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HomeMy WebLinkAboutHabitat for Humanity Oshkosh 2019 FEE: $20.00 ANNUAL RIGHT-OF-WAY OBSTRUCTION LICENSE Application iss made forfo a license to maintain street/sidewalk obstruction: V NAME: t��abeal"`ta s� ` 1 ' wi C - Type of organization �JJ pp ����n } I,� '/� I, n /� _individual A partnership E-MAIL: 'CiI.U-gi V IF�J I"`' v s l�-(JS�'l •V i- 1 _corporation ,A 1 J ADDRESS: I l�LI 0 S koel,( of ci • `J State of Incorporation V V t 04214 osk , WI 9-1-cib�✓' 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) $500,000 products—completed operations aggregate and shall name the City of Oshkosh, its officers, council members, agents, employees, and authorized volunteers as an additional insured thereon. Proof of said coverage in the form of an insurance certificate shall be submitted to the City of Oshkosh prior to issuance of any permit for street or sidewalk obstruction. Each individual project/address at which an obstruction will be placed requires a separate permit which may be obtained from the City of Oshkosh Department of Public Works-Engineering Division. DATE ISSUED: ilia(zol`I EXPIRATION: , _ 12111 11611 BOND TERM: `;I/7S(2b(9 To f Z/3I/201 INSURANCE TERM: Li /)17.6ty 're 9 i/web, DATE: '{ I23(zee, M / / Nit XCI-ct Ap licanit.ignature Telephone Number I:\Engineering\ROW Permits\Annual ROW Obstruction Bond&License_1-8-19.doc :a". .h-t- :_i;7=3- -PzaeZ^ v.:$ ANNUAL RIGHT-OF-WAY OBSTRUCTION BOND BOND NO.Q96 8162955 PRINCIPAL(S)(Legal name(s)and business address(es)) Type of organization: HABITAT FOR HUMANITY OF OSHKOSH INC PO BOX 2692 ____Individual _Partnership OSHKOSH WI 54903-2692 X Corporation Surety(ies)(Name(s)and business address(es)) State of Incorporation WISCONSIN ERIE INSURANCE COMPANY 100 ERIE INSURANCE PLACE ERIE PA 16530 Penal Sum of Bond: $5,000.00 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(I)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 APRIL 11,2019 (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 maintenan a issues brought to the attention of the Principal(s)upon receiving notice from the City of Oshkosh within the two(2)year maintenanccriod. SIGNATURES/SEALS: :. : a 'a/4 '. ,For the Pri l:HA T FOR HUMANITY OF OSHKOSH INc For the S ety: EWE issuRANcc COMPANY HAW ,16i Signature Signature A. • 6" J (S�ivtan� EowAROAMAll€O e)y dyt Name Name i7t NiC Xe v�-W✓e__ t rr c AIn tncyar+•FACr Title Title 100 ERlF,INSURANCE PLACE,ERIE PA 18500 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. i l frF Erie LIMITED POWER OF ATTORNEY �\ Insuranceo KNOW ALL MEN BY THESE PRESENTS: That ERIE INSURANCE COMPANY, a corporation of the Commonwealth of Pennsylvania,having its principal office in the City of Erie, Pennsylvania,does hereby make, constitute and appoint Marc Cipriani, Senior Vice President; Leo Heintz, Vice President; Edward A. Mazzco; Katherine D. Pawlak; and Darlene Kujawa, its true and lawful Attorney(s)-in-Fact, in their separate capacity if more than one is named above, to make,execute, seal and deliver for and on its behalf as surety,any and all bonds which are or may be allowed,required or permitted by law,statute,rule regulation,contract or otherwise, provided, however, that the penal sum of any one such instrument executed hereunder shall not exceed FIVE MILLION DOLLARS ($5,000,000) and that the execution of such instrument shall be binding upon ERIE INSURANCE COMPANY. This Power of Attorney is signed and scaled by facsimiles under and by the authority of the following Resolu- tion adopted by the Board of Directors of ERIE INSURANCE COMPANY at a meeting duly called and held on the 2nd day of September, 2016,and said resolution has not been amended or repealed: RESOLVED,that the signature of Timothy G.NeCastro.as Chief Executive Officer oldie Company,and the Seal of the Company may be affixed by the following facsimiles on any Limited Power ofAttorney for the execution of bonds,undertakings.recognizances,contracts and other writings in the nature thereof,and the signature of Brian W.Bolash,as Secretary of the Company,the Seal of Iht Company,the signature of Sheila M.Hirsch,as Notary Public,and her notarial seal,may also be affixed by the following facsimiles to any certificate or acknowledg- ment of any such Limited Power of Attorney,and only under such circumstances shall said facsimiles be valid and binding on the Company. IN WITNESS WHEREOF,ERIE INSURANCE COMPANY has caused these presents to be signed by its Chief Executive Officer, and its corporate seal to be hereto affixed this 2nd day of September, 2016. J, 1ANC,,' ,,', a��cAproiyrFoi A rr- ,1111 , ` 1972 s by /S TJ0y rnoth G NeC Biro Chief Execulive Officer •,Rif P1•:f. ssss ,n,,,,*nu„,,,,. STATE OF PENNSYLVANIA COUNTY OF ERIE ss. On this 18th day of October.2016.before me personally came Timothy G.NeCastro.Chief Executive Officer.to me known.who being by me duly sworn.did depose and say:that he is Chief Executive Officer of ERIE INSURANCE COMPANY.the corporation 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 order of the Board of Directors of said corporation and that lie signed his name thereto by like order. th 1Ni OF Y1C) %.1.