HomeMy WebLinkAboutGriese Construction of the Fox Valley 2019 RECEIVED
FEE: $20.00
MAY - R ?Pig
,A
NNUAL RIGHT-OF-WAY EXCAVATION LICENSE
DEPT PUBLIC WORKS
OSHKOSH, WISCONSIN
Application is made for a license to work within the Ri ht-of-Way:
_ 1 p�L CCU
NAME: KY)
iJs('i"YPe of organization:
individual _partnership
E-MAIL: MI 1 k.0 p\ t'ss-e, co!) +(on , CC)n-1 corporation
ADDRESS: 3C I S ; State of Incorporation _
CD '311CC:O-L, cSy 90 4'
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 Twenty Five Thousand Dollars($25,000.00).
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 to perform work within the right-of-way.
Each individual project/address at which work will be performed requires a separate permit which may be obtained from
the City of Oshkosh Public Works Department
t---Engineering Division.
--/&)
DATE ISSUED: / /
EXPIRATION: i2I Si 12cM
BOND TERM: -I•ZUIR -re. 12.3I•Zibl9
INSURANCE TERM: S• 11•Wet 're 5•l%.
DATE: SIB Ion
y/c4_5:2__
Applicant's Signature
9:92C - � � P.- c3/ac
Telephone Number
1.\Engineering\ROW Permits\Annual ROW Excavation Bond 6i License_1.8-19.doc
Bond No. 72144237 -
ANNUAL RIGHT-OF-WAY EXCAVATION BOND
PRINCIPAL(SXLegal name(s)and business address(es))
Type of organization:
Griese Construction of The Fox Valley LLC — individual - partnership
6061 State Rd 91, Oshkosh, WI 54904 corporation `.W-44L
RECEIVED State of Incorporation _ w
Surety(ies)(Name(s)and business address(es))
WESTERN SURETY COMPANY
P.O. Box 5077 MAY — 8 2019
Sioux Falls, SD 57117-5077 DEPT OF PUBLIC WORKS
Penal Sum of Bond: $25,000.00
OSHKOSH, WISCONSIN
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 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 Prin '9 a period beginning on the date of issuance of this bond through a two(2)year period from the expiration date of
i�a�. �r�
the nt a� efend, and hold harmless the City of Oshkosh from and against any and all claims, damages, costs, and
exp a any kini c acter arising out of or resulting, however remotely, from the work performed by the Principal under the
at�li l y. not limited to,all accidents and damages caused by any failure to erect and maintain sufficient barriers or
liii cbe place w " '-ee has placed obstruction or performed work,or by failure to guard against injury to persons passing upon
tl or sidewalk,orairiulure to promptly remove all tools,implements,refuse,and unused materials from said right-of-way. The
l in a fl refund to the City of Oshkosh all sums which it may become obligated to pay,including damages,punitive
d ,..a_tld Cede court costs,within thirty(30)days of written demand for payment;however,the penal sum of this bond shall
not "s .O0,
a
It is unogisicat.iusittxreed by the Principals)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 4, 2019 (Date of Issuance)to December 31, 2019
(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: - For the -i WESTERN SURETY COMPANY
Signature(\cyt1/4.\\16 y...A...„1/4.94a e. 7--
g v p Signature 4-5-2 019
F►
1 ' `l V1.. () r l `tst Paul T. Bruflat
Name Name
0W'/ y SLr Vice President
Tide Title
P.O. Box 5077
Sioux Falls, SD 57117-5077
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 Excavation Bond&License_1-8-19.doc
RECEIV Western Surety Corn anMAY - 82CL /
DFPT OF PUBLIC WORKS POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS:
That WESTERN SURETY COMPANY, a corporation organized and existing under the laws of the State of South Dakota, and
authorized and licensed to do business in the States of Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut,
Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine,
Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New
Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South
Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming, and the
United States of America, does hereby make, constitute and appoint
Paul T. Bruflat _ of_ _-___—__ _Sioux Falls
State of _South Dakota , its regularly elected Vice President
as Attorney-in-Fact, with full power and authority hereby conferred upon him to sign, execute, acknowledge and deliver for and on
its behalf as Surety and as its act and deed,the following bond:
One RIGHT—OF—WAY EXCAVATION CITY OF OSU1cOSH __
bond with bond number 72144237
for GRIESE CONSTRUCTION OF THE FOX VALLEY LLC
as Principal in the penalty amount not to exceed: a?5,000.00
Western Surety Company further certifies that the following is a true and exact copy of Section 7 of the by-laws of Western Surety Company duly
adopted and now in force,to-wit:
Section 7. Ali 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, any 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.
In Witness Whereof, the said WESTERN SURETY COMPANY has caused these presents to be executed by
Vice President with the corporate seal affixed this ',t 11 day of r i 1.
2019
ATTEST WEST SURET COMPANY
CDT 2414.0.71--/ By
L. Nelson,Assistant Secretary Paul T. t,Vice President
Nis buy,
05104
ma` s t�=
STATE OF SOUTH DAKOTA : ;�ss at. .
COUNTY OF MINNEHAHA
On this 5th day di April 2019 before me, a Notary Public, personally appeared
Paul T. Bruflat and w_. .__L
who, being by me duly sworn,acknowledged that they signed the above Power of Attorney as Vice President
and Assistant Secretary, respectively, of the said WESTERN SURETY COMPANY,and acknowledged said instrument to be the
voluntary act and deed of said Corporation.
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J. MOHR i
g
NOTARY PUBLIC S; �
i SOUTH DAKOTAC��.�/i
ititiytirrtirtititiaa'.4�ti�tiatititi+ My Commission Expires June 23, 2021 Notary Pubic
To validate bond authenticity,go to www.cnasurety.com >Owner/Obligee Services >Validate Bond Coverage.
Fomr F1975-1-2016