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2018-17RESOLUTION NO.2018 -17 A RESOLUTION APPROVING THE PROJECT SPECIFIC AGREEMENT BETWEEN THE COUNTY OF LAKE AND THE VILLAGE OF BUFFALO GROVE FOR THE IMPROVEMENT OF WEILAND ROAD AND FOR THE DEDICATION OF RIGHT-OF-WAY AND GRANTING OF TEMPORARY EASEMENTS FROM LAKE COOK ROAD TO APTAKISIC ROAD WHEREAS, the Village of Buffalo Grove is a Home Rule Unit pursuant to the Illinois Constitution of 1970; and, WHEREAS, the quality of life is enhanced by a high quality arterial street transportation system which allows both commuters and residents to travel efficiently in and out of the Village of Buffalo Grove and reduces the amount of "cut through" traffic through the neighborhood streets; and, WHEREAS, the County and the Village entered into the AGREEMENT BETWEEN THE COUNTY OF LAKE AND THE VILLAGE OF BUFFALO GROVE FOR THE ROADWAY IMPROVEMENT, MAINTENANCE RESPONSIBILITIES AND JURISDICTIONAL TRANSFERS OF BUSCH ROAD/PARKWAY AND DEERFIELD PARKWAY; BUFFALO GROVE ROAD/PORT CLINTON ROAD/PRAIRIE ROAD; WEILAND ROAD; AND PRAIRIE ROAD dated the thirteenth day of June, A.D. 1995 and amended the nineteenth day of January, A.D. 2017 by Amendment #1 to said aforementioned Agreement (the Agreement and Amendment # 1 collectively shall hereinafter be referred to as the 1995 AGREEMENT) stipulating specific improvements, maintenance and the jurisdictional transfers of said named roadways located within the VILLAGE; and, 1 WHEREAS, said 1995 AGREEMENT requires that the COUNTY and the VILLAGE enter into a project specific agreement for each stage of improvement for said named roadways prior to the commencement of the construction of a specific improvement; and, WHEREAS, THIS AGREEMENT sets forth the specific duties and responsibilities of the COUNTY and the VILLAGE for the improvement of Weiland Road (COUNTY Highway 73) from Lake Cook Road to Aptakisic Road (COUNTY Highway 33), and as such, complies with the requirement set forth in the 1995 AGREEMENT for a project specific agreement; and, WHEREAS, the COUNTY and the VILLAGE mutually agree that the terms and conditions outlined in THIS AGREEMENT shall supersede the 1995 AGREEMENT relating to the subject matter contained herein THIS AGREEMENT, and in the event of a conflict between THIS AGREEMENT and the 1995 AGREEMENT, THIS AGREEMENT shall control. NOW, THEREFORE, BE IT RESOLVED by the Village President and Board of Trustees of the Village of Buffalo Grove, Cook and Lake Counties, Illinois, as follows: The Village of Buffalo Grove hereby approves the Project Specific Agreement for the Weiland Road Improvements from Lake Cook Road to Aptakisic Road with the County of Lake. AYES: 6 — Berman Stein Ottenheimer, Weidenfeld Johnson Smith NAYES: 0 — None ABSENT: 0 - None PASSED: August 20, 2018 2 APPROVED: August 20, 2018 APPROVED: everly Suss , Village President ATTEST: Janet W. Sirabian, Village Clerk RESOLUTION 2018 - 17 Owner: The Village of Buffalo Grove Route: Weiland Rd Section: 14-00158-11-W R County: Lake Project No.: Lake Cook Rd to IL 22 Job No.: R-55-001-97 Parcel No.: 0041 & TE, 009 TE & 019 TE P.I.N. No.: 15-28-219-003, 15-33-212- 050 & 15-28-417-004 CERTIFIED RESOLUTION (Governmental Entity) I Beverly Sussman Village President of Village of Buffalo Grove, 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 of the 20th day of August , 20 18, and 2. The resolution has not been amended or revoked and is in full force and effect. Resolved that BeverlySuy the Village President and Janet Sirabian , the Villge . rk of the Council or Board of the above -referenced governmental entity are hereby authorized and directed to convey and grant the governmental entity's interest in the following described real estate in Lake County, Illinois to the Lake County Division of Transportation ("County") for highway purposes for the sum of one and no/100 Dollars ($1.00): See attached legal description. Further resolved that they are authorized and directed to execute and deliver such instruments as may be necessary or convenient to consummate such sale. 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 60514 voted for the adoption of this resolution as follows: AYE 6 .; NAY 0 ; ABSENT 0 Page 1 of 2 (Rev. 11/11) By: Lk�2�- �Gigtore �Mt4,eh4 Print me and Title State of ss County of �DolL ) This Instrument was acknowledged eforo eon f�cd�S , 20 by t Kok of Village of Buffalo Grove, (SEAL) Julie Kamka Notary Public - State of Illinois My Commission Expires oaro�l2ol9 Notary Public My Commission Expires: oY 1 o(o /go 19 Page 2 of 2 (Rev. 11/11) Route F.A.U. 2665 (Weiland Road) Section: 14-00158-11-WR County : Lake Job No.: R-55-001-97 Parcel 0009T.E. Sta. 40+35.00 To Sta. 40+62.89 Index No. 15-33-212-050 That part of Outlot A in Amberley, being a subdivision in the North Half of Section 33, Township 43 North, Range 11 East of the Third