STATUTORY FORM — Arizona

CONDITIONAL WAIVER AND RELEASE ON PROGRESS PAYMENT

Arizona Revised Statutes §33-1008(D)(1)

Project:	Sample Project
Job No.:	PO-0000
Owner:	Sample Project Owner LLC
Job Location:	123 Jobsite Rd, Anytown, AZ, 00000
Name of Claimant:	Sample Subcontractor LLC
Name of Customer:	Sample General Contractor LLC
Through Date:	June 30, 2026
Payment Amount:	$50,000.00

On receipt by the undersigned of a check from Sample General Contractor LLC (maker of check) in the sum of $50,000.00 payable to Sample Subcontractor LLC (payee or payees of check) 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 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 that the undersigned has on the job of Sample Project Owner LLC (owner) located at Sample Project — described in the contract (job description) to the following extent. This release covers a progress payment for all labor, services, equipment or materials furnished to the jobsite or to Sample General Contractor LLC (person with whom undersigned contracted) through June 30, 2026 (date) only and does not cover any retention, pending modifications and changes or items furnished after that date. Before any recipient of this document relies on it, that person should verify evidence of payment to the undersigned.

The undersigned warrants that he either has already paid or will use the monies he receives from this progress 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 up to the date of this waiver.

Dated: _______________

Sample Subcontractor LLC
(Company name)

By: ___________________________ (Signature)

Printed Name of Authorized Signer: ___________________________

___________________________ (Title)

Administrative Reference Certificate

Review before relying on this waiver: These reference fields are generated from customer-provided and connected system data. They are provided to help identify the project, contract, PO, invoice, payment application, amount, payment period, and payment-status attestation. If any field is inaccurate or incomplete, do not sign or rely on this waiver; contact the sender for correction. This certificate is not legal advice and is not part of any statutory lien waiver form body.

Project:	Sample Project
Project Location:	123 Jobsite Rd, Anytown, AZ, 00000
Project County:	Sample County
Property Description:	Sample Project — described in the contract
Owner:	Sample Project Owner LLC
Claimant / Subcontractor:	Sample Subcontractor LLC
Customer / Contractor:	Sample General Contractor LLC
Contract / PO Number:	PO-0000
Contract / PO Title:	Sample Scope
Invoice Number:	INV-0000
Payment Application Number:	PA-01
Payment Period:	Sample period
Through Date:	June 30, 2026
Payment Amount:	$50,000.00

Arizona lien waiver requirements

The Arizona statutory conditional progress waiver