HomeMy WebLinkAbout24-24 Certified Signed Owner: City of Elgin Resolution No. 24-24
Route: US 20
Section: Randall Road to Shales
Parkway
County: Kane
Project No.:
Job No.: R-91-007-20
Parcel No.: 1020004 PE & TE
P.I.N. No.: 06-24-351-010
CERTIFIED RESOLUTION
AUTHORIZING EXECUTION OF A PERMANENT EASEMENT AND A TEMPORARY
CONSTRUCTION EASEMENT WITH THE STATE OF ILLINOIS, DEPARTMENT OF
TRANSPORTATION FOR HIGHWAY PURPOSES FROM RANDALL ROAD TO SHALES
PARKWAY
I, David J. Kaptain, Mayor of the City of Elgin, a governmental entity organized and
existing under the laws of the State of Illinois, including without limitation, city, village,
incorporated town, county, park district, or township, do hereby certify that:
1. The following is a true and correct copy of a resolution adopted by the Council or Board
of said governmental entity,a quorum of its members,trustees,or commissioners being
present at a meeting held on the 24th day of January, 2024, and;
2. The resolution has not been amended or revoked and is in full force and effect.
BE IT RESOLVED that David J. Kaptain,the Mayor of the above-referenced governmental
entity is hereby authorized and directed to convey a permanent easement and a temporary
construction easement in the following described real estate in Kane County, Illinois to the People
of the State of Illinois, Department of Transportation for highway purposes for the sum of One
Hundred Forty Eight Thousand and no/100 Dollars ($148,000.00):
See attached legal descriptions.
BE IT FURTHER RESOLVED that they are authorized and directed to execute and deliver
such instruments as may be necessary or convenient to consummate such sale.
BE IT FURTHER RESOLVED that the members, aldermen, trustees or commissioners of
the Council or Board of the governmental entity or electors of the governmental entity, pursuant
to 50 ILCS 605/4 voted for the adoption of this resolution as follows:
M
David J. Kal,01 , Ma r
ork
04: $,
Presented: January 24, 2024
Adopted: January 24, 2024
Omnibus Vote: Yeas: 9 Nays: 0
Attest:
Kimberly Dewis, Cr..dt Clerk
State of Illinois )
) ss
County of Kane )
This instrument was acknowledged before me on January 24, 2024, by David J. Kaptain,
as Mayor of the City of Elgin.
"OFFICIAL SEAL" t
(SEAL) JENNIFER J QUINTON
Notary Public,State of Illinois ary Pu lc
Commission No.982682
i My Commission fires December 06,2027
My Commission Expires: OSe
2
Legal Description for Temporary Construction Easement:
Route: US 20
Section: Randall Rd.to
Shales Pkwy.
County: Kane
Job No.: R-91-007.20
Parcel No IO20004TE
Station: 384+18.22 to
395.65 67(Route 20)
Index No.: 06 24.351-010
That part of the Northwest Quarter of Southwest Quarter of Section 24,Township 41 North,Range 8 East
of the Third Principal Meridian, in Elgin Township, Kane County,Illinois,bearings and distances are based
on the Illinois State Place Coordinate System,East Zone,NAD83(2011 Adjustment)with a combined factor
of 0.99995674;described as follows
Commencing at the intersection of the west line of the C&NW RR and the north line of US Route 20 per
document number 579414, recorded April 4, 1947, in Kane County IL., thence North 21 degrees 21
minutes 35 seconds West along said west line of C&NW RR, 76 44 feet to the Point of Beginning; thence
North 75 degrees 39 minutes 47 seconds West, 51.00 feet, thence North 81 degrees 21 minutes 10
seconds West, 386.03;thence North 84 degrees 23 minutes 25 seconds West, 56.00 feet; thence North
81 degrees 16 minutes 15 seconds West, 142 23 feet; thence North 76 degrees 04 minutes 37 seconds
West, 141.22 feet; thence North 75 degrees 13 minutes 4S seconds West, 160 20 feet, thence North 79
degrees 56 minutes 32 seconds West,91 03 feet;thence North 65 degrees 06 minutes 23 seconds West,
108.58 feet; thence South 67 degrees 37 minutes 34 seconds East, 61.78 feet, hence South 76 degrees
18 minutes 11 seconds East, 136.70 feet; thence South 73 degrees 47 minutes 56 seconds East, 160.05
feet; thence North 71 degrees 02 minutes 22 seconds East, 33.74 feet; thence South 79 degrees 48
minutes 38 seconds East 254.12 feet;thence South 80 degrees 18 minutes 49 seconds East,481.40 feet
to said west line of the C&NW RR;thence South 21 degrees 21 minutes 35 seconds East along said west
line.20.00 feet to the Point of Beginning.