Principal Meridian, according to the plat thereof recorded July 13, 1988 as document number 2700262, in Lake County, Illinois, described as follows: Beginning at the northeast corner of said Outlot A; thence on an Illinois Coordinate System NAD 83(2007) East Zone bearing of South 17 degrees 08 minutes 58 seconds West along the easterly line of said Outlot A, a distance of 27.89 feet; thence North 73 degrees 02 minutes 11 seconds West, a distance of 10.71 feet; thence North 16 degrees 57 minutes 49 seconds East, a distance of 24.57 feet to the north line of said Outlot A; thence North 89 degrees 52 minutes 52 seconds East along the north line of said Outlot A, a distance of 11.30 feet to the point of beginning. Said temporary easement containing 0.006 acres, more or less, or 282 square feet, more or less. Said temporary easement to be used for grading purposes. Route F.A.U. 2665 (Weiland Road) Section: 14-00158-11-WR County : Lake Job No.: R-55-001-97 Parcel 0019T.E. Sta. 64+28.36 To Sta. 64+65.00 Index No. 15-28-417-004 That part of Lot A in Sterling Creek Subdivision, being a subdivision of part of the Southeast Quarter of Section 28, Township 43 North, Range 11 East of the Third Principal Meridian, according to the plat thereof recorded October 20, 1995 as document number 3737886, in Lake County, Illinois, described as follows: Commencing at the northwest corner of said Lot A; thence southerly 218.20 feet along the westerly line of said Lot A on a curve to the right having a radius of 5789.58 feet, the chord of said curve bears on an Illinois Coordinate System NAD 83(2007) East Zone bearing of South 7 degrees 37 minutes 13 seconds West, 218.19 feet to the point of beginning; thence South 81 degrees 11 minutes 49 seconds East, a distance of 19.07 feet; thence South 24 degrees 25 minutes 25 seconds East, a distance of 18.21 feet; thence southerly 21.98 feet along a curve to the right having a radius of 5819.58 feet, the chord of said curve bears South 9 degrees 03 minutes 41 seconds West, 21.98 feet to the southwesterly line of said Lot A; thence northwesterly 48.85 feet along the southwesterly line of said Lot A on a curve to the right having a radius of 35.00 feet, the chord of said curve bears North 31 degrees 15 minutes 18 seconds West, 44.98 feet to the westerly line of said Lot A; thence northerly 2.79 feet along the westerly line of said Lot A on a curve to the left having a radius of 5789.58 feet, the chord of said curve bears North 8 degrees 42 minutes 49 seconds East, 2.79 feet to the point of beginning. Said temporary easement containing 0.017 acres, more or less. Said temporary easement to be used for grading purposes. Route F.A.U. 2665 (Weiland Road) Section: 14-00158-11-WR County : Lake Job No.: R-55-001-97 Parcel 0041 Sta. 106+26.20 To Sta. 106+72.04 Index No. 15-28-219-003 That part of Lot 24 in Whispering Lakes Estates Subdivision, being a subdivision in the Northeast Quarter of Section 28, Township 43 North, Range 11 East of the Third Principal Meridian, according to the plat thereof recorded December 16, 2005 as document number 5915929, in Lake County, Illinois, described as follows: Beginning at the northeast corner of said Lot 24; thence on an Illinois Coordinate System NAD 83(2007) East Zone bearing of South 0 degrees 05 minutes 04 seconds West along the east line of said Lot 24, a distance of 3.01 feet; thence North 86 degrees 59 minutes 34 seconds West, a distance of 45.89 feet to the north line of said Lot 24; thence North 89 degrees 14 minutes 37 seconds East along the north line of said Lot 24, a distance of 45.84 feet to the point of beginning. Said parcel containing 0.002 acres, more or less, or 69 square feet, more or less. Route F.A.U. 2665 (Weiland Road) Section: 14-00158-11-WR County : Lake Job No.: R-55-001-97 Parcel 0041T.E. Sta. 106+26.20 To Sta. 106+72.00 Index No. 15-28-219-003 That part of Lot 24 in Whispering Lakes Estates Subdivision, being a subdivision in the Northeast Quarter of Section 28, Township 43 North, Range 11 East of the Third Principal Meridian, according to the plat thereof recorded December 16, 2005 as document number 5915929, in Lake County, Illinois, described as follows: Commencing at the northeast corner of said Lot 24; thence on an Illinois Coordinate System NAD 83(2007) East Zone bearing of South 0 degrees 05 minutes 04 seconds West along the east line of said Lot 24, a distance of 3.01 feet to the point of beginning; thence North 86 degrees 59 minutes 34 seconds West, a distance of 45.89 feet to the north line of said Lot 24; thence South 0 degrees 45 minutes 23 seconds East, a distance of 5.01 feet; thence South 86 degrees 59 minutes 34 seconds East, a distance of 45.82 feet to the east line of said Lot 24; thence North 0 degrees 05 minutes 04 seconds East along the east line of said Lot 24, a distance of 5.01 feet to the point of beginning. Said