Bond No.

KNOW ALL MEN BY THESE PRESENTS, That I(We)

(Name of Applicant)

(Mailing Address)

as Principal, and

(Surety Company

a corporation organized and existing under the laws of the State of __________ and licensed to do business in the State of Illinois, are held firmly bound unto the People of the State of Illinois in the penal sum of___________ Dollars ($_____________) lawful money of the United States well and truly to be paid unto said People of the State of Illinois, for payment of which we bind ourselves, our successors and assigns, jointly, severally, and firmly by these presents.

WHEREAS, Highway Permit No. _________________ issued by the Department of

Transportation of the State of Illinois grants to ______________________________ permission and authority to construct, locate, operate, and maintain the work described in said Permit, upon or adjacent to ________ Route _____________________________ in _____________________ Conty as more fully described in said Permit and Sketch, which by this reference are made a part hereof as if written herein at length, in and by which Permit and Sketch the said Principal has promised and agreed to perform said described operation and related activities in accordance with the terms and conditions of and description in said Permit and Sketch.

NOW, THEREFORE, if the said Principal shall well and truly perform said operation

in accordance with the terms and conditions of and description in said Permit and Sketch to the satisfaction of said Department, and shall perform no other work or construction at said location without first applying for and receiving another permit from said Department, and shall indemnify and save harmless the State of Illinois against all claims for damages that may occur to persons or property, due to accidents or otherwise by reason of the location, operation, or maintenance of the work authorized by the referenced highway permit, including damages to property belonging to the State of Illinois arising out of the performance of said described operation and related activities during a period of five years from the date of approval of this bond by the Department, then this obligation to be void. Otherwise, this bond or so much thereof as may be necessary shall inure to the said Department as cost and expense to change and correct said construction to conform to the terms and conditions of and description in said Permit and Sketch.

IN WITNESS WHEREOF, WE HAVE DULY EXECUTED THE FOREGOING THIS _______

DAY OF ___________19____.

Surety

Principal

Address

Address

City-State

City-State

By

(Seal)

By

(Seal)

Attorney in Fact

Department of Transportation

Agent for Surety

Address

By

District/Region Engineer

City-State

By