Said parcel containing 0.386 Acres,more or less.
APPROVED
By William Wright at 8:07 am, Jan 12, 2023
3
Legal Description for Permanent Easement:
Route: US 20
Section: Randall Rd.to
Shales Pkwy.
County: Kane
Job No.: R-91-007-20
Parcel No.: 1020004PE
Station: 383+60.31 to
396+37.66(Route 20)
Index No.: 06-24-351-010
That part of the Northwest Quarter of Southwest Quarter of Section 24,Township 41 North,Range 8 East
of the Third Principal Meridian,in Elgin Township,Kane County,Illinois,bearings and distances are based
on the Illinois State Place Coordinate System,East Zone,NAD83(2011 Adjustment)with a combined factor
of 0.99995674;described as follows:
Beginning at the intersection of the west line of the C&NW RR and the north line of US Route 20 per
document number 579414,recorded April 4, 1947,in Kane County IL.;thence westerly along said north
line of US 20,being a curve to the right having a radius of 4,398.44 feet,a distance of 323.80 feet through
a central angle of 04 degrees 13 minutes 04 seconds, the chord of which bears North 76 degrees 55
minutes 56 seconds West, 323.72 feet; thence North 78 degrees 13 minutes 06 seconds West, 496.06
feet; thence North 72 degrees 22 minutes 01 seconds West, 390.23 feet; thence North 15 degrees 24
minutes 07 seconds West, 47.00 feet; thence South 57 degrees 13 minutes 05 seconds East, 60.00
feet; thence South 65 degrees 06 minutes 23 seconds East, 108.58 feet; thence South 79 degrees 56
minutes 32 seconds East,91.03 feet;thence South 75 degrees 13 minutes 45 seconds East, 160.20 feet;
thence South 76 degrees 04 minutes 37 seconds East, 141.22 feet; thence South 81 degrees 16
minutes 15 seconds East, 142.23 feet; thence South 84 degrees 23 minutes 25 seconds East, 56.00
feet; thence South 81 degrees 21 minutes 10 seconds East, 386.03 feet; thence South 75 degrees 39
minutes 47 seconds East, 51.00 feet to said west line of the C&NW RR; thence South 21 degrees 21
minutes 35 seconds East,along said west line 76.44 feet to the Point of Beginning.
Said parcel containing 0.992 Acres,more or less.
APPROVED
By William Wright at 1:16 pm, Dec 14, 2023
4
Illinois Department
of Transportation
Receipt of Conveyance Documents and
Disbursement Statement
Owner: City of Elgin
Job No.: R-91-007-20
Parcel No.: 1020004 PE & TE
The People of the State of Illinois, Department of Transportation (Grantee) acknowledges Receipt of the
following:
(check all that apply)
❑ Warranty Deed covering 0.000 acres
® Permanent Easement covering 0.992 acres
® Temporary Easement covering 0.386 acres
all located in Kane County, Illinois as right of way for US 20, Section Randall Road to Shales Parkway, dated
January 24 , 20 24 , executed by the undersigned Grantors.
Grantor and Grantee agree as follows:
1. The payment of the sum of One Hundred Forty Eight Thousand and no/100 Dollars ($148,000.00)to Grantor
as total consideration for the deed and easement by Grantee is subject to Grantee's approval of title and
documentation and, if applicable, Grantee's final approval in accordance with Section 9.02 of the Illinois State
Finance Act.
2. No improvements located, wholly or partially, on the parcel shall become the property of the State of Illinois.
3. Possession and transfer of easement rights to IDOT occur when Grantee delivers a state warrant to
Grantor, in person or to the address stated herein, in the amount of the above stated consideration,
unless provided herein. Grantor shall have the sole responsibility and obligation to protect, preserve and
maintain the parcel and improvements thereon until delivery of possession to Grantee.
