CONDITIONAL WAIVER OF LIEN AND RELEASE OF CLAIM



SUPPLIER / 2nd TIER SUBCONTRACTOR

CONDITIONAL WAIVER OF LIEN AND RELEASE OF CLAIM

CONDITIONAL ON RECEIPT OF FUNDS

Date: Today’s Date

TO: HENDRICK CONSTRUCTION, INC.

9144 ArrowPoint Blvd., Suite 150

Charlotte, NC 28273

KNOW ALL MEN BY THESE PRESENTS:

WHEREAS, the undersigned has supplied labor and/or materials to (Subcontractor Name) for the construction or improvement known as: Project Name

NOW THEREFORE, upon receipt of and in consideration of $ amount of open invoices and other valuable consideration, the undersigned does hereby waive and release any and all liens, claims, or rights of liens or claims (i) on or against the Project under the laws of the state in which the project is located, (ii) under any payment or performance bonds furnished in connection with the Project, (iii) against Hendrick Construction, Inc., or any subsidiary thereof, (iv) against all sureties on any of said bonds, (v) against the owner of the Project, and (vi) against any successor or assign thereof. This release shall extend to any right which might arise on account of labor and/or materials furnished by the undersigned and used or intended for use in the project for materials purchased through latest date of open invoices above .

I further certify I have complied with Federal, State and local tax laws, including Social Security laws and Unemployment Compensation laws and Workman’s Compensation laws insofar as applicable to the performance of this Contract.

WITNESS the due execution hereof this            day of                     , 20

CLAIMANT: Supplier Name

BY: ____________________________________

Signature

Printed Name: ___________________________

Title: ____________________________________

Subscribed and sworn before the this __________ day of ________________________, 20

__________________________________________

Notary Public

My Commission Expires: _____________________ NOTARY SEAL

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