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Home My WebLink AboutMid State Asphalt 2019 FEEL .2O OO ANNUAL RIGHT-OF-WAY EXCAVATION LICENSE RECEIVED APR — 8 2019 Application is made for a license to work within the Right-of-Way: DEPT OF PUBLIC WORKS � f J ,� OSHKOSH, WISCONSIN NAME: /" '/J' ' 5 4 ,k ✓/'/hs I1 L L L Type of organixatinn ,f / - lydividual partnership E-MAIL: 'd-541 k oriobL e ya h�,-e corporation ADDRESS: )I ( A/ f 1,,2.�- L t, state of Incorporation Mt../Lei.k, G✓� ' )1' 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-Engineering Division, DATE ISSUED: '1 /l0(ZOi°1 EXPIRATION: IZ(3I Xtck ( BOND TERM: y-1-Zeal +C 1Z-31-Zoi INSURANCE TERM: C6-11-1 (.-11-20l°1 DATE: ltol cote\ App icant's Signature q20 1 z_ („52L( Telephone Number Cl rnvinw'rinv\ROW N'rmil.\Annual ROVI kcavation Mond t4l is'*MP 144,1V,Mr ANNUAL RIGHT-OF-WAY EXCAVATION BONO (so - ►at 4 l s j y N,• PRINCII'AL(S)(Legal na me(s and business address(es)) Type of organi:wation= Mid-State Asphalt, LLC _individual _partnership 519 N. Shawano Street — x �rporatiun New London, WI 54961 RECEIVED -" Surety(ies)(Name(s)and businessaddress(es)) grate of Ua u WI y( ) APR — Cincinnati Insurance Companies 8 2019 6200 S Gilmore Rd DEPT OF PUBLIC WORKS Penal Sum of Bond: $25,000.00 NSIN 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 Fare 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, Wiscattsin; 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-el- way. The Principal shall indemnity and refund to the City of Oshkosh all sums which it may become obligated to pays 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 doss 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 1. 2019 (pate of Issuance) to Pecember 31, 24�9._.(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: 4110 For the Principal: For le rety. Signature i attire Corey Prinsen _____ Karie Radtke Name N,ime Owner -Agent - Title T!tie New London, WI 54961 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-`.rnuirorri,wi ROW Punnit.%Annual R(n11,. sarinnBnn,l ,I,,vn-- I-R-19chic THE CINCINNATI INSURANCE COI1I PANY Fairfield,Ohio POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS:That THE CINCINNATI INSURANCE COMPANY,a corporation organized under the laws of the State of Ohio. and having its principal office in the City of Fairfield,Ohio,does hereby constitute and appoint Mary Hoffman, Kane Radtke,Frank Radtke, of New London, WI its true and lawful Attorney(s)-in-Fact to sign, execute,seal and deliver on its behalf as Surety, and as its act and deed,any and all bonds, policies, undertakings. or other like instruments,as Follows: Five Million Dollars and 00/100 (S5,000,000.00) This appointment is made under and by authority of the following resolution passed by the Board of Directors of said Company at a meeting held in the Principal office of the Company, a quorum being present and voting, on the bth day of December, 1958, which resolution is still in effect: "RESOLVED, that the President or any Vice President be hereby authorized, and empowered to appoint Attorneys-in- Fact of the Company to execute any and all bonds, policies, undertakings, or other like instruments on behalf of the Corporation, and may authorize any officer or any such Attorney-in-Fact to affix the corporate seal: and may with or without cause modify or revoke any such appointment or authority.Any such writings so executed by such Attorneys-in- Fact shall be binding upon the Company as if they had been duly executed and acknowledged by the regularly elected officers of the Company." This Power of Attorney is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of Directors of the Company at a meeting duly called and held on the 7'h day of December. 1973. "RESOLVED, that the signature of the President or a Vice President and the seal of the Company may be affixed by facsimile on any power of attorney granted, and the signature of the Secretary or Assistant Secretary and the seal of the Company may he affixed by facsimile to any certificate of any such power and any such power of certificate bearing such facsimile signature and seal shall be valid and binding on the Company. Any such power so executed and sealed and certified by certificate so executed and sealed shall, with respect to any bond or undertaking to which it is attached, continue to be valid and binding on the Company." IN WITNESS WHEREOF,THE CINCINNATi INSURANCE COMPANY has caused these presents to be sealed with its corporate seal, duly attested by its Vice President this 10th day of May,2012. THE CINCiNNATI INSURANCE COMPANY tT CORPORATE 3 SEAL A - • ONtO Vice President STATE OF OHIO ) ss: COUNTY OF BUTLER On this 10i°day of May,2012,before me came the above-named Vice President of THE CINCINNATI INSURANCE COMPANY, to me personally known to be the officer described herein,and acknowledged that the seal affixed to the preceding instrument is the corporate seal of said Company and the corporate seal and the signature of the officer were duly affixed and subscribed to said instrument by the authority and direction of said corporation. ,,,ttttmtuu,, p 3 MARK J.H LLER,Attorney at Law NOTARY PUBLIC-STATE OF OHIO ��7;-ateeterg'Ors• My commission has no expiration date.Section 147.03 O.R.C. 1,the undersigned Secretary or Assistant Secretary of THE CINCINNATI INSURANCE COMPANY,hereby certify that the above is a true and correct copy of the Original Power of Attorney issued by said Company, and do hereby further certify that the said Power of Attorney is still in full force and effect. GIVEN under my hand and seal of said Company at Fairfield. Ohio. this day of /g7 Ctif Viz , CORPORATE o ,Assistant Secretary SEAL off"'°)