4. Grantor directs Grantee to disburse the above stated consideration by warrant or by separate warrants as
follows:
Name* TIN/FEIN/SSN** Address Amount
City of Elgin 150 Dexter Ct. $148,000.00
Elgin, IL, 60120
*If multiple names, on the same warrant, list first and circle the name of the person or entity whose TIN/FEIN/SSN is
entered above. If lien holder is to be paid by warrant, use Grantor's TIN or SSN with their name listed first and lien holder
second. The first payee must match the TIN used.
**Attach a current W-9 form for each TIN/FEIN/SSN.
Page 1 of 2 LA 4112A Template(Rev.02/9/16)
5. NON-FOREIGN CERTIFICATION — FIRPTA. Section 1445 of the Internal Revenue Code provides that a
transferee (buyer) of a U.S. real property interest must withhold tax if the transferor is a foreign person. For
purposes of this paragraph, "Transferee" shall mean "Grantee" and "Transferor" shall mean "Grantor". To
inform the Grantee that withholding of tax is not required upon the disposition of a U.S. real property interest
by Grantor, the Grantor hereby certifies the following:
a. Transferor is the owner of the real property being conveyed;
b. Transferor is not a foreign person (as such term is defined in the Internal Revenue Code and Income Tax
Regulations); and
c. Transferor's U.S. Taxpayer Identification Number and address set forth above are true and correct.
Transferor understands that this certification may be disclosed to the Internal Revenue Service by nsferee
and that any false statement contained herein could be punished by fine, imprisonment or bot, /
/ "drIf
yInitial
6. Illinois law (15 ILCS 405/10.05 to 405/10.05b) requires the State of Illinois Comptroller to deduct from any
State of Illinois warrants or payments the amount of any outstanding account or claim in favor of the State of
Illinois and any amount necessary to satisfy past due child support or delinquent student loan and financial
aid obligations on any loan guaranteed by the Illinois Student Assistance Commission.
7. This Receipt of Conveyance Documents and Disbursement Statement is the entire and exclusive agreement
between the parties and supersede any written or oral understanding, promise or agreement, directly or
indirectly related to the conveyance of parcel and improvements. The parties agree that any changes to this
Receipt may only be made in writing and signed by the parties.
Date: January 24 , 20 24
Grantor: City of Elgin
%2uret
David J. Kaptain, Mayor
Print Name(and Title if applicable)
Date: , 20
Grantee:
The People of the State of Illinois, Department of Transportation
for State of Illinois,Department of Transportation
Page 2 of 2 LA 4112A Template(Rev.02/9/16)
Owner: City of Elgin
Route: US 20
Section: Randall Road to Shales
Parkway
County: Kane
Project No.:
Job No.: R-91-007-20
Parcel No.: 1020004 PE & TE
P.I.N. No.: 06-24-351-010
TEMPORARY CONSTRUCTION EASEMENT
(Governmental Entity)
City of Elgin, a governmental entity organized and existing under and by virtue of the
laws of the State of Illinois and duly authorized to do business under the Statutes of the State of
Illinois, (Grantor), by David J. Kaptain , its Mayor , for and in
consideration of Eighteen Thousand Dollars ($18,000.00), receipt of which is hereby
acknowledged, and pursuant to the provisions of 50 ILCS 605/4 hereby represents that Grantor
owns the fee simple title to and grants and conveys to the People of the State of Illinois,
Department of Transportation, (Grantee), a temporary construction easement for the purpose of
roadway construction and other highway purposes, on, over, and through the following
described real estate:
See attached legal description.
Address: North Side of US Route 20, west of The Chicago & Northwestern Railroad
tracks, Elgin, Illinois
situated in the County of Kane, State of Illinois. The above-described real estate and
improvements located thereon are herein referred to as the "premises."
The right, easement and privilege granted herein shall terminate Five years from the
execution of this document, or on the completion of the proposed project, whichever is the
sooner.
Grantor shall have and retain all rights to use and occupy the premises and access to
Grantor's remaining property, except as herein expressly granted; provided, however, that
Grantor's use and occupation of the premises may not interfere with Grantee's use of the
premises in the purposes herein described.
