Form IL482-0690 "Partnership Irrigation Contractor - Lawn Sprinkler Systems Surety Bond" - Illinois

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Download Form IL482-0690 "Partnership Irrigation Contractor - Lawn Sprinkler Systems Surety Bond" - Illinois

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Partnership Irrigation Contractor-
State of Illinois
Illinois Department of Public Health
Lawn Sprinkler Systems Surety Bond
060 - _______________________________
__________________________
Illinois Irrigation Contractor Registration Number
Bond Number (Required)
(If Renewal, Must Be Completed)
KNOW ALL PERSONS BY THESE PRESENT, that ________________________________________________________
(Name of Irrigation Contractor as on application)
___________________________________________________________________________(_____)_________________
(Irrigation Contractor Address)
City
State
ZIP
Telephone No.
as principal, and____________________________________________________________________________________
(Surety Indemnification Company Name)
___________________________________________________________________________(_____)_________________
(Surety Indemnification Company Address)
City
State
ZIP
Telephone No.
a corporation licensed to do business in the state of Illinois as Surety, are jointly and severally held and firmly bound to
Director of the Department of Public Health, State of Illinois, as Obligee, for the benefit of any person injured or suffering
financial loss by reason of the Principal’s failure to comply with the requirements of the Illinois Lawn Sprinkler System
Code (77 Illinois Administrative Code Part 892), in the sum of TWENTY THOUSAND DOLLARS ($20,000) for the payment
of which, we bind ourselves, our heirs, executors, administrators, successors and assigns firmly by these presents.
WHEREAS, a registration has been issued by the Obligee to the irrigation contractor named above; and
WHEREAS, Section 320/2.5 of Chapter 225, Illinois Compiled Statutes, requires every irrigation contractor installing lawn
sprinkler systems in the state of Illinois to provide to the Obligee a bond guaranteeing that funds shall be available only to the
Obligee, and shall be released upon written notification by the Obligee in the same amount for any work on lawn sprinkler
systems performed by the Principal.
NOW, THEREFORE, the condition of this obligation is such that, if the Principal shall comply with all provisions of 77 Illinois
Administrative Code Part 892 and avoid causing injury or financial loss by reason of failing to comply with such provisions,
then this obligation shall be null and void. Otherwise, it shall remain in full force and effect until its stated expiration date.
This bond shall run concurrently with the annual registration period beginning ______________________ and terminating
on February 28, 20____.
During the term of this obligation, the Principal and Surety will pay to the Obligee, or as otherwise directed by the Obligee,
the amount needed to correct noncomplying irrigation work, not to exceed the amount stated above.
PROVIDED, it is understood and agreed that:
1. The aggregate liability of the Surety pertains to all claims arising during the period defined above.
2. In the event the bond penalty is insufficient for correction of all noncomplying irrigation work, the exhaustion of the
bond does not relieve the undersigned Principal of liability for correcting noncomplying work.
3. This bond is an obligation which may be canceled at any time as to further liability upon the Surety’s giving at least
15 days written notice to the Obligee. In the event of cancellation, the Surety shall not be discharged from any liability
already accrued under this bond, or which shall accrue before the expiration of the 15 day notice period.
Signed and sealed this ____ day of _________________, 20___. Surety Company _____________________________
By
__________________________________________________
Original Signature of Attorney in Fact for Surety Company
_____________________________________________
_____________________________________________
Print Name of Owner/Officer
Original Signature of Owner/Officer
Notarization of these signatures must be completed (see reverse side of this bond)
IL 482-0690
IOCI 15-183
Partnership Irrigation Contractor-
State of Illinois
Illinois Department of Public Health
Lawn Sprinkler Systems Surety Bond
060 - _______________________________
__________________________
Illinois Irrigation Contractor Registration Number
Bond Number (Required)
(If Renewal, Must Be Completed)
KNOW ALL PERSONS BY THESE PRESENT, that ________________________________________________________
(Name of Irrigation Contractor as on application)
___________________________________________________________________________(_____)_________________
(Irrigation Contractor Address)
City
State
ZIP
Telephone No.
as principal, and____________________________________________________________________________________
(Surety Indemnification Company Name)
___________________________________________________________________________(_____)_________________
(Surety Indemnification Company Address)
City
State
ZIP
Telephone No.
a corporation licensed to do business in the state of Illinois as Surety, are jointly and severally held and firmly bound to
Director of the Department of Public Health, State of Illinois, as Obligee, for the benefit of any person injured or suffering
financial loss by reason of the Principal’s failure to comply with the requirements of the Illinois Lawn Sprinkler System
Code (77 Illinois Administrative Code Part 892), in the sum of TWENTY THOUSAND DOLLARS ($20,000) for the payment
of which, we bind ourselves, our heirs, executors, administrators, successors and assigns firmly by these presents.