temporary easement containing 0.005 acres, more or less, or 229 square feet, more or less. Said temporary easement to be used for construction purposes. Owner: Village of Buffalo Grove Route: Weiland Rd Section: 14-00158-11 -WR County: Lake Project No.: Lake Cook Rd to IL 22 Job No.: R-55-001-97 Parcel No.: 0041 & TE P.I.N. No.: 15-28-219-003 QUITCLAIM DEED (Government Entity) (Non -Freeway) Village of Buffalo Grove, a government 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), for and in consideration of one and Noll00 Dollars ($1.00), receipt of which is hereby acknowledged, conveys and quitclaims to the Lake County Division of Transportation ("County") (Grantee), all existing legal and equitable rights of Grantor, including, without limitation, any after -acquired title, in and to the following described real estate situated in the County of Lake in the State of Illinois, to -wit: See attached legal description. Address: South side of Aptakisic Road, between Weiland Road and Joseph Court 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. Dated this ol� day of � - 20. &. Page 1 of 2 (Rev. 2115115) Village of Buffalo Grove ATTEST: By;.,:. Signature �..U. Print Name and Title State of Z 11111 VI i ) County of ) ss �01( ) This instrument was acknowledged before me on _ , 20 & by r % , as UevL and s , as cr of Village of Buffalo Grove, ( Julie Kamka Notary Public - State of Illinois My Commission Expires Notary Public 04/06/20 1 9 My Commission Expires: w ord o10/ Exempt under 35 ILCS 200/31-45(b), Real Estate Transfer Tax Law. gaa� ate Puyer, Seffe,r or Representative This instrument was prepared by: J. Steve Santacruz, Santacruz Land Acquisitions, 222 Northfield Road, Northfield, IL 60093 and after recording, mail this instrument and future tax bills to: Lake County Division of Transportation, Attn: Chuck Good 600 W. Winchester Rd, Libertyville, IL 60048-1381 Page 2 of 2 (Rev. 2115115) Route F.A.U. 2665 (Weiland Road) Section: 14-00158-11-WR County : Lake Job No.: R-55-001-97 Parcel : 0041 Sta. 106+26.20 To Sta. 106+72.04 Index No. 15-28-219-003 That part of Lot 24 in Whispering Lakes Estates Subdivision, being a subdivision in the Northeast Quarter of Section 28, Township 43 North, Range 11 East of the Third Principal Meridian, according to the plat thereof recorded December 16, 2005 as document number 5915929, in Lake County, Illinois, described as follows: Beginning at the northeast corner of said Lot 24; thence on an Illinois Coordinate System NAD 83(2007) East Zone bearing of South 0 degrees 05 minutes 04 seconds West along the east line of said Lot 24, a distance of 3.01 feet; thence North 86 degrees 59 minutes 34 seconds West, a distance of 45.89 feet to the north line of said Lot 24; thence North 89 degrees 14 minutes 37 seconds East along the north line of said Lot 24, a distance of 45.84 feet to the point of beginning. Said parcel containing 0.002 acres, more or less, or 69 square feet, more or less. Owner: Village of Buffalo Grove Route: Weiland Rd Section: 14-00158-11-WR County: Lake Project No.: Lake Cook Rd to IL 22 Job No.: R-55-001-97 Parcel No.: 0041 & TE P.I.N. No.: 15-28-219-003 TEMPORARY CONSTRUCTION EASEMENT (Governmental Entity) Village of Buffalo Grove, 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 V ecI 6,6, its A- , for and in consideration of One Dollar ($1.00" , 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 Lake County Division 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: South side of Aptakisic Road, between Weiland Road and Joseph Court situated in the County of Lake, 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. 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. Page 1 of 2 (New 11/11) Dated this d -P- day of iqRctLASJ _ 20 /IF. Village of Buffalo Grove ATTEST: By. • Signature Print Name and Title State of -T: kk j V'�o I S ) ss County of d This instrument was acknowledged before me on �� usi ate, 20, by i��, as and s , as . \ as it - of Village of Buffalo Grove, a governmental entity organized and existing under the laws of Illinois. (SEA tfli K � ECil�lo - fa of Illinois My ��611s No ary Public My Commission Expires: 0,410(o a-O This instrument was prepared by: J. Steve Santacruz, Santacruz Land Acquisitions, 222 Northfield Road, Northfield, IL 60093 and after recording, mail this instrument to: Lake County Division of Transportation, Attn: Chuck Good 600 W. Winchester Rd, Libertyville, IL 60048-1381 Page 2 of 2 (New 11/11) Route F.A.U. 2665 (Weiland Road) Section: 14-00158-11-WR County : Lake Job No.: R-55-001-97 Parcel 0041T.E. Sta. 106+26.20 To Sta. 106+72.00 Index No. 15-28-219-003 That part of Lot 24 in Whispering Lakes Estates Subdivision, being a subdivision in the Northeast Quarter of Section 28, Township 43 North, Range 11 East of the Third Principal Meridian, according to the plat thereof recorded December 