HomeMy WebLinkAboutTDS Metrocom 2019 (2) FEE: $20.00 ----
RECEIVED
ANNUAL RIGHT-OF-WAY OBSTRUCTION LICENSE
FEB 1 4 2019
Application is made for a license to maintain street/sidewalk obstruction: DEFT OF PUBLIC WORKS
OSHKO�Ii. 11 ItiC ONSIN
NAME: TDS Metrocom, LLC Type of organization:
individual _partnership
E-MAIL: rachel.revolinski(C7tdstelecom.com X corporation
ADDRESS: 525 Junction Road Madison, WI 53717 Stale of Incorporation DE
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: 1-16-2A1c%
EXPIRATION: (2.^ S I 2 i 9
BOND TERM: I - 1-ZOIQ %ea 12-31'20t 1
INSURANCE TERM: I -I-IC" }o I--(-2020
DATE: 14"Z-1019
Rachel Revolinski w -
Applicant's Signature
608-664-7110
Telephone Number
I:\Engineering\ROW 1'crnils\Annua1120W O1,,Iructiun bond&Licury_L8-19.do(
ANNUAL RIGHT-OF-WAY OBSTRUCTION BOND
PRINCIPAL(S)(Legal name(s)and business address(es)) Type of organization:
TDS Metrocom _Individual _Partnership
20875 Crossroads Circle. Suite 800 X Corporation
Waukesha,WI 53186
Surety(ies)(Name(s)and business add ress(es)) State of Incorporation Delaware CEIVED
Travelers Casualty and Surety Company of America APR -
215 Shuman Blvd. 8 201
Naperville. IL 60563-8458 Bond*1041 I641B(Ar, P
OF 9
utiL
Penal Sum of Bond: $5,000.00 OSHI osH,fSC NORKS
OBLIGATION: IN
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.
SIGNATURES/SEALS:
For the Principal: TDS Metrocom Fur t 'urety•
•
Signature !� ignature
f�`"t `e_\ 1�,?A/Ottrr1sY Trinly
Name Name
Ne,-(-vvor- Spa,
r j al i s f' Attorney-in-Fact
Title � Title
540 W.Madison St., 12th Floor,Chicago, IL 60661
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.
Engineering.ROW Permits+Annual ROW( fruition Bond&Licenec• 1•8•19.doc
State of IL
County of Cook ) ss:
On 1/1/2019 ,before me.a Notary Public in and for said County and State,residing
therein,duly commissioned and sworn,personally appeared
Triniy Garcia
known to me to be Attorney-in-Fact of Travelers Casualty and Surety Company of America
the corporation described in and that executed the within and foregoing instrument,and known to me to be the person who executed
the said instrument in behalf of the said corporation.and he duly acknowledged to me that such corporation executed the same.
IN WITNESS WHEREOF,I have hereunto set my hand and affixed my official seal.the day and year stated in this certificate above.
My Commission Expires _ 12/15/2019
Adrienne . tevenson Notary Public
ADRIENNE C STEVENSON
Official Seal tq'�
Notary Public -State of Illinois F)
My Commission Expires Dec 15, 2019
Travelers Casualty and Surety Company of America
Travelers Casualty and Surety Company
TRAVELERS St. Paul Fire and Marine Insurance Company
of
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS- That Travelers Casualty and Surety Company of America.Travelers Casualty and Surety Company. and St
Paul Fire and Marine Insurance Company are corporations duly organized under the laws of the State of Connecticut (herein collectively called the
"Companies").and that the Companies do hereby make,constitute and appoint Triniy Garcia
of Chicago Illinois ,their true and lawful Attorney-in-Fact to sign, execute.seal and acknowledge any and all
bonds. recognizances.conditional undertakings and other wntings obligatory in the nature thereof on behalf of the Companies in their business of
guaranteeing the fidelity of persons,guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted
in any actions or proceedings allowed by law
IN WITNESS WHEREOF.the Companies have caused this instrument to be signed,and their corporate seals to be hereto affixed,this 3rd day of February.