Anything in this permanent easement to the contrary notwithstanding, Grantee's use of
the premises for the purposes herein described shall not interfere with or adversely impact any
of Grantor's improvements located in or on the premises or Grantor's property located adjacent
thereto, including but not limited to (1) Grantor's existing 66" storm sewer line located in the
premises, (2) the shelter structure, concrete pad, and grill on the park property adjoining the
premises, and (3) the bike/walking path located on property adjoining the premises. All
construction by Grantee shall be in a good and workmanlike manner, and the premises shall be
restored to the similar condition prior to any construction activities undertaken by grantee as
depicted in plan sheets.
Page 1 of 3 (New 4/12)
Grantor, without limiting the interest above granted and conveyed, acknowledges that
upon payment of the agreed consideration, all claims arising out of the above acquisition have
been settled, including without limitation, any diminution in value to any remaining property of
the Grantor caused by the opening, improving and using the premises for highway purposes.
This acknowledgment does not waive any claim for trespass or negligence against the Grantee
or Grantee's agents which may cause damage to the Grantor's remaining property.
This grant shall constitute a covenant, which runs with the land, and shall be binding
upon the legal representatives, successors and assigns of Grantor.
Dated this 24th day of January ,20 24 .
City of Elgin
By:
Si ture
David J. Kaptain, Mayor
Print Name and Title
ATTEST:
By
nature
Kimberly A. Dewis, City Clerk
Print Name and Title
State of Illinois
) ss
County of Kane
This instrument was acknowledged before me on January 24 , 20 24, by
David J. Kaptain , as Mayor
and Kimberly A. Dewis , as City Clerk
of City of Elgin, a governmental entity organized and existing under the laws of Illinois.
(SEA y�ss
OFFICIAL SEAL"
JENNIFER J QUINTON otary Public
Notary Public,State of Illinois
Commission No.982682 II
My Commission Exphes December 06,2027 My Commission Expires: l oioia,l a0 024
� g��44Ti 44�i4�� 11(
This instrument was prepared by and after recording, mail this instrument to:
Page 2 of 3 (New 4/12)
Illinois Department of Transportation
ATTN: Bureau of Land Acquisition
201 Center Court, Schaumburg, IL 60196-1096
Page 3 of 3 (New 4/12)
Route: US 20
Section: Randall Rd. to
Shales Pkwy.
County: Kane
Job No.: R-91-007-20
Parcel No.: 1020004TE
Station: 384+18.22 to
395+65.67 (Route 20)
Index No.: 06-24-351-010
That part of the Northwest Quarter of Southwest Quarter of Section 24,Township 41 North, Range 8 East
of the Third Principal Meridian, in Elgin Township, Kane County, Illinois, bearings and distances are based
on the Illinois State Place Coordinate System, East Zone,NAD83(2011 Adjustment)with a combined factor
of 0.99995674; described as follows:
Commencing at the intersection of the west line of the C&NW RR and the north line of US Route 20 per
document number 579414, recorded April 4, 1947, in Kane County IL.; thence North 21 degrees 21
minutes 35 seconds West along said west line of C&NW RR, 76.44 feet to the Point of Beginning; thence
North 75 degrees 39 minutes 47 seconds West, 51.00 feet; thence North 81 degrees 21 minutes 10
seconds West, 386.03; thence North 84 degrees 23 minutes 25 seconds West, 56.00 feet; thence North
81 degrees 16 minutes 15 seconds West, 142.23 feet; thence North 76 degrees 04 minutes 37 seconds
West, 141.22 feet; thence North 75 degrees 13 minutes 45 seconds West, 160.20 feet; thence North 79
degrees 56 minutes 32 seconds West, 91.03 feet;thence North 65 degrees 06 minutes 23 seconds West,
108.58 feet; thence South 67 degrees 37 minutes 34 seconds East, 61.78 feet; thence South 76 degrees
18 minutes 11 seconds East, 136.70 feet; thence South 73 degrees 47 minutes 56 seconds East, 160.05
feet; thence North 71 degrees 02 minutes 22 seconds East, 33.74 feet; thence South 79 degrees 48
minutes 38 seconds East 254.12 feet; thence South 80 degrees 18 minutes 49 seconds East, 481.40 feet
to said west line of the C&NW RR;thence South 21 degrees 21 minutes 35 seconds East along said west
line, 20.00 feet to the Point of Beginning.
