STATUTORY FORM — Nevada

CONDITIONAL WAIVER AND RELEASE UPON PROGRESS PAYMENT

NRS 108.2457(5)(a)

Property Name:	Sample Project
Property Location:	123 Jobsite Rd, Anytown, NV, 00000
Undersigned's Customer:	Sample General Contractor LLC
Invoice/Payment Application Number:	PA-01
Payment Amount:	$50,000.00

Upon receipt by the undersigned of a check in the above-referenced Payment Amount payable to the undersigned, 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 and the undersigned shall be deemed to waive any notice of lien, any private bond right, any claim for payment and any rights under any similar ordinance, rule or statute related to payment rights that the undersigned has on the above-described Property to the following extent:

This release covers a progress payment for the work, materials or equipment furnished by the undersigned to the Property or to the Undersigned's Customer which are the subject of the Invoice or Payment Application, but only to the extent of the Payment Amount or such portion of the Payment Amount as the undersigned is actually paid, and does not cover any retention withheld, any items, modifications or changes pending approval, disputed items and claims, or items furnished that are not paid. Before any recipient of this document relies on it, the recipient should verify evidence of payment to the undersigned. The undersigned warrants that he or she either has already paid or will use the money received from this progress payment promptly to pay in full all laborers, subcontractors, materialmen and suppliers for all work, materials or equipment that are the subject of this waiver and release.

Dated: _______________

Sample Subcontractor LLC
(Company Name)

By: ___________________________

Printed Name of Authorized Signer: ___________________________

Its: ___________________________

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, NV, 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

Nevada lien waiver requirements

The Nevada statutory conditional progress waiver