STATUTORY FORM — Utah

UTAH CONDITIONAL WAIVER AND RELEASE UPON PROGRESS PAYMENT

UCA §38-1a-802

Property Name:	Sample Project
Property Location:	123 Jobsite Rd, Anytown, UT, 00000
Undersigned's Customer:	Sample General Contractor LLC
Invoice/Payment Application Number:	PA-01
Payment Amount:	$50,000.00
Payment Period:	Through June 30, 2026

To the extent provided below, this document becomes effective to release and the undersigned is considered to waive any notice of lien or right under Utah Code Ann., Title 38, Chapter 1a, Preconstruction and Construction Liens, or any bond right under Utah Code Ann., Title 14, Contractors' Bonds, or Section 63G-6a-1103 related to payment rights the undersigned has on the above described Property once: (1) the undersigned endorses a check in the above referenced Payment Amount payable to the undersigned; and (2) the check is paid by the depository institution on which it is drawn.

This waiver and release applies to a progress payment for the work, materials, equipment, or combination of work, materials, and 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. This waiver and release does not apply to any retention withheld; any items, modifications, or changes pending approval; disputed items and claims; or items furnished or invoiced after the Payment Period.

The undersigned warrants that the undersigned either has already paid or will use the money received from this progress payment promptly to pay in full all the undersigned's laborers, subcontractors, materialmen, and suppliers for all work, materials, equipment, or combination of work, materials, and equipment that are the subject of this waiver and release.

Restrictive endorsement: If a check is used, the endorsement should identify whether it is a progress or final payment. If it does not, Utah law treats it as a progress payment.

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, UT, 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

Utah lien waiver requirements

The Utah statutory conditional progress waiver