Said parcel containing 0.386 Acres, more or less.
APPROVED
By William Wright at 8:07 am, Jan 12, 2023
Owner: City of Elgin
Route: US 20
Section: Randall Road to Shales
Parkway
County: Kane
Project No.:
Job No.: R-91-007-20
Parcel No.: 1020004 PE & TE
P.I.N. No.: 06-24-351-010
PERMANENT EASEMENT
(Governmental Entity)
City of Elgin, a governmental entity organized and existing under and by virtue of the
laws of the State of Illinois and duly authorized to do business under the Statutes of the State of
Illinois, (Grantor), by David J. Kaptain , its Mayor , for and in
consideration of One Hundred Thirty Thousand Dollars ($130,000.00), receipt of which is
hereby acknowledged, and pursuant to the provisions of 50 ILCS 605/4 hereby represents that
Grantor owns the fee simple title to and grants and conveys to the People of the State of Illinois,
Department of Transportation, (Grantee), a permanent easement for the purpose of roadway
purposes and for other highway purposes, on, over and through the following described real
estate:
See attached legal description.
Address: North Side of US Route 20, west of The Chicago & Northwestern Railroad
tracks, Elgin, Illinois
situated in the County of Kane, State of Illinois and hereby releases and waives all right under
and by virtue of the Homestead Exemption Laws of the State of Illinois. The above-described
real estate and improvements located thereon are herein referred to as the "premises."
Grantor shall have and retains all rights to use and occupy the premises and access to
Grantor's remaining property, except as herein expressly granted; provided, however, Grantor's
use and occupation of the premises may not interfere with Grantee's use of the premises for the
purposes herein described.
Anything in this permanent easement to the contrary notwithstanding, Grantee's use of
the premises for the purposes herein described shall not interfere with or adversely impact any
of Grantor's improvements located in or on the premises or Grantor's property located adjacent
thereto, including but not limited to (1) Grantor's existing 66" storm sewer line located in the
premises, (2) the shelter structure, concrete pad, and grill on the park property adjoining the
premises, and (3) the bike/walking path located on property adjoining the premises. All
construction by Grantee shall be in a good and workmanlike manner, and the premises shall be
restored to the similar condition prior to any construction activities undertaken by grantee as
depicted in plan sheets.
This permanent easement is made, executed and delivered pursuant to a resolution duly
adopted at a meeting held on the 24 day of January , 20 24
Page 1 of 3 (Rev.4/12)
Grantor, without limiting the interest above granted and conveyed, acknowledges that
upon payment of the agreed consideration, all claims arising out of the above acquisition have
been settled, including without limitation, any diminution in value to any remaining property of
the Grantor caused by opening, improving, and using the premises for highway purposes. This
acknowledgment does not waive any claim for trespass or negligence against the Grantee or
Grantee's agents which may cause damage to Grantor's remaining property.
This grant shall constitute a covenant, which runs with the land, and shall be binding
upon the legal representatives, successors and assigns of Grantor.
Dated this 24th day of January 2024 .
City of Elgin
Sign ure
David J. Kaptain, Mayor
Print Name and Title
ATTEST:
By:
S n Lure
Kimberly A. Dewis, City Clerk
Print Name and Title
State of Illinois
ss
County of Kane )
This instrument was acknowledged before me on January 24 , 20 24, by
David J. Kaptain , as Mayor
and Kimberly A. Dewis , as City Clerk
of City of Elgin, a governmental entity organized and existing under the laws of Illinois.
(SE �•.
"OFFICIAL SEAL" 4
JENNIFER J QUINTON
Notary Public,State of Illinois 'z N ry Public
Commission No.982682
Mh`CommissionExpires December 06,2027 My Commission Expires: 1406k0a-4-
This instrument was prepared by and after recording, return to:
Page 2 of 3 (Rev.4/12)
Illinois Department of Transportation
ATTN: Bureau of Land Acquisition
201 Center Court, Schaumburg, IL 60196-1096
Page 3 of 3 (Rev.4/12)
Route: US 20
Section: Randall Rd.to
Shales Pkwy.
