The undersigned has been paid in full for all labor, services,
equipment or material furnished to the jobsite entitled:
Described as:
Located at :
and does hereby waive and 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 in the amount of $ __________
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 his laborers, subcontractors, materialmen and suppliers for all work, materials, equipment or services provided for or to the above referenced project up to the date of this waiver.
Date: _________ By: _____________________
Title: ___________ Signature: __________________