HomeMy WebLinkAboutBoldt Company 2019 (2) FEE: $20.00
ANNUAL RIGHT-OF-WAY OBSTRUCTION LICENSE ECEIVED
FEB 1 9 2019
Application is made for a license to maintain street/sidewalk obstruction: I D I I'1 ()1 PUBLIC WORKS
USlIhuSHH, WISCONSIN
NAME: THE BOLDT COMPANY Type of organization:
individual _partnership
E-MAIL: michele.hagerty@boldt.com X corporation
State of Incorporation WI
ADDRESS: 2525 N.ROEMER RD, PO BOX 419
APPLETON,WI 54912
I (We) further agree to provide the City of Oshkosh with a surety bond issued by a company licensed in the State of
Wisconsin in the amount of Five Thousand Dollars($5,000.00).
I(we)further agree to secure a Commercial General Liability Policy with limits of:
(a) $500,000 each occurrence
(b) $500,000 personal liability and advertising injury
(c) $500,000 general aggregate
(d) $500,000 products—completed operations aggregate
and shall name the City of Oshkosh, its officers, council members, agents, employees, and authorized volunteers as an
additional insured thereon. Proof of said coverage in the form of an insurance certificate shall be submitted to the City of
Oshkosh prior to issuance of any permit for street or sidewalk obstruction.
Each individual project/address at which an obstruction will be placed requires a separate permit which may be obtained
from the City of Oshkosh Department of Public Works-Engineering Division.
DATE ISSUED: Z 1 I9 1 Z01'\
EXPIRATION: IZ 1 31 1 Zol 1
BOND TERM: 1/1/2019-12/31/2019
INSURANCE TERM: 1/1/2019-12/31/2019
DATE: 2/14/2019
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pplicant's Signature RANDALL HARK,ASSISTANT SECRETARY
920-739-6321
Telephone Number
[:\Engineering\ROW Permits\Annual ROW Obstruction Bond&License_1-8-19.doc
ANNUAL RIGHT-OF-WAY OBSTRUCTION BOND Bond No.929599810
PRINCIPAL(S)(Legal name(s)and business address(es)) Type of organization:
The Boldt Company Individual _Partnership
2525 North Roemer Road,P.O.Box 419 X Corporation
Appleton,WI 54912
Surety(ies)(Name(s)and business address(es)) State of incorporation J LCLfVJ D
Western Surety Company FEB
151 North Franklin Street 1 9 2019
Chicago,IL 60606 i 1 f f
Penal Sum of Bond: $5,000.00 n�i i i�O� I t ii3�i L-_U S I k S
OBLIGATION:
We,the Principal(s)and Surety(ies),are firmly bound to the City of Oshkosh in the above penal sum. For payment of the penal sum,
we bind ourselves,our heirs,executors,administrators,and successors,jointly and severally.
CONDITIONS:
The Principal contemplates placing an obstruction within right-of-way area(s)within the City of Oshkosh from time to time during the
calendar year shown below. The Principal desires that all of those projects be covered by a single bond rather than a separate bond for
each contract.
The Principal shall faithfully perform all work done in the City of Oshkosh with proper care and skill; obey all laws of the State of
Wisconsin and ordinances of the City of Oshkosh in connection with such work performed and with the employment of labor;properly
replace and restore any street, sidewalk, terrace, or other public right-of-way, vacated right-of-way, or City easement areas in
accordance with the current edition of the Standard Specifications for City of Oshkosh, Wisconsin; and pay to the City of Oshkosh any
amounts due for services or materials furnished in connection therewith within one(1)month of invoice.
The Principal shall for a period beginning on the date of issuance of this bond through a two(2)year period from the expiration date of
the annual license save, defend, and hold harmless the City of Oshkosh from and against any and all claims, damages, costs, and
expenses of any kind or character arising out of or resulting,however remotely,from the work performed by the Principal under the
attached license,including but not limited to,all accidents and damages caused by any failure to erect and maintain sufficient barriers
or lights at the place where licensee has placed obstruction or performed work,or by failure to guard against injury to persons passing
upon the street or sidewalk,or by failure to promptly remove all tools,implements, refuse, and unused materials from said right-of-
way. The Principal shall indemnify and refund to the City of Oshkosh all sums which it may become obligated to pay, including
damages,punitive damages,attorney fees,and court costs,within thirty(30)days of written demand for payment;however,the penal
sum of this bond shall not exceed$5,000.
It is understood and agreed by the Principal(s)and Surety(ies)that this bond supplements,but does not take the place of,any liability
insurance required to be carried by said Principal(s)herein by the City of Oshkosh policies or ordinances.
TERM OF BOND:
This bond shall cover work performed from January 1,2019 (Date of Issuance) to December 31, 20 19 (the annual license
period). This bond shall cover claims made for work performed during this annual license period and for an additional two(2)year
maintenance period beyond the expiration of this annual license period. The principal agrees to correct all maintenance issues brought
to the attention of the Principal(s)upon receiving notice from the City of Oshkosh within the two(2)year maintenance period.