County: Kane
Job No.: R-91-007-20
Parcel No.: 1020004PE
Station: 383+60.31 to
396+37.66(Route 20)
Index No.: 06-24-351-010
That part of the Northwest Quarter of Southwest Quarter of Section 24,Township 41 North,Range 8 East
of the Third Principal Meridian, in Elgin Township, Kane County, Illinois, bearings and distances are based
on the Illinois State Place Coordinate System,East Zone,NAD83(2011 Adjustment)with a combined factor
of 0.99995674; described as follows:
Beginning at the intersection of the west line of the C&NW RR and the north line of US Route 20 per
document number 579414, recorded April 4, 1947, in Kane County IL.; thence westerly along said north
line of US 20,being a curve to the right having a radius of 4,398.44 feet,a distance of 323.80 feet through
a central angle of 04 degrees 13 minutes 04 seconds, the chord of which bears North 76 degrees 55
minutes 56 seconds West, 323.72 feet; thence North 78 degrees 13 minutes 06 seconds West, 496.06
feet; thence North 72 degrees 22 minutes 01 seconds West, 390.23 feet; thence North 15 degrees 24
minutes 07 seconds West, 47.00 feet; thence South 57 degrees 13 minutes 05 seconds East, 60.00
feet; thence South 65 degrees 06 minutes 23 seconds East, 108.58 feet; thence South 79 degrees 56
minutes 32 seconds East, 91.03 feet; thence South 75 degrees 13 minutes 45 seconds East, 160.20 feet;
thence South 76 degrees 04 minutes 37 seconds East, 141.22 feet; thence South 81 degrees 16
minutes 15 seconds East, 142.23 feet; thence South 84 degrees 23 minutes 25 seconds East, 56.00
feet; thence South 81 degrees 21 minutes 10 seconds East, 386.03 feet; thence South 75 degrees 39
minutes 47 seconds East, 51.00 feet to said west line of the C&NW RR; thence South 21 degrees 21
minutes 35 seconds East, along said west line 76.44 feet to the Point of Beginning.
Said parcel containing 0.992 Acres, more or less.
APPROVED
By William Wright at 1:16 pm, Dec 14, 2023
Illinois Department
of Transportation Affidavit of Title
Owner: City of Elgin
Address: North Side of US Route 20, west of The Chicago & Northwestern Railroad tracks, Elgin, Illinois
Route: US 20
Section: Randall Road to Shales Parkway
County: Kane
Project:
Job No. R-91-007-20
Parcel No. 1020004 PE &TE
P.I.N. No. 06-24-351-010
State of Illinois
ss.
County of Kane )
David J. Kaptain , Mayor , being first duly sworn
upon oath states as follows:
1. Affiant has personal knowledge of the facts averred herein.
2. ® There are no parties other than Grantor in possession of any portion of the premises described in
the attached Exhibit"A" through easement, lease, oral or written, or otherwise, whether or not of
record.
❑ There are no parties other than Grantor and the parties listed below in possession of any portion
of the premises described in the attached Exhibit "A"through easement, lease, oral or written, or
otherwise, whether or not of record:
SEE ATTACHED EXHIBIT "A"
3. This affidavit is made to provide factual representation as a basis for the State of Illinois to accept a
document of conveyance for the premises described in said conveyance, the premises being a portion
of or all of the above described premises, from the record owners thereof.
4. The affiant has no knowledge of any driveway agreements, encroachments, overlaps, or boundary line
disputes involving the premises to be conveyed.
5. The said premises described in Exhibit "A" are: (Check One)
❑ Vacant and unimproved ❑ Agricultural and unimproved
® Improved and
(A) There have been no improvements made or contracted for on the premises within six (6)
months immediately preceding the date of the affidavit, out of which a claim for a mechanics'
lien could accrue or has accrued, and
(B) To the best of my knowledge all improvements now on the premises comply with all local
building and zoning ordinances.
Page 1 of 3 LA 4111A(Rev. 11/07/11)
6. There are no chattel mortgages, conditional sales contracts or financing statements existing on or in
connection with the premises to be conveyed which are not shown by the public records.