16, 2005 as document number 5915929, in Lake County, Illinois, described as follows: Commencing at the northeast corner of said Lot 24; thence on an Illinois Coordinate System NAD 83(2007) East Zone bearing of South 0 degrees 05 minutes 04 seconds West along the east line of said Lot 24, a distance of 3.01 feet to the point of beginning; thence North 86 degrees 59 minutes 34 seconds West, a distance of 45.89 feet to the north line of said Lot 24; thence South 0 degrees 45 minutes 23 seconds East, a distance of 5.01 feet; thence South 86 degrees 59 minutes 34 seconds East, a distance of 45.82 feet to the east line of said Lot 24; thence North 0 degrees 05 minutes 04 seconds East along the east line of said Lot 24, a distance of 5.01 feet to the point of beginning. Said temporary easement containing 0.005 acres, more or less, or 229 square feet, more or less. Said temporary easement to be used for construction purposes. Lake County Division of Transportation Owner: Village of Buffalo Grove Address: South side of Aptakisic Road, between Weiland Road and Joseph Court Route: Weiland Rd Section: 14-00158-11-WR County: Lake Project: Job No. R-55-001-97 Parcel No. 0041 & TE P.I.N. No. 15-28-219-003 State of Illinois ) —�,) ss. County of Lake Affidavit of Title ,A \\ a , being first duly sworn upon oath states as foll ws: 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 Lake County Division of Transportation 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 Otte) ® Vacant and unimproved ❑ Agricultural and unimproved ❑ Improvedand (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. 11107/11) 6. ® The affiant has no knowledge of any unrecorded easements or leases over, under, upon or across the premises to be conveyed. ❑ The affiant has no knowledge of any unrecorded easements over or leases, under, upon or across the premises to be conveyed other than; 7. 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. 8. 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. 9. 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 *1 2. 3. 4. Address 0 Land Trust or Declaration of Trust. The identity of each beneficiary of Grantor Trust is as follows: Name *1. 2. 3. 4. Address * 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. 11107/11) Dated this ag day of , 20_LE, Village By: State of 1 ® ) /�11 ) ss. L. County of aOyL ) This instrument was acknowledged before me on qpa.1OL 20_�L, by (SEAL)LNOtaty amka (I)nois SEAL K tate of 1 Notary Public issian 1�xpi s6/2019 My Commission Expires O� __/o& /a0/2 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) Route F.A.U. 2665 (Weiland Road) Section: 14-00158-11-WR County : Lake Job No.: R-55-001-97 Parcel 0041 Sta. 106+26.20 To Sta. 106+72.04 Index No. 15-28-219-003 That part of Lot 24 in Whispering Lakes Estates Subdivision, being a subdivision in the Northeast Quarter of Section 28, Township 43 North, Range 11 East of the Third Principal Meridian, according to the plat thereof recorded December 16, 2005 as document number 5915929, in Lake County, Illinois, described as follows: Beginning at the northeast corner of said Lot 24; thence on an Illinois Coordinate System NAD 83(2007) East Zone bearing of South 0 degrees 05 minutes 04 seconds West along the east line of said Lot 24, a distance of 3.01 feet; thence North 86 degrees 59 minutes 34 seconds West, a distance of 45.89 feet to the north line of said Lot 24; thence North 89 degrees 14 minutes 37 seconds East along the north line of said Lot 24, a distance of 45.84 feet to the point of beginning. Said parcel containing 0.002 acres, more or less, or 69 square feet, more or less. Ej"(Arstr A (C Route F.A.U. 2665 (Weiland Road) Section: 14-00158-11-WR County : Lake Job No.: R-55-001-97 Parcel 0041T.E. Sta. 106+26.20 To Sta. 106+72.00 Index No. 15-28-219-003 That part of Lot 24 in Whispering Lakes Estates Subdivision, being a subdivision in the Northeast Quarter of Section 28, Township 43 North, Range 11 East of the Third Principal Meridian, according to the plat thereof recorded December 16, 2005 as document number 5915929, in Lake County, Illinois, described as follows: Commencing at the northeast corner of said Lot 24; thence on an Illinois Coordinate System NAD 83(2007) East Zone bearing of South 0 degrees 05 minutes 04 seconds West along the east line of said Lot 24, a distance of 3.01 feet to the point of beginning; thence North 86 degrees 59 minutes 34 seconds West, a distance of 45.89 feet to the north line of said Lot 24; thence South 0 degrees 45 minutes 23 seconds East, a distance of 5.01 feet; thence South 86 degrees 59 minutes 34 seconds East, a distance of 45.82 feet to the east line of said Lot 24; thence North 0 degrees 05 minutes 04 seconds East along the east line of said Lot 24, a distance of 5.01 feet to the point of beginning. Said temporary easement containing 0.005 acres, more or