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Home My WebLink AboutDelrar 2019 FEE: $20.00 ANNUAL RIGHT-OF-WAY OBSTRUCTION LICENSE Application is made for a license to maintain street/sidewalk obstruction: �NAME: l I air-' C ' Type of organization: ion ö �p r individual _partnership OL I E-MAIL: i • lJ UL ra r. COf corporation BCD —T / )0 ( (� Ro . State of Incorporation tADDRESS: lei l�/� l Rot P l'ejkrY) W I 5-163 IL+ 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: C42 — — ZOI EXPIRATION: (Z j 3 I 1 ZQI 1 BOND TERM: INSURANCE TERM: DATE: ( -'lam- ?AL°t 7,4 pplicant's Signature qa- EH(o—I Telephone Number I:\Engineering\ROW Permits\Annual ROW Obstruction Bond&Licensc_1-8-19.doc ' BEND ND.. 5048200 • ANNUAL RIGHT-OF-WAY EXCAVATION BOND , PRINCIPAL(S)(Legal name(s)and business address(es)) _ Type of organization: t•C N136 Its Mile Rex 3 individual _partnership EjvED corporation JIJN Appletcn, WI 54914 Surety(ies)(o Casualty ame(�s)1 d business� ad�dress(es)) State of Incorporation Wi Il 3 20�g The ' 62 Maple Avenue Insurance n�rUS y, W SCO M KS Keene, I\ti 03431 NSIN Penal Sum of Bond: $25,000.00 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. CONDTFIONS: The Principal contemplates performing work within the 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$25,000. 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 L 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 th ncipal: Fort Surety: lLettit; ,-- Vtigl€4....--- Signature Sil, attire Tie tits T Le ti re Kathryn A. Weicher Name Name 14 Attorney in-Feet Title Tide, Maple Avenue Keene, Ili 03431 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:'.Engineer ng'ROW Perni!s%Annual ROW Excavation Bond&1-3c,•nse_1-S-19.doc r THIS POWER OF ATTORNEY IS NOT VALID UNLESS IT IS PRINTED ON RED BACKGROUND. -This Power of Attorney limits the acts of those named herein,and they have no authority to bind the Company except in the manner and to the extent herein stated. Certificate No. 7761849 Liberty Mutual Insurance Company • The Ohio Casualty Insurance Company West American Insurance Company POWER OF ATTORNEY KNOWN ALL PERSONS BY THESE PRESENTS:That The Ohio Casualty Insurance Company is a corporation duly organized under the laws of the State of New Hampshire, that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts. and West American Insurance Company is a corporation duly organized under the laws of the State of Indiana(herein collectively called the"Companies"),pursuant to and by authority herein set forth,does hereby name,constitute and appoint. Ann Stockhausen;Donald J.Hauser;E C.Bowerman;Gerald Aman;Gregory A.Barney;Jay Zahn;Jenny Hirth;Joyce Gott;Julia Liebelt;Kathryn A. Weidner;Kristy Enger;Linda Famularo;Lisa Murawski;Mary Breitrick;Robet M.Ulatt all of the city of Waukesha .state of WI _ each individually if there be more than one named,its true and lawful attorney-in-fact to make,execute.seal,acknowledge and deliver,for and on its behalf as surety and as its act and deed,any and all undertakings,bonds,recognizances and other surety obligations,-in pursuance of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper persons. IN WITNESS WHEREOF,this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed thereto this 10th day of May , 2017 . >, of *,:cr INst,,, JP�,tNSup.14 Cr�trdU^.,,,,,'"c„.,_, 4.. The Ohio Casualty Insurance Company hJyoaratt `9y, J~F<Jcw rFa"<^ �cO" co F, co M s Liberty Mutual Insurance Company 1a p 1919 m >ti. _r 1912 1991 West American Insurance Company - r • ••�N• a=.aD A a 2 Y �- y ��'1 Nnrecs:'t`a � .sncnus• � ,;a.,u� i/ * * * By: /� r"i.'23 >, C STATE OF PENNSYLVANIA ss David M.Carey,Assistant Secretary fa ▪ RCOUNTY OF MONTGOMERY _ cc d 0) On this 10th day of May , 2017.before me personally appeared David M.Carey,who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance U I— O N Company. The Ohio Casualty Company, and West American Insurance Company, and that he, as such, being authorized so to do,execute the foregoing instrument for the purposes >,W p 2 therein