WHEREAS, a registration has been issued by the Obligee to the irrigation contractor named above; and
WHEREAS, Section 320/2.5 of Chapter 225, Illinois Compiled Statutes, requires every irrigation contractor installing lawn
sprinkler systems in the state of Illinois to provide to the Obligee a bond guaranteeing that funds shall be available only to the
Obligee, and shall be released upon written notification by the Obligee in the same amount for any work on lawn sprinkler
systems performed by the Principal.
NOW, THEREFORE, the condition of this obligation is such that, if the Principal shall comply with all provisions of 77 Illinois
Administrative Code Part 892 and avoid causing injury or financial loss by reason of failing to comply with such provisions,
then this obligation shall be null and void. Otherwise, it shall remain in full force and effect until its stated expiration date.
This bond shall run concurrently with the annual registration period beginning ______________________ and terminating
on February 28, 20____.
During the term of this obligation, the Principal and Surety will pay to the Obligee, or as otherwise directed by the Obligee,
the amount needed to correct noncomplying irrigation work, not to exceed the amount stated above.
PROVIDED, it is understood and agreed that:
1. The aggregate liability of the Surety pertains to all claims arising during the period defined above.
2. In the event the bond penalty is insufficient for correction of all noncomplying irrigation work, the exhaustion of the
bond does not relieve the undersigned Principal of liability for correcting noncomplying work.
3. This bond is an obligation which may be canceled at any time as to further liability upon the Surety’s giving at least
15 days written notice to the Obligee. In the event of cancellation, the Surety shall not be discharged from any liability
already accrued under this bond, or which shall accrue before the expiration of the 15 day notice period.
Signed and sealed this ____ day of _________________, 20___. Surety Company _____________________________
By
__________________________________________________
Original Signature of Attorney in Fact for Surety Company
_____________________________________________
_____________________________________________
Print Name of Owner/Officer
Original Signature of Owner/Officer
Notarization of these signatures must be completed (see reverse side of this bond)
IL 482-0690
IOCI 15-183
Partnership Irrigation Contractor-
State of Illinois
Illinois Department of Public Health
Lawn Sprinkler Systems Surety Bond
A notary public must use this page to notarize the signatures
of individuals on the front of this bond.
Everyone must complete both Sections
Notarization of signature on front of bond for Partnership Irrigation Contractor
State of Illinois
)
) SS.
County of _________________________)
On this _____ day of ___________________, 20____, personally came _______________________________________
to me well known to be the identical person (s) described in and who executed the foregoing bond and he/she/they
acknowledged the same to be his/her/their own free act and deed.
___________________________________________________
_____/_____/__________
Notary Public
Date
(SEAL)
My commission expires: _____/_____/__________
Date
Notarization of signature on front of bond for Surety Company’s Attorney in Fact
(If an original Power of Attorney is attached this section is not required to be completed.)
State of Illinois
)
) SS.
County of _________________________)
On this _____ day of ___________________, 20____, personally came _______________________________________
to me personally known, who being by my duly sworn, did say that he/she is the attorney in fact, of
_______________________________________________, the surety company whose name is affixed to the foregoing
instrument; that the seal affixed to the foregoing instrument is the corporate seal of the said surety company; and that said
instrument was executed in behalf of said surety company by authority of its board of directors and said
______________________________________________ acknowledged that he/she executed said instrument as attorney
in fact as the free act and deed of said surety company.
___________________________________________________
_____/_____/__________
Notary Public
Date
(SEAL)
My commission expires: _____/_____/__________
Date
Important Notice
This State Agency is requesting disclosure of information that is necessary to accomplish the statutory purpose as outlined under the Illinois Plumbing
Code. Disclosure of this information is mandatory pursuant to 77 IL Admin., Code 892.50. Failure to provide this form may result in suspension, denial
or revocation of the Irrigation Contractor Registration. This form has been approved by the Forms Management Center IL 482-0690.
IL 482-0690
IOCI 15-183
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