Limited Liability Plumbing Contractor-
Surety Bond
State of Illinois
Illinois Department of Public Health
IL 482-0689
IOCI 15-293
0
55 - ________________________________ __________________________
Illinois Plumbing Contractor Registration Number Bond Number (Required)
(If Renewal, Must Be Completed)
KNOW ALL PERSONS BY THESE PRESENT, that ________________________________________________________
(
Name of Plumbing Contractor as on application)
___________________________________________________________________________(_____)_________________
(Plumbing 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 the
Director of the Department of Public Health, State of Illinois, as Obligee, 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 plumbing contractor named above; and
WHEREAS, Illinois Statutes, section 894.20, requires a bond for all plumbing work.
NOW, THEREFORE, the condition of this obligation is such that, if the undersigned Principal or such persons authorized to
perform plumbing under the Principal’s supervision performs plumbing in compliance with the plumbing codes as required
pursuant to Illinois rules, Part 894, then this obligation shall be null and void. Otherwise, it shall remain in full force and
effect until its stated expiration date. The period of this bond is ________________________ through September 30,____.
During the term of this obligation, the Principal and Surety will pay unto the Obligee, or as otherwise directed by the
Obligee, the amount needed to correct noncomplying plumbing work, not to exceed TWENTY THOUSAND DOLLARS
($20,000) for the benefit of persons injured or suffering financial loss by reason of failure to comply with the requirements
of the Illinois Plumbing Code, Illinois Rules, Chapter 894.
FURTHERMORE, 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 plumbing work, the exhaustion of the
bond does not relieve the undersigned Principal of liability for correcting noncomplying work.
3. This bond is an obligation that 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 that 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 Plumber of Record Original Signature of Plumber of Record
_____________________________________________ _____________________________________________
Print Name of Owner/Officer Original Signature of Owner/Officer
Notarization of these signatures must be completed (see reverse side of this bond)
S
tate of Illinois
Illinois Department of Public Health
Notarization of Signature for LLC Contractor
A notary public must use this page to notarize the signatures of individuals on the front of this bond.
Both Sections Must be Completed
State of Illinois )
) SS.
County of _________________________)
BEFORE ME, the undersigned authority, on this day personally appeared, ______________________________________
known to me to be the person whose name is subscribed to the foregoing instrument and acknowledged to me that he/she
represents ___________________________________________, a Limited Liability Corporation; and said instrument was
executed on behalf of the LLC, that he/she acknowledged said instrument to be the free act and deed of the LLC.
Subscribed and sworn before me this ___________ day of ___________________, 20 ___.
___________________________________________________
Notary Public
(SEAL)
Notarization of signature for Surety Company’s Attorney in Fact
(Not required if an original Power of Attorney is attached)
State of Illinois )
) SS.
County of _________________________)
BEFORE ME, the undersigned authority, on this day personally appeared, ______________________________________
known to me to be the person whose name is subscribed to the foregoing instrument and acknowledged to me that he/she
is the attorney in fact for ___________________________________________, the surety corporation, whose name and
seal are affixed to the instrument, and said instrument was executed on behalf of said surety corporation by authority of its
board of directors.
Subscribed and sworn before me this ___________ day of ___________________, 20 ___.
___________________________________________________
Notary Public
(SEAL)
Limited Liability Plumbing Contractor-
Surety Bond
IL 482-0979
IOCI 15-293
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 894.20. Failure to provide this form may result in suspension, denial
or revocation of the Plumbing Contractor Registration. This form has been approved by the Forms Management Center IL 482-0979.