contained by signing on behalf of the corporations by himself as a duly authorized officer. its E E o > IN WITNESS WHEREOF,I have hereunto subscribed myit,, name and affixed my notarial seal at King of Prussia,Pennsylvania,on the day and year first above/� written. Y Q y = PAST OMMONWEALTH Of PENNSYLVANIA 7/ Q M/f/2�.0 �ONW E9r<<(-5, Notarial Seal A�) 0C'yJ- c, i , Teresa Pastella.Notary Public By: ,_-0 O i OF I Upper Merlon Twp.,Montgomery County Teresa Pastella,Notary Public y = ` ' AP . My Commission Expires March 28.2021 3 CO 4)O 4Zs.Mt'SVL`1P� E A �' Member.Pennsylvania Assoriafion of Nokinus d O d e 03 This Power of Attorney is made and executed pursuant to and by authority of the following By-laws and Authorizations of The Ohio Casualty Insurance Company, Liberty Mutual to p, ` Insurance Company,and West American Insurance Company which resolutions are now in full force and effect reading as follows: c •0 Q1 a+ O j ra 2 ARTICLE IV-OFFICERS-Section 12.Power of Attorney.Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President.and subject 0 c 2 a; to such limitation as the Chairman or the President may prescribe,shall appoint such attorneys-in-fact,as may be necessary to act in behalf of the Corporation to make,execute,seal, ,% O.E acknowledge and deliver as surety any and all undertakings,bonds,recognizances and other surety obligations. Such attorneys-in-fact,subject to the limitations set forth in their respective 'a E +. powers of attorney,shall have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so •�sk a)O executed,such instruments shall be as binding as if signed by the President and attested to by the Secretary.Any power or authority granted to any representative or attorney-in-fact under > the provisions of this article may be revoked at any time by the Board,the Chairman,the President or by the officer or officers granting such power or authority. r }.tV .R c ARTICLE XIII-Execution of Contracts-SECTION 5.Surety Bonds and Undertakings.Any officer of the Company authorized for that purpose in writing by the chairman or the president, E 0O > d and subject to such limitations as the chairman or the president may prescribe,shall appoint such attorneys-in-fact,as may be necessary to act in behalf of the Company to make,execute, iNy, Z c• 5 seal,acknowledge and deliver as surety any and all undertakings,bonds,recognizances and other surety obligations. Such attorneys-in-fact subject to the limitations set forth in their o C 1 respective powers of attorney,shall have full power to bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the Company. When so U "' executed such instruments shall be as binding as if signed by the president and attested by the secretary. FO—ca Certificate of Designation-The President of the Company,acting pursuant to the Bylaws of the Company,authorizes David M.Carey,Assistant Secretary to appoint such attorneys-in- fact as may be necessary to act on behalf of the Company to make,execute,seal,acknowledge and deliver as surety any and all undertakings,bonds,recognizances and other surety obligations. Authorization-By unanimous consent of the Company's Board of Directors,the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the Company,wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds,shall be valid and binding upon the Company with the same force and effect as though manually affixed. I, Renee C. Llewellyn, the undersigned. Assistant Secretary, The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and West American Insurance Company do hereby certify that the original power of attorney of which the foregoing is a full,true and correct copy of the Power of Attorney executed by said Companies, is in full force and effect and has not been revoked. n IN TESTIMONY WHEREOF.I have hereunto set my hand and affixed the seals of said Companies this Of o('V( day of II a/ ,20 1 ri . , v 4NSUp� ,iNSUR NtNSU,y? e N. " m g t 'F 0 1919 re', N. 1912 ° r 1991 o By: i �° , y a Renee C.Llew ,1�ssistant Secretary ti.1 * * * 386 of 500 LMS_I2873_022017