less, or 229 square feet, more or less. Said temporary easement to be used for construction purposes. Lake County Division of Transportation Receipt for Donation Owner: Village of Buffalo Grove Job No.: R-55-001-97 Parcel No.: 0041 & TE The Lake County Division of Transportation ("County") (Grantee) acknowledges Receipt for Quitclaim Deed covering 0.002 acres (69 square feet) Temporary Construction Easement (pin 15-28-219-003) covering 0.005 acres (229 square feet) dated , 20_, in Lake County, State of Illinois as right of way for Weiland Rd, and executed by the undersigned Grantor for the parcel referenced above. Grantor and Grantee agree as follows: All improvements located, wholly or partially, on the parcel being conveyed shall become the property of the County, unless provided as follows: None. 2. Grantor and Grantee agree that possession and transfer of legal title pursuant to the quitclaim deedto Grantee occurs when title has been reviewed and approved by Grantee. The Grantor also agrees to protect, preserve and maintain the property and improvements purchased by Grantee until delivery of possession to Grantee, and this shall be the sole responsibility of the Grantor until such time. 3. This Receipt and conveyance documents are the entire and exclusive agreement between the parties and supersede any written or oral understanding promise or agreement, directly or indirectly related to the donation of the parcel and improvements. The parties agree that any changes to this Receipt may only be made in writing and signed by the parties. Villa) By: Receipt of the donation executed by this Grantor is acknowledged. Qlh he , D to "If-bor'LLake County Division of Transportation ("County") Shane E. Schn0,de,r; P.E. - County Engineer Page 1 of 1 (Rev. 09111) Donation Statement 041 & TE Dated: auou a-.22 Pont 1 recognize my right to an appraisal and compensation in the full amount of the approved appraisal. However, I wish to donate the necessary right of way. The Village of Buffalo Grove inaturre Print N ai me & Tltle Statement of Compliance with the Public Officers Prohibited Activities Act w CHECK ONE ® Grantor has not received and will not receive a non -monetary benefit from the Lake County Division of Transportation (for example, an added improvement, re -built or relocated improvement or any other valuable service) in exchange for the donation of this parcel. OR ❑ Grantor has received or will receive a non -monetary benefit from the Lake County Division of Transportation in exchange for the donation of this parcel. To comply with 50 ILCS 105/3.1, Grantor shall disclose, in writing, all owners, beneficiaries, etc. of this parcel. The Village of Buffalo Grove Confirmed: Lake County Division of Transportation Shane E. Schneider, P.E., County Engineer 9 /1' bal D to Owner: Village of Buffalo Grove Route: Weiland Rd Section: 14-00158-11-WR County: Lake Project No.: Lake Cook Rd to IL 22 Job No.: R-55-001-97 Parcel No.: 0009 TE P.I.N. No.: 15-33-212-050 TEMPORARY CONSTRUCTION EASEMENT (Governmental Entity) Village of Buffalo Grove, 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 *- ,,, its *1 11 4AC ,ewe ;_, for and in consideration of One Dollar ($1.00), rebipt 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 Lake County Division 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: West side of Weiland Road, north of W. Pauline Avenue, Buffalo Grove, ILQi111: • situated in the County of Lake, 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. 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. Page 1 of 2 (New 11/11) Dated this day of 2019. Village of Buffalo Grove BYWAM4 u re -P-d kA Print Name and Title ATTEST: By: 1 4, u Signature Print Name and Title State of t 01 County of ��� ) ss This instrument was acknowledged before me on !q s+ as , 20 0, by f ,ash and -,as ca of Village of Buffalo Grove, a governmental entity organized a existing under the laws of Illinois. (SEAL) Julie Kamka Notary Public _ State of Minois My Commission Expires otary Public 04IM2019 My Commission Expires: This instrument was prepared by: J. Steve Santacruz, Santacruz Land Acquisitions, 222 Northfield Road, Northfield, IL 60093 and after recording, mail this instrument to: Lake County Division of Transportation, Attn: Chuck Good 600 W. Winchester Rd, Libertyville, IL 60048-1381 Page 2 of 2 (New 11/11) Route F.A.U. 2665 (Weiland Road) Section: 14-00158-11-WR County : Lake Job No.: R-55-001-97 Parcel 0009T.E. Sta. 40+35.00 To Sta, 40+62.89 Index No. 15-33-212-050 That part of Outlot A in Amberley, being a subdivision in the North Half of Section 33, Township 43 North, Range 11 East of the Third Principal Meridian, according to the plat thereof recorded July 13, 1988 as document number 2700262, in Lake County, Illinois, described as follows: Beginning at the northeast corner of said Outlot A; thence on an