7. There are no taxes or special assessments which are not shown as existing liens by the public records
involving the premises described in Exhibit A.
8. Per 50 ILCS 105/3.1, the identities of all owners and beneficiaries having an interest in the premise to
be conveyed are as follows (check applicable box(es) and complete information requested):
❑ Individual. Individual owner of the property is:
❑ Nonprofit Organization. There is no individual or other organization receiving distributable
income from the organization.
® Public Organization, including units of local government. There is no individual or other
organization receiving distributable income from the organization.
❑ Publicly-Traded Corporation. There is no readily known shareholder having more than 7-1/2%
of the total distribution income of the corporation.
❑ Corporation, Partnership, Limited Liability Company. Those entitled to receive more than 7-
1/2% of the total distributable income of said entity are as follows:
Name Address
*1.
2.
3.
4.
O Land Trust or Declaration of Trust. The identity of each beneficiary of Grantor Trust is as
follows:
Name Address
*1.
2.
3.
4.
* IF THE INITIAL DISCLOSURES SHOW INTERESTS HELD BY ANOTHER CORPORATION,
PARTNERSHIP, LIMITED LIABILITY COMPANY, OR TRUST, THEN FURTHER DISCLOSURES SHOULD
BE PROVIDED UNTIL THE NAMES OF INDIVIDUALS OWNING THE INTEREST IN THE ENTITY ARE
DISCLOSED.
Page 2 of 3 LA 4111A(Rev. 11/07/11)
Dated this 24 day of January , 20 24 .
By: 41/701'
David J.Kaptain,Mayor
Print Name and Title if applicable
State of Illinois
ss.
County of Kane
This instrument was acknowledged before me on January 24 20 24 , by
David J. Kaptain, Mayor
(SEAL) "OFFICIAL SEAL" / 421, Notary Public
JENNIFER J QUINTON rY
Notary Public,State of Illinois
M Commission No.982682 My Commission Expires: 401.1ao.al
y Commission Expires December 06,2027 •
« ttto-4 ; s s•.
NOTE: THIS AFFIDAVIT MAY BE EXECUTED AND ACKNOWLEDGED ON BEHALF OF THE RECORD
OWNER(S) BY ANY ONE OF THE RECORD OWNERS, OFFICERS, MANAGERS, PARTNERS,
OR TRUSTEES HAVING KNOWLEDGE OF THE FACTS IN THIS AFFIDAVIT.
Page 3 of 3 LA 4111A(Rev. 11/07/11)
Date:05/23/2023
Job R-91-007-20
US 20
County Kane
Section
Parcel 1020004
WTC Number: I1-2021KN-1744.0
A.L.T.A. COMMITMENT FORM
Schedule A Continued
LEGAL DESCRIPTION
THAT PART OF THE NW 1/4 OF THE SW 1/4 OF SECTION 24, TWP 41N,R
8E OF THE 3RD PM LYING SOUTH OF THE SOUTH RIGHT OF WAY LINE
OF SOUSTER AVE.,AND LYING WEST OFTHE WESTERLY RIGHT OF
WAY LINE OF THE C&NW RR,AND LYING NORTH AND EAST OF
ROUTE 20 AS DEPICTED IN RIGHT OF WAY PLAT RECORDED AS
SOCUMENT 579414, SITUATED IN KANE COUNTY, ILLINOIS.
PERMANENT TAX NUMBER(S): 06-24-351-010
ISSUED BY:
Wheatland Title Company
105 W.Veterans Parkway
Yorkville,Illinois 60560
Agent for:
Fidelity National Title Insurance Company
W-9Request for Taxpayer
Form Give Form to the
(Rev.October 2018) Identification Number and Certification requester.Do not
Department of the Treasury send to the IRS.
Internal Revenue Service ►Go to www.irs.gov/FormW9 for instructions and the latest information.