\Yhsn' �` e,;• My commission expires lure 27.2020 Notar) Public CERTIFICATE 1,Brian W.Bolash,Secretary of ERIE INSURANCE COMPANY.do hereby certify that the original LIMITED POWER OF ATTORNEY,of which the foregoing is a full,true and correct copy and is in full force and effect. In witness whereof.I have hereunto subscribed m) name and affixed the corporate Seal of the Company by facsimiles pursuant to the action of the Board of Directors of the Company,this 18th day of April 2019 „t,,,,,,,,,,, 614./tf4. /366,42-XI •6 / : Brian W.Bolash,Secretary ,elf, UF831 12/17 ANNUAL RIGHT-OF-WAY OBSTRUCTION BOND BOND NO. Q96 8162955 • PRINCIPAL(S)(Legal name(s)and business address(es)) Type of organization: HABITAT FOR HUMANITY OF OSHKOSH INC PO BOX 2692 _Individual _Partnership OSHKOSH WI 54903-2692 X- Corporation Surety(ies)(Name(s)and business address(es)) Ttra,WET) State of Incorporation WISCONSIN ERIE INSURANCE COMPANY 100 ERIE INSURANCE PLACE APR 2 4 2019 ERIE PA 16530 put.LIC WORKS Penal Sum of Bond: $5,000.00 DEFT OFSHI,W SCONSIN OBLIGATION: OS11K0 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 APRIL 11, 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 maintenan.e issues brought to the attention of the Principal(s)upon receiving notice from the City of Oshkosh within the two(2)year maintenanc eriod. SIGNATURES/SEALS: :•'• ..+j 3/1 • For the Prin 'pal: TAT FOR HUMANITY OF OSHKOSH INC For the Su ety: ERIE INSURANCE COMPANY Signature Signature (. -1 '%� 1 /O -P )/-'- "V EDWARD A MAZZEO 1'.1 ��O v� A� Name tt Name ' iltjv� X«)vt 0Let..L..70f ATTORNEY-IN-FACT Title Title 100 ERIE INSURANCE PLACE,ERIE PA 16530 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_1-8-19.doc • Erie LIMITED POWER OF ATTORNEY elk Insurance KNOW ALL MEN BY THESE PRESENTS: That ERIE INSURANCE COMPANY, a corporation of the Commonwealth of Pennsylvania, having its principal office in the City of Erie, Pennsylvania,does hereby make, constitute and appoint Marc Cipriani, Senior Vice President; Leo Heintz, Vice President; Edward A. Mazzeo; Katherine D. Pawlak; and Darlene Kujawa, its true and lawful Attorney(s)-in-Fact, in their separate capacity if more than one is named above,to make, execute, seal and deliver for and on its behalf as surety, any and all bonds which are or may be allowed,required or permitted by law,statute,rule regulation,contract or otherwise, provided, however, that the penal sum of any one such instrument executed hereunder shall not exceed FIVE MILLION DOLLARS ($5,000,000) and that the execution of such instrument shall be binding upon ERIE INSURANCE COMPANY. This Power of Attorney is signed and sealed by facsimiles under and by the authority of the following Resolu- tion adopted by the Board of Directors of ERIE INSURANCE COMPANY at a meeting duly called and held on the 2nd day of September,2016, and said resolution has not been amended or repealed: RESOLVED,that the signature of Timothy G.NeCastro,as Chief Executive Officer of the Company,and the Seal of the Company may be affixed by the following facsimiles on any Limited Power of Attorney for the execution of bonds,undertakings,recognizances,contracts and other writings in the nature thereof,and the signature of Brian W.Bolash,as Secretary of the Company,the Seal of the Company,the signature of Sheila M.Hirsch,as Notary Public,and her notarial seal,may also be affixed by the following facsimiles to any certificate or acknowledg- ment of any such Limited Power of Attorney,and only under such circumstances shall said facsimiles be valid and binding on the Company. IN WITNESS WHEREOF,ERIE INSURANCE COMPANY has caused these presents to be signed by its Chief Executive Officer,and its corporate seal to be hereto affixed this 2nd day of September, 2016. �.`',PANCF it'll1972 i•°= by >; imothy G.NeC stro Chief Executive Officer ,,` n ,r *n„,'''� STATE OF PENNSYLVANIA COUNTY OF ERIE ss. On this 18th day of October,2016,before me personally came Timothy G.NeCastro,Chief Executive Officer,to me known,who being by me duly sworn,did depose and say:that he is Chief Executive Officer of ERIE INSURANCE COMPANY,the corporation 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 by order of the Board of Directors of said corporation and that he signed his name thereto by like order. ,z: Si OF :CI_ ;tip•:MV �P�'�P`�v; My commission expires June 27,2020 Notary Public rq RY ,,,, CERTIFICATE I,Brian W.Bolash,Secretary of ERIE INSURANCE COMPANY,do hereby certify that the original LIMITED POWER OF ATTORNEY,of which the foregoing is a full,true and correct copy and is in full force and effect. In witness whereof,I have hereunto subscribed my name and affixed the corporate Seal of the Company by facsimiles pursuant to the action of the Board of Directors of the Company,this 18th day of April 2019 ,,,,,,,,,,,,,,,,,, `JF1A N C F W; 1972 1.111 t3U44L W /3664.--, cc: I? Brian W.Bolash,Secretary a,,,, UF831 12/17