Illinois Coordinate System NAD 83(2007) East Zone bearing of South 17 degrees 08 minutes 58 seconds West along the easterly line of said Outlot A, a distance of 27.89 feet; thence North 73 degrees 02 minutes 11 seconds West, a distance of 10.71 feet; thence North 16 degrees 57 minutes 49 seconds East, a distance of 24.57 feet to the north line of said Outlot A; thence North 89 degrees 52 minutes 52 seconds East along the north line of said Outlot A, a distance of 11.30 feet to the point of beginning. Said temporary easement containing 0.006 acres, more or less, or 282 square feet, more or less. Said temporary easement to be used for grading purposes. Lake County Division of Transportation Affidavit of Title Owner: Village of Buffalo Grove Address: West side of Weiland Road, north of W. Pauline Avenue, Buffalo Grove, IL 60089 Route: Weiland Rd Section: 14-00158-11-WR County: Lake Project: Job No. R-55-001-97 Parcel No. 0009 TE P.I.N. No. 15-33-212-050 State of Illinois ) ) ss. County of Lake ) I,v�, 'w l� , being first duly sworn upon oath states as Wows, 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 Lake County Division of Transportation 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. ® The affiant has no knowledge of any unrecorded easements or leases over, under, upon or across the premises to be conveyed. ❑ The affiant has no knowledge of any unrecorded easements over or leases, under, upon or across the premises to be conveyed other than: 7. 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. 8. 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. 9. 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 *1, 2. 3. 4. Address C7 Land Trust or Declaration of Trust. The identity of each beneficiary of Grantor Trust is as follows: Name *1, 2. 3. 4. Address * 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. 11107/11) Dated this a� day of oj —t- , 20�12 ,e^ Dal •aw .w ., State of =11 tvt ) ss. County of C�� ) This instrument was acknowledged before me on �_20 i R l by (SEAL) NotarJulie Kamka j;_., j4, �i- y public - tote of llliuo s My xpims Notary Public My Commission Expires: o o a o / `) 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. 11/07111) � c lrw ''.` Route F.A.U. 2665 (Weiland Road) Section: 14-00158-11-WR County : Lake Job No.: R-55-001-97 Parcel 0009T.E. Sta. 40+35.00 To Sta. 40+62.89 Index No. 15-33-212-050 That part of Outlot A in Amberley, being a subdivision in the North Half of Section 33, Township 43 North, Range 11 East of the Third Principal Meridian, according to the plat thereof recorded July 13, 1988 as document number 2700262, in Lake County, Illinois, described as follows: Beginning at the northeast corner of said Outlot A; thence on an Illinois Coordinate System NAD 83(2007) East Zone bearing of South 17 degrees 08 minutes 58 seconds West along the easterly line of said Outlot A, a distance of 27.89 feet; thence North 73 degrees 02 minutes 11 seconds West, a distance of 10.71 feet; thence North 16 degrees 57 minutes 49 seconds East, a distance of 24.57 feet to the north line of said Outlot A; thence North 89 degrees 52 minutes 52 seconds East along the north line of said Outlot A, a distance of 11.30 feet to the point of beginning. Said temporary easement containing 0.006 acres, more or less, or 282 square feet, more or less. Said temporary easement to be used for grading purposes. Lake County Division of Transportation Receipt for Donation Owner: Village of Buffalo Grove Job No.: Weiland Road Parcel No.: 0009 TE The Lake County Division of Transportation ("County") (Grantee) acknowledges Receipt for Temporary Construction Easement (pin 15-33-212-050) covering 0.006 acres (282 square feet) dated , 20_, in Lake County, State of Illinois as right of way for Buffalo Grove Rd and executed by the undersigned Grantor for the parcel referenced above. Grantor and Grantee agree as follows: 1„ All improvements located, wholly or partially, on the parcel being conveyed shall become the property of the County, unless provided as follows: NONE 2. This Receipt and conveyance documents are the entire and exclusive agreement between the parties and supersede any written or oral understanding promise or agreement, directly or indirectly related to the donation of the parcel and improvements. The parties agree that any changes to this Receipt may only be made in writing and signed by the parties. The Village of Buffalo Grove r , • u I hnt Name and Title Receipt of the donation executed by this Grantor is acknowledged. C1 to Dat for Lake County [division of Transportation ("County") Shane E. Schneider, P.E., County Engineer Page 1 of 1 (Rev. 09111) Donation Statement 009 TE Dated; k -- X 90 / I recognize my right to an appraisal and compensation in the full amount of the approved appraisal. However, I wish to donate the necessary right of way. The Village of Buffalo Grove ^ I-U� - ignature Print Flame & itle Statement of Compliance with the Public Officers Prohibited Activities Act 50 ILLS 105/ .1 CHECK ONE ® Grantor has not received and will not receive a non -monetary benefit from the Lake County Division of Transportation (for example, an added improvement, re -built or relocated improvement or any other valuable service) in exchange for the donation of this parcel. •V ❑ Grantor has received or will receive a non -monetary benefit from the Lake County Division of Transportation in exchange for the donation of this parcel. To comply with 50 ILCS 105/3.1, Grantor shall disclose, in writing, all owners, beneficiaries, etc. of this parcel. - ..