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Home My WebLink AboutZivkovich, Mercedes 2019 FEE: $20.00 ANNUAL RIGHT-OF-WAY OBSTRUCTION LICENSE Application is made for a license to maintain street/sidewalk obstruction: NAME: 1 v\e-re ,P Z lr' kov,Y,k Type of organization: II// ^ )L individual -partnership E-MAIL: i cedeS . v kat)+ C:1II��"`9MCI t I Cotvi —corporation I d-�3 Mar ney State of Incorporation bur ADDRESS: �I C)sh -1 -gc1o1 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: 6- /°J EXPIRATION: 13 1°I BOND TERM: 5'q!19 k 1743j j INSURANCE TERM: (61-gnia0- �e (1-v3r7Cil DATE: 5 (C J f I Applicn s Signature la) 5—() �1 Lf / Telephone Number L\Engineering\ROW Peanits\Annual ROW Obstruction Bond&License_1-8-19.doc ANNUAL RIGHT-OF-WAY OBSTRUCTION BOND PRINCIPAL(S)(Legal name(s)and business address(es)) Type of organization: Mercedes Zivkovich ✓ Individual _Partnership 1243 Harney Ave Oshkosh,WI 54901-5438 _Corporation Surety(ies)(Name(s)and business address(es)) State of Incorporation t'tii _ West Bend Mutual Insurance Company PO Box 620976 Middleton,WI 53562 Penal Sum of Bond: S5,000.00 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(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, induding 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 May 9'2019 (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: Mercedes Ztvkovich ^ For the r We B d M I Ice Company i Signature Suture Mercedes Zivkovich LUKE MONGIN Name Name Attorney-in-fact Title Title PO Box 620976 Middleton,WI 53562 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.\Env...erinf 1 ROW Permits Annual ROW OIMn6,11.m Rona A I inv -1-6-19dnr WEST BEND THE SILVER LINING' A MUTUAL INSURANCE COMPANY Bond No. 2411261 POWER OF ATTORNEY Know all men by these Presents,That West Bend Mutual Insurance Company,a corporation having its principal office in the City of West Bend,Wisconsin does make,constitute and appoint: LUKE MONGIN lawful Attorney(s)-in-fact,to make,execute,seal and deliver for and on its behalf as surety and as its act and deed any and all bonds, undertakings and contracts of suretyship,provided that no bond or undertaking or contract of suretyship executed under this authority shall exceed in amount the sum of: Five Thousand Dollars(55,000 00) This Power of Attorney is granted and is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of Directors of West Bend Mutual Insurance Company at a meeting duly called and held on the 21,'day of December. 1999. Appointment ofAttorney-In-Fact. The president or any vice president,or any other officer of West Bend Mutual Insurance Company may appoint by written certificate Attorneys-in-Fact to act on behalf of the company in the execution of and attesting of bonds and undertakings and other written obligatory instruments of like nature. The signature of any officer authorized hereby and the corporate seal may be affixed by facsimile to any such power of attorney or to any certificate relating therefore and any such power of attorney or certificate bearing such facsimile signatures or facsimile seal shall be valid and binding upon the company,and any such power so executed and certified by facsimile signatures and facsimile seal shall be valid and binding upon the company in the future with respect to any bond or undertaking or other writing obligatory in nature to which it is attached. Any such appointment may be revoked,for cause,or without cause,byanysaid officer at any time. In witness whereof.the West Bend Mutual Insurance Company has caused these presents to be signed by its president undersigned and its corporate seal to be hereto duly attested by its secretary this 22nd day of J "~ Se tember,2017. Attest A�•L;D:Iyi".Li . ` — 4 ' c� G. a .< -- —Christopher C.Ziavgart J°oRPoa'`rE S. Kevin A.Steiner Secretary .,k SFAL ' Chief Executive Officer/President ri:m(P. State of Wisconsin . County of Washington On the 22nd day of September,2017,before me personally came Kevin A.Steiner,to me known being by duly sworn,did depose and say that he resides in the County of Washington.State of Wisconsin;that he is the President of West Bend Mutual insurance Company. the corporation described in and which executed the above instrument;that he knows the seal of the said corporation;that the seal affixed to said instrument is such corporate seal:that is was so affixed by order of the board of directors of said corporation and that he • signed his name thereto by like order. .••....lir ••, ,"YrAAr7. Juli nedum woe ;? Senior .orporate Attorney 'rtpf xys�o�'y' Notary Public,Washington Co.,WI My Commission is Permanent The undersigned,duly elected to the office slated below, now the incumbent in West Bend Mutual Insurance Company,a Wisconsin corporation authorized to make this certificate, Do Hereby Certify that the foregoing attached Power of Attorney remains in full force effect and has not been revoked and that the Resolution of the Board of Directors,set forth in the Power of Attorney is now in force. Signed and sealed at West Bend,Wisconsin this 9th day of May , 2019 ?J �,OiiPOrtAiF �, J lits4S:Lgi• !leather Dunn — — `i' Vice President—Chief Financial Officer Notice: Any questions concerning this Power of Attorney may be directed to the Bond Manager at NSI,a division of West Bend Mutual Insurance Company. moo S.Iffir'Ave. West Rend,WI 5.3093 I ph(262) 334-6430 I I-KW-236-5M M I fix(262) 338-SI158 I www.thestIveriuung.com