1 Name(as shown on your income tax return).Name is required on this line;do not leave this line blank.
2 Business name/disregarded entity name,if different from above
City of Elgin
m 3 Check appropriate box for federal tax classification of the person whose name is entered on line 1.Check only one of the 4 Exemptions(codes apply only to
a:
cr following seven boxes. certain entities,not individuals;see
co
a. instructions on page 3):
o ❑ Individual/sole proprietor or ❑ C Corporation ❑ S Corporation ❑ Partnership ❑Trust/estate
single-member LLC Exempt payee code(if any)
❑ Limited liability company.Enter the tax classification(C=C corporation,S=S corporation,P=Partnership)►
2 Note:Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check Exemption from FATCA reporting
a LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC Is'c E another LLC that is not disregarded from the owner for U.S.federal tax purposes.Otherwise,a single-member LLC that code(If any)
a. O is disregarded from the owner should check the appropriate box for the tax classification of its owner.
❑I Other(see instructions)► Municipality Orcw:ro.«arKsrnanfwoo.A eneus,
!A 5 Address(number,street,and apt.or suite no.)See instructions. Requester's name and address(optional)
rU
in 150 Dexter Court
6 City,state,and ZIP code
Elgin, IL 60120
7 List account number(s)here(optional)
Part I Taxpayer Identification Number(TIN)
Enter your TIN in the appropriate box.The TIN provided must match the name given on line 1 to avoid 1 Social security number
backup withholding.For individuals,this is generally your social security number(SSN). However,for a
resident alien,sole proprietor,or disregarded entity,see the instructions for Part I,later.For other - -
entities,it is your employer identification number(EIN).If you do not have a number,see How to get a
TIN, later. or
Note:If the account is in more than one name,see the instructions for line 1.Also see What Name and Employer identification number
Number To Give the Requester for guidelines on whose number to enter.
3 6 - 6 0 0 5 8 6 2
Part II Certification
Under penalties of perjury,I certify that:
1.The number shown on this form is my correct taxpayer identification number(or I am waiting for a number to be issued to me);and
2.I am not subject to backup withholding because:(a)I am exempt from backup withholding,or(b)I have not been notified by the Internal Revenue
Service(IRS)that I am subject to backup withholding as a result of a failure to report all interest or dividends,or(c)the IRS has notified me that I am
no longer subject to backup withholding;and
3.I am a U.S. citizen or other U.S.person(defined below);and
4.The FATCA code(s)entered on this form(if any)indicating that I am exempt from FATCA reporting is correct.
Certification instructions.You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because
you have failed to report all interest and dividends on your tax return.For real estate transactions,item 2 does not apply.For mortgage interest paid.
acquisition or abandonment of secured property,cancellation of debt,contributions to an individual retirement arrangement(IRA),and generally,payments
other than interest and dividends.you are riot required to sign the certification,but you must provide your correct TIN.See the instructions for Part II,later.
Sin
9 Signature o1
Here U.S.person► �� 19e G ni Date► I - a - oZ Oc
General Instructions •Form 1099-DIV(dividends,including those from stocks or mutual
funds)
Section references are to the Internal Revenue Code unless otherwise •Form 1099-MISC(various types of income,prizes,awards,or gross
noted. proceeds)
Future developments. For the latest information about developments •Form 1099-B(stock or mutual fund sales and certain other
related to Form W-9 and its instructions,such as legislation enacted transactions by brokers)
after they were published,go to www.irs.gov/FormW9.
•Form 1099-S(proceeds from real estate transactions)
Purpose of Form •Form 1099-K(merchant card and third party network transactions)
An individual or entity(Form W-9 requester)who is required to file an •Form 1098(home mortgage interest), 1098-E(student loan interest),
information return with the IRS must obtain your correct taxpayer 1098-T(tuition)
identification number(TIN)which may be your social security number •Form 1099-C(canceled debt)
(SSN),individual taxpayer identification number(ITIN),adoption •Form 1099-A(acquisition or abandonment of secured property)
taxpayer identification number(ATIN),or employer identification number
(EIN),to report on an information return the amount paid to you,or other Use Form W-9 only if you are a U.S.person(including a resident
amount reportable on an information return.Examples of information alien),to provide your correct TIN.
retums include,but are not limited to,the following. If you do not return Form W-9 to the requester with a TIN,you might
•Form 1099-INT(interest earned or paid) be subject to backup withholding.See What is backup withholding,
later.
Cat.No.10231X Form W-9(Rev.10-2018)