HomeMy WebLinkAboutPTS Contractors 2019 FEE: $20.00
ANNUAL RIGHT-OF-WAY EXCAVATION LICENSE
Application is made for a 1. se to work within the Right-of-Way:
nJ A���1 Ccpe of organizaton:
NAME: 1 � .� �
w _individual _partnership
E-MAIL: CINFA I IZ 5Cc. 72dt crag-5, 1ue r corporation
�j� 7S �� �^ State of Incorporation
ADDRESS: � j� ✓J
(tE•ettJ Vvri
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: •Z 13 r 7151�1
EXPIRATION: %2,8112419
BOND TERM: Z/S/Zot9- /Z/E 1/2619
INSURANCE TERM: -/!4/2018- 17-/lb/7b4 at
DATE: Z—l3-2of`j
Applicant's Signature
q20- 37( -352f
Telephone Number
I:\Engineering\ROW Permits\Annual ROW Excavation Bond&License_1-8-19.doc
r
«.s•
ANNUAL RIGHT-OF-WAY EXCAVATION BOND Bond No.354223052'
PRINCIPAL(S)(Legal name(s)and business address(es)) Type of organization:
PTS Contractors,Inc. _individual _partnership
4075 Eaton Road,Green Bay,WI 54311 X corporation
Incorporation 11Ni onsin
Surety(ies)(Name(s)and business address(es)) State of Incorp tLIVED
Liberty Mutual Insurance Company
175 Berkeley St,Boston,MA 0216 FEB — 7 Z019
Penal Sum of Bond: $25,000.00 DEpn P KO( {(I BLfC WORKS
•OBLIGATION: W I SCONS.1N
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 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 2/5/2019 (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 i'ri • Contr ctors,Inc. For the Surety: Liberty Mutual Insurance Company
Signature Signature
Steve C. Horn Roxanne Jensen
Name Name
Vice—President Attorney-in-Fact
Title Title
175 Berkeley St,Boston,MA 02116
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
r
rev 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.
`�'1 % Liberty Liberty Mutual Insurance Company
11*` Mutual. The Ohio Casualty Insurance Company Certificate No:8196827-354019
West American Insurance Company
SURETY
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, Kelly Cody;
Christopher Hovden;Roxanne Jensen;Christopher H.Kondrick;Brian L.Krause;Trudy A.Szalewski
all of the city of Green Bay 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 12th day of September , 2018 .
Liberty Mutual Insurance Company
P,INSURy POSY INSU , 1NSUR,1 The Ohio Casualty Insurance Company
A, coePO'tir 4, �J c&Pak'T�y CBy: %
West American Insurance Com an 3 4 pym� �: o aco
ui -.. (V
c - David M.Carey,Assistant Secretary F)
co State of PENNSYLVANIA
15 T County of MONTGOMERY ss co
` cr>
U a) On this 12th day of September , 2018 before me personally appeared David M.Carey,who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance 0
o @ 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—11-
r
'a-) > therein contained by signing on behalf of the corporations by himself as a duly authorized officer. o lL
II; IN WITNESS WHEREOF,I have hereunto subscribed my name and affixed my notarial seal at King of Prussia,Pennsylvania,on the day and year first above written. 2 a
..,7 ?, PQ S `p 0
O ` Q�'�.,ONv,E^T�( COMMONWEALTH OF PENNSYLVANIA 4
a Q o� CS(7 Notarial Seal /I��� �1 Q-O
OF Teresa Pastella,Notary Public �'�- ��I�/ m
O N Upper Me non Twp.,Montgomery County By: Q /(I
c (5 � ��r My Commission Expires March 28,2021
'I, "+sy��a �o Teresa Pastella,Notary Public 3 E
kn cr. 13\, Member,Pennsylvania Association of Notaries O
CO 0 CD
cr)a) 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 w rn
0.E Insurance Company,and West American Insurance Company which resolutions are now in full force and effect reading as follows: o CD
`aS ARTICLE IV-OFFICERS:Section 12.Power of Attorney. S
o m Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President, and subject to such limitation as the Chairman or the m,,
-o > President may prescribe,shall appoint such attorneys-in-fact,as may be necessary to act in behalf of the Corporation to make,execute,seal,acknowledge and deliver as surety >c
TIZI E any and all undertakings,bonds,recognizances and other surety obligations.Such attorneys-in-fact,subject to the limitations set forth in their respective powers of attorney,shall,N
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 executed,such ""0O
Zinstruments 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 M
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. a co
o
ARTICLE XIII-Execution of Contracts:Section 5.Surety Bonds and Undertakings. c.)c)Any officer of the Company authorized for that purpose in writing by the chairman or the president,and subject to such limitations as the chairman or the president may prescribe, H
shall appoint such attorneys-in-fact,as may be necessary to act in behalf of the Company to make,execute,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 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 executed such instruments shall be as binding as if
signed by the president and attested by the secretary.
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.
IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed the seals of said Companies this 19 day of PC',iir-). , I vl
. 1NSU 01 INSU 1NSt1
,.p'GORPo2a yam Q.)'?"oapo�T'PT y VPaoaPor��yC+ J/
3 Cy _ Fo m V
s 1912 o 0 1919 1991 `G.(,u�
?Cr-in, c 12 dL Z0' N H„,t Y N991 L� By:
9/7 * 1.t dRl * ,,a s''M * *�a Renee C.Llewellyn,Assistant Secretary
LMS-12873 LMIC OCIC WAIC Multi Co 062018