Public Notice of Claim

Notice of Claim Under Public Improvement

Return To:

CONTRACTOR’S BOND PURSUANT TO 30 ILCS 550/1 AND 550/2; AND THE ILLINOIS MECHANICS LIEN ACT, 770 ILCS § 60/23

NOTICE DELIVERED TO:

[_____]    STATE AGENCY (Name & Address)

 

 

 

 

[_____]    BONDING COMPANY (Name & Address)

 

 

 

 

Bond No:

[_____]    PRIME CONTRACTOR (Name & Address of Prime Contractor)

 

 

 

 

[_____]    HIRING PARTY (Name & Address of party who hired the CLAIMANT)

 

 

 

 

NOTICE FROM THE CLAIMANT:

 

 

 

 

NOTICE REGARDING:

PROJECT

Project Address:

Contract Number:

Public Improvement Reference & Description:

 

 

 

 

THE  CONTRACT

Date of Contract: ___/____/20____

Total Amount of Contract: $

AMOUNT OF CLAIM:

$

 

Services, labor, materials, equipment and/or work provided by the Lienor (“SERVICES”):

 

 

 

 

YOU ARE HEREBY NOTIFIED that the undersigned and above-identified CLAIMANT, entered into a contract with the HIRING PARTY to provide the abovedescribed SERVICES in connection with the above-identified PROJECT.

The amount of the CONTRACT is above-identified. After adding all extras and additions, and deducting all payments, credits and offsets, the balance due and owing to the CLAIMANT is above-identified as the AMOUNT OF CLAIM. This AMOUNT OF CLAIM is due despite demand being made therefore, and pursuant to 770 ILCS 60/23, the CLAIMANT claims a lien for the amounts owed to the PRIME CONTRACTOR and/or the HIRING PARTY in the AMOUNT OF CLAIM.

THE CLAIMANT does, therefore, claim a lien upon all moneys, bonds, or warrants due or to become due to the PRIME CONTRACTOR and/or the HIRING PARTY, and you are hereby notified to withhold payment to the PRIME CONTRACTOR and/or the HIRING PARTY in an amount sufficient to pay the AMOUNT OF CLAIM. The CLAIMANT further claims against the bond furnished by the BONDING COMPANY, above-identified, to the STATE AGENCY, above-identified.

THIS NOTICE IS GIVEN TO YOU PURSUANT TO 770 ILCS 60/23, AS AMENDED, RELATING TO A LIEN AGAINST FUNDS DUE OR TO BECOME DUE CONTRACTORS FOR PUBLIC IMPROVEMENTS, AND 30 ILSC 550/1 AND 550/2, AS AMENDED, RELATING TO RECOVERY BY A SUBCONTRACTOR ON THE BOND REQUIRED BY THE PUBLIC BODY.

State of

County of

On the date indicated to the right of this verification, ____________________, Agent for CLAIMANT, and represented by _____________________________, personally came and appeared before me, and voluntarily executed this instrument in the agent’s stated capacity. The deponent says that s/he has read the foregoing Notice of Claim and knows the contents thereof, that as the appointed agent for the CLAIMANT the deponent has been provided the information indicated in this notice, and that the same is true upon the deponent’s information, knowledge and belief.

 

Notary Public

Signed this ____ day

of _________________, 20____.

Agent for Lienor

Signed by

Title:

PROOF OF SERVICE AFFIDAVIT

I, __________________________, being duly sworn, deposes and says that I am over the age of 18 years old, that this affidavit is made upon my own personal knowledge, and that on the _____ day of _____________, 20____, I served the attached Statement of Account and Claim of Lien, and the attached Notice of Demand for Attorneys Fees, to the following parties at these stated addresses:

[______]   State Agency

[______]   Bonding Company

[______]   Prime Contractor

[______]   Hiring Party

I served the attached document:

[______]   By personally delivering the notice to the identified parties;

[______]   By First Class Certified or Registered Mail service, return receipt requested, postage prepaid.

State of

County of

Sworn to and subscribed before me, undersigned Notary Public, on the date inscribed to the right of this verification.

 

Notary Public

Signed this ____ day

of _________________, 20____.

 

Agent for Lienor

Signed by

Title:

Over 90K FREE Resources Downloaded from zlien Need this form? Download it for FREE
DOWNLOAD