- •Buffalo Grove Print Name & Title Confirmed: Lake County Division of Transportation Shane E. Schneider P.E., County Engineer By: CIA h e Date Owner: The Village of Buffalo Grove Route: Weiland Rd Section: 14-00158-1 1-WR County: Lake Project No.: Lake Cook Rd to IL 22 Job No.: R-55-001-97 Parcel No.: 0019 TE P.I.N. No.: 15-28-417-004 —TEMPORARY CONSTRUCTION EASEMENT (Governmental Entity) The Village of Buffalo Grove, 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 ��y ��+ „ its 2h5.Jew* _, for and in consideration of One Dollar (1.00), re eipt 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 Lake County Division 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: Northeast corner of Marvins Way and Weiland Road, Buffalo Grove, IL situated in the County of Lake, 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. 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. Page 1 of 2 (New 11/11) Dated this - 012 day of20_1j. ATTEST: Signature �Ltrip Print Name and Title State of T 11; ✓ta>' s ) ) ss County of C.Y ) This instrument was acknowledged before me on u Lx-/-- , 20 % , by tier 1 as a and aO-k% k , as of The Village of Buffalo Grove, a governmental entity organ ed and existing under the laws of Illinois. (SEAL) J ulie Notaty My ---- Notary Public My Commission Expires: o 4 / 9 This instrument was prepared by: J. Steve Santacruz, Santacruz Land Acquisitions, 222 Northfield Road, Northfield, IL 60093 and after recording, mail this instrument to: Lake County Division of Transportation, Attn: Chuck Good 600 W. Winchester Rd, Libertyville, IL 60048-1381 Page 2 of 2 (New 11/11) Route F.A.U. 2665 (Weiland Road) Section: 14-00158-11-WR County : Lake Job No.: R-55-001-97 Parcel 0019T.E. Sta. 64+28.36 To Sta. 64+65.00 Index No. 15-28-417-004 That part of Lot A in Sterling Creek Subdivision, being a subdivision of part of the Southeast Quarter of Section 28, Township 43 North, Range 11 East of the Third Principal Meridian, according to the plat thereof recorded October 20, 1995 as document number 3737886, in Lake County, Illinois, described as follows: Commencing at the northwest corner of said Lot A; thence southerly 218.20 feet along the westerly line of said Lot A on a curve to the right having a radius of 5789.58 feet, the chord of said curve bears on an Illinois Coordinate System NAD 83(2007) East Zone bearing of South 7 degrees 37 minutes 13 seconds West, 218.19 feet to the point of beginning; thence South 81 degrees 11 minutes 49 seconds East, a distance of 19.07 feet; thence South 24 degrees 25 minutes 25 seconds East, a distance of 18.21 feet; thence southerly 21.98 feet along a curve to the right having a radius of 5819.58 feet, the chord of said curve bears South 9 degrees 03 minutes 41 seconds West, 21.98 feet to the southwesterly line of said Lot A; thence northwesterly 48.85 feet along the southwesterly line of said Lot A on a curve to the right having a radius of 35.00 feet, the chord of said curve bears North 31 degrees 15 minutes 18 seconds West, 44.98 feet to the westerly line of said Lot A; thence northerly 2.79 feet along the westerly line of said Lot A on a curve to the left having a radius of 5789.58 feet, the chord of said curve bears North 8 degrees 42 minutes 49 seconds East, 2.79 feet to the point of beginning. Said temporary easement containing 0.017 acres, more or less. Said temporary easement to be used for grading purposes. Lake County Division of Transportation Affidavit of Title Owner: The Village of Buffalo Grove Address: Northeast corner of Marvins Way and Weiland Road, Buffalo Grove, IL 60089 Route: Weiland Rd Section: 14-00158-11-WR County: Lake Project: Job No. R-55-001-97 Parcel No. 0019 TE P.I.N. No. 15-28-417-004 State of Illinois ) ss. County of Lake ) upon oath states as Mows: ,being first duly sworn 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 Lake County Division of Transportation 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. ® The affiant has no knowledge of any unrecorded easements or leases over, under, upon or across the premises to be conveyed. ❑ The affiant has no knowledge of any unrecorded easements over or leases, under, upon or across the premises to be conveyed other than: 7. 