2017. yp�
4. .,1 A,. ie0744"Na
p2 „jetEA 4
Q J CQMK
^roFe to oil
State of Connecticut . -
By:
City of Hartford ss Robert L.Raney,SA or Vice President
On this the 3rd day of February. 2017. before me personally appeared Robert L. Raney,who acknowledged himself to be the Senior Vice President of
Travelers Casualty and Surety Company of America. Travelers Casualty and Surety Company, and St. Paul Fire and Marine Insurance Company, and
that he.as such, being authorized so to do,executed the foregoing instrument for the purposes therein contained by signing on behalf of the corporations
by himself as a duly authorized officer.
In Witness Whereof. I hereunto set my hand and official seal T
G � r._ •,�
My Commission expires the 30th day of June,2021 A!T1�� \(3.A_.t- C J�
* ♦ Mane C Tetreault, Notary Public
This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of Travelers Casualty and
Surety Company of America, Travelers Casualty and Surety Company.and St Paul Fire and Marine Insurance Company, which resolutions are now in
full force and effect,reading as follows
RESOLVED that the Chairman. the President. any Vice Chairman, any Executive Vice President, any Senior Vice President. any Vice President. any
Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary may appoint Attorneys-in-Fact and
Agents to act for and on behalf of the Company and may give such appointee such authority as his or her certificate of authority may prescribe to sign with
the Company's name and seal with the Company's seal bonds. recognizances, contracts of indemnity, and other writings obligatory in the nature of a
bond,recognizance,or conditional undertaking,and any of said officers or the Board of Directors at any time may remove any such appointee and revoke
the power given him or her.and it is
FURTHER RESOLVED. that the Chairman. the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice
President may delegate all or any part of the foregoing authority to one or more officers or employees of this Company.provided that each such delegation
is in writing and a copy thereof is filed in the office of the Secretary,and it is
FURTHER RESOLVED, that any bond, recognizance. contract of indemnity. or writing obligatory in the nature of a bond, recognizance, or conditional
undertaking shall be valid and binding upon the Company when(a)signed by the President,any Vice Chairman,any Executive Vice President,any Senior
Vice President or any Vice President. any Second Vice President, the Treasurer. any Assistant Treasurer. the Corporate Secretary or any Assistant
Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary. or(b)duly executed(under seal, if required)by
one or more Attorneys-in-Fact and Agents pursuant to the power prescribed in his or her certificate or their certificates of authority or by one or more
Company officers pursuant to a written delegation of authority.and'his
FURTHER RESOLVED,that the signature of each of the following officers President, any Executive Vice President,any Senior Vice President,any Vice
President, any Assistant Vice President, any Secretary, any Assistant Secretary.and the seal of the Company may be affixed by facsimile to any Power
of Attorney or to any certificate relating thereto appointing Resident Vice Presidents. Resident Assistant Secretaries or Attorneys-in-Fact for purposes only
of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof,and any such Power of Attorney or certificate bearing
such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile
signature and facsimile seal shall be valid and binding on the Company in the future with respect to any bond or understanding to which it is attached
I, Kevin E. Hughes, the undersigned. Assistant Secretary of Travelers Casualty and Surety Company of Amenca. Travelers Casualty and Surety
Company, and St. Paul Fire and Marine Insurance Company, do hereby certify that the above and foregoing is a true and correct copy of the Power of
Attorney executed by said Companies.which remains in full force and effect
Dated this '1st day of January r, 2019
41.1
tit
3 KNIr1GM HAFTFOIG.` 4
\ • mil` • �i '1 / e•�
Kevin E Hughes.Ass tant Secretary
To verify the authenticity of this Power of Attorney,p/ease call us at 1-800-421-3880.
Please refer to the above-named Attorney-in-Fact and the details of the bond to which the power is attached.
Marsh