SIGN ATURES/SEALS:
For the 'ncipal:The• dt Company For the Surety: Western Surety Company
Signature Signature
; ^/, (,r Heather R.Goedtel
Name Name
St c r z Va ry Attorney-in-Fact
Title Title
8400 Normandale Lake Boulevard,Suite 1700
Bloomington,MN 55437
Address
Any person signing in a representative capacity(e.g.,an attorney-in-fact)must furnish evidence of authority if that representative is not
a member of the firm or partnership or an officer of the corporation involved.
1:\Engineering\ROW Permits\Annual ROW Obstruction Bond&License_7-8-19.doc
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Surety Acknowledgment
State of Minnesota }
} ss.
County of Hennepin }
On this 1st day of January 2019, before me personally came Heather R. Goedtel, to me
known,who being by me duly sworn, did depose and say that she is the Attorney-in-Fact of
Western Surety Company described in and which executed the above instrument; that she/he knows the
seal of said corporation; that the seal affixed to said instruments is such corporate seal, that it was so
affixed by order of the Board of Directors of said corporation, and that she/he signed her/she/his name to
it by like order.
sd4i '' KELLY NICOLE BRUGGEMAN
� ',NOTARY PUBLIC-MINNESOTA
t
Commi G/v
ssion Number:31076678
My Commission Expires January 31.2021 Notary Public
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Western Surety Company
POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY-IN-FACT
Know All Men By These Presents,That WESTERN SURETY COMPANY,a South Dakota corporation,is a duly organized and existing corporation
having its principal office in the City of Sioux Falls,and State of South Dakota,and that it does by virtue of the signature and seal herein affixed hereby
make,constitute and appoint
Jill N. Swanson, Brian D. Carpenter, Jessica Hoff, Nicole Langer, Craig Olmstead, Trisha
Kasper, Blake S. Bohlig, Kelly Nicole Bruggeman, Heather R. Goedtel, Michelle Halter,
Individually
of Bloomington,MN,its true and lawful Attorney(s)-in-Fact with full power and authority hereby conferred to sign,seal and execute for and on its behalf
bonds,undertakings and other obligatory instruments of similar nature
- In Unlimited Amounts -
and to bind it thereby as fully and to the same extent as if such instruments were signed by a duly authorized officer of the corporation and all the acts of said
Attorney,pursuant to the authority hereby given,are hereby ratified and confirmed,
This Power of Attorney is made and executed pursuant to and by authority of the By-Law printed on the reverse hereof,duly adopted,as indicated,by
the shareholders of the corporation.
In Witness Whereof, WESTERN SURETY COMPANY has caused these presents to be signed by its Vice President and its corporate seal to be
hereto affixed on this 15th day of August,2018.
WESTERN SURETY COMPANY
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%8'e AN,
�'� Pi aul T.Bniflat,Vice President
State of South Dakota
ss
County of Minnehaha
On this 15th day of August,2018,before me personally came Paul T.Bruflat,to me known,who,being by me duly sworn,did depose and say: that he
resides in the City of Sioux Falls.State of South Dakota;that he is the Vice President of WESTERN SURETY COMPANY described in and which executed
the above instrument;that he knows the seal of said corporation;that the seal affixed to the said instrument is such corporate seal; that it was so affixed
pursuant to authority given by the Board of Directors of said corporation and that he signed his name thereto pursuant to like authority,and acknowledges
same to be the act and deed of said corporation.
My commission expires J.M Ho R v�y //� /�
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June 23,2021 �501._.... SA iC):719`�'7�V �-
J.Mohr,Notary Public
CERTIFICATE
I,L.Nelson,Assistant Secretary of WESTERN SURETY COMPANY do hereby certify that the Power of Attorney hereinabove set forth is still in
force,and further certify that the By-Law of the corporation printed on the reverse hereof is still in force. In testimony whereof I have hereunto subscribed
my name and affixed the seal of the said corporation this 1ST day of January , 2019 .
S""Er``• WESTERN SURETY COMPANY
`S,AV �.t
L.Nelson,Assistant Secretary
Form F4280-7-2012
Go to www.cnasuretv.com>Owner/Obligee Services>Validate Bond Coverage,if you want to verify bond authenticity
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Authorizing By-Law
ADOPTED BY THE SHAREHOLDERS OF WESTERN SURETY COMPANY
This Power of Attorney is made and executed pursuant to and by authority of the following By-Law duly adopted by the shareholders
of the Company.
Section 7. All bonds, policies, undertakings, Powers of Attorney, or other obligations of the corporation shall be executed in the
corporate name of the Company by the President, Secretary, and Assistant Secretary, Treasurer, or any Vice President,or by such other
officers as the Board of Directors may authorize. The President,any Vice President, Secretary,any Assistant Secretary,or the Treasurer
may appoint Attorneys in Fact or agents who shall have authority to issue bonds, policies,or undertakings in the name of the Company.
The corporate seal is not necessary for the validity of any bonds, policies, undertakings, Powers of Attorney or other obligations of the
corporation. The signature of any such officer and the corporate seal may be printed by facsimile.