to Potential Purchasers
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Disclosure of Information on Lead-Based Paint and/or Lead-Based Paint Hazards.
Lead Warning Statement
Every purchaser of any interest in residential real property on which a residential dwelling was built prior to 1978 is notified that such property may present exposure to lead from lead-based paint that may place young children at risk of developing lead poisoning. Lead poisoning in young children may produce permanent neurological damage, including learning disabilities, reduced intelligence quotient, behavioral problems, and impaired memory. Lead poisoning also poses a particular risk to pregnant women. The seller of any interest in residential real property is required to provide the buyer with any information on lead-based paint hazards from risk assessments or inspections in the seller’s possession and notify the buyer of any known lead-based paint hazards. A risk assessment or inspection for possible lead-based hazards is recommended prior to purchase.
Seller’s Disclosure
The Illinois Department of Transportation’s knowledge of lead-based paint and/or lead-based paint hazards present in the housing is as follows (check one):
Known lead-based paint and/or lead-based paint hazards are present in housing (explain below).
The Illinois Department of Transportation has no knowledge of lead-based paint and/or lead-based paint hazards in the housing.
Records and Reports Available to Purchaser (check one)
The Illinois Department of Transportation has provided the purchaser with all available records and reports pertaining to lead-based paint and/or lead-based paint hazards present in the housing. These documents are as follows:
The Illinois Department of Transportation has no reports or records pertaining to lead-based paint and/or lead-based paint hazards in the housing.
All bidders must sign this Disclosure of Information on Lead-Based Paint and/or Lead-Based Paint Hazards and return it with the bid. Bids received without signed disclosure forms will be rejected. Should any questions arise concerning the disclosure of information, including time for purchasers to inspect, please call at .
Purchaser’s Acknowledgment
This proposal is contingent upon risk assessment or inspection of the property for the presence of lead-based paint and/or lead-based paint hazards at the purchaser’s expense until 9:00 p.m. on the tenth (10th) calendar day after ratification, or (insert date 10 days after contract ratification or a date mutually agreed upon). (Intact lead-based paint that is in good condition is not necessarily a hazard. See the EPA pamphlet Protect Your Family from Lead in Your Home for more information.) This contingency will terminate at the above predetermined deadline unless the purchaser (or purchaser’s agent) delivers to the Illinois Department of Transportation a written contract addendum listing the specific existing deficiencies and corrections needed, together with a copy of the inspection and/or risk assessment report.
If this notice is not forthcoming, the department will proceed to finalize the sale and no refund of the deposit will be allowed.
If the purchaser provides the Illinois Department of Transportation with the results of the risk assessment or inspection for the presence of lead-based paint and/or lead-based paint hazards within the time specified and chooses not to proceed with the purchase, the department will refund the purchaser’s deposit and will then notify the next highest bidder to complete the sale. (IN NO EVENT WILL THE BID PRICE SUBMITTED FOR THIS SALE BE ADJUSTED OR WILL THE DEPARTMENT OF TRANSPORTATION EXPEND FUNDS TO REMOVE LEAD-BASED PAINT AND/OR LEAD-BASED PAINT HAZARDS AS A CONDITION OF COMPLETING THIS SALE.)
By the signing of this disclosure, purchaser waives any further opportunity to conduct a risk assessment or inspection for the presence of lead-based paint and/or lead-based paint hazards.
Purchaser has received copies of all information listed above.
Purchaser has received the pamphlet Protect Your Family from Lead in Your Home.
Purchaser has received a ten day opportunity (or mutually agreed upon period) to conduct a risk assessment or inspection for the presence of lead-based paint and/or lead-based paint hazards.
Certification of Accuracy
The following parties have reviewed the information above and certify, to the best of their knowledge, that the information they have provided is true and accurate. Upon signing, purchaser further waives any additional time for purposes of assessment or inspection for the presence of lead-based paint and/or lead-based paint hazards.
Illinois Department of Transportation Purchaser
By:
Signature Signature
Title:
Printed Name
Date: Purchaser
Signature
Printed Name
Page 1 of 2 LA 676 (Rev. 08/19/11)
(Replaces LA 5076 Template)