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. 8. 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. 9. 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 *1. 2. 3. 4. Address 0 Land Trust or Declaration of Trust. The identity of each beneficiary of Grantor Trust is as follows: Name *1. 2. 3. 4. Address * 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 09 day of &t f: 2019 State ofvloi S ) ) ss. County of _ ) This instrument was acknowledged (SEAL) Julie Kamka Notary Pu lip - State of Illinois My Commission Expires i�bl201 before me on aa- 20 a, by ------ ---- - - Notary Public My Commission Expires: Off, aU/' 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. 11107/11) �+krsrr ` Ik, Route F.A.U. 2665 (Weiland Road) Section: 14-00158-11-WR County : Lake Job No.: R-55-001-97 Parcel 0019T.E. Sta. 64+28.36 To Sta. 64+65.00 Index No. 15-28-417-004 That part of Lot A in Sterling Creek Subdivision, being a subdivision of part of the Southeast Quarter of Section 28, Township 43 North, Range 11 East of the Third Principal Meridian, according to the plat thereof recorded October 20, 1995 as document number 3737886, in Lake County, Illinois, described as follows: Commencing at the northwest corner of said Lot A; thence southerly 218.20 feet along the westerly line of said Lot A on a curve to the right having a radius of 5789.58 feet, the chord of said curve bears on an Illinois Coordinate System NAD 83(2007) East Zone bearing of South 7 degrees 37 minutes 13 seconds West, 218.19 feet to the point of beginning; thence South 81 degrees 11 minutes 49 seconds East, a distance of 19.07 feet; thence South 24 degrees 25 minutes 25 seconds East, a distance of 18.21 feet; thence southerly 21.98 feet along a curve to the right having a radius of 5819.58 feet, the chord of said curve bears South 9 degrees 03 minutes 41 seconds West, 21.98 feet to the southwesterly line of said Lot A; thence northwesterly 48.85 feet along the southwesterly line of said Lot A on a curve to the right having a radius of 35.00 feet, the chord of said curve bears North 31 degrees 15 minutes 18 seconds West, 44.98 feet to the westerly line of said Lot A; thence northerly 2.79 feet along the westerly line of said Lot A on a curve to the left having a radius of 5789.58 feet, the chord of said curve bears North 8 degrees 42 minutes 49 seconds East, 2.79 feet to the point of beginning. Said temporary easement containing 0.017 acres, more or less. Said temporary easement to be used for grading purposes. Lake County Division of Transportation Receipt for Donation Owner: The Village of Buffalo Grove Job No.: R-55-001-97 Parcel No.: 0019 TE The Lake County Division of Transportation ("County") (Grantee) acknowledges Temporary Construction Easement (pin 15-28-417-004) covering 0.017 acres (741 square feet) dated , 20_, in Lake County, State of Illinois as right of way for Weiland Rd, and executed by the undersigned Grantor for the parcel referenced above. Grantor and Grantee agree as follows: All improvements located, wholly or partially, on the parcel being conveyed shall become the property of the County, unless provided as follows: None. 2. This Receipt and conveyance documents are the entire and exclusive agreement between the parties and supersede any written or oral understanding promise or agreement, directly or indirectly related to the donation of the parcel and improvements. The parties agree that any changes to this Receipt may only be made in writing and signed by the parties. VillageThe of Buffalo Grove By: 1X6. A JA Vnt Name and TiM Receipt of the donation executed by this Grantor is acknowledged. CityIL . ge�4:�, �- ate oar Lake County Division of Transportation ("County") Shane E. Schneider, P..E., County Engineer Page 1 of 1 (Rev. 09/11) Donation Statements 019 TE Dated: 44o;) o(,S, I recognize my right to an appraisal and compensation in the full amount of the approved appraisal. However, I wish to donate the necessary right of way. The Village of Buffalo Grove 3N'upe tLA &SS(VXO-V'% Print Name & 'Title Statement of Compliance with the Public Officers Prohibited Activities Act CHECK ONE ® Grantor has not received and will not receive a non -monetary benefit from the Lake County Division of Transportation (for example, an added improvement, re -built or relocated improvement or any other valuable service) in exchange for the donation of this parcel. ❑ Grantor has received or will receive a non -monetary benefit from the Lake County Division of Transportation in exchange for the donation of this parcel. To comply with 50 ILCS 105/3.1, Grantor shall disclose, in writing, all owners, beneficiaries, etc. of this parcel. The Village of Buffalo Grove 11 III y e�pot 'a"- rint Name & Title Confirmed: Lake County Division of Transportation Shane E. Schneider, P.E. - County Engineer bate