OF ARIZONA

(Pursuant to Arizona Revised Statutes §33-1008)

Project: ________________________

________________________

Job No. ________________________

The undersigned has been paid in full for all labor, services, equipment of material furnished to

the jobsite or to ____________________________________________________________________

(Person with whom undersigned contracted)

on the job of ______________________________________________________________________

(Owner)

located at ________________________________________________________________________

(Job Description)

and does hereby release any right to 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, except for disputed claims

for extra work in the amount of $________________________.

(Amount of Disputed Claims)

The undersigned warrants that he either has already paid or will use the monies he receives

from this final payment to promptly pay in full all of his laborers, subcontractors, materialmen and

suppliers for all work, materials, equipment or services provided for or to the above referenced

project.

DATED on _______________, 20_____ _________________________________________

(Claimant name)

By: ___________________________________

Its: ___________________________________

Address:____________________________

___________________________________

Phone: ____________________________

Fax: _______________________________

NOTICE: THIS DOCUMENT WAIVES RIGHTS UNCONDITIONALLY AND STATES THAT YOU

HAVE BEEN PAID FOR GIVING UP THOSE RIGHTS. THIS DOCUMENT IS ENFORCEABLE

AGAINST YOU IF YOU SIGN IT, EVEN IF YOU HAVE NOT BEEN PAID. IF YOU HAVE NOT BEEN

PAID, USE A CONDITIONAL RELEASE FORM.