HomeMy WebLinkAboutJ.C. Santy Construction 2019 FEE: $20.00-
RECEIVED
ANNUAL RIGHT-OF-WAY EXCAVATION LICENSE
MAR 14 ;,019
DE TOI ! rill/ it'
OSW
Application is made for a license to work within the Right-of-Way: HKOSy, "ISCONS1NS
NAME: J.C. Sail f j C t rke. �-I�bn LI-C Type of organization:
n JJ individual partnership
E-MAIL: tf ' }c sa . tom corporation
�I)git S �^ <J R_ ne, State of Incorporation
ADDRESS: � '1 Y 1 �TlDrive
rk�0.S`C iI CO I 541(02
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: 3/jy 17CI°1
EXPIRATION: 12.1 Si j zc 1
BOND TERM: Z'5 I q //2.,3I•/9
INSURANCE TERM: I'/8'19 ^ !-
DATE: 3' Y '/9
Applicant's Signature
(qzo g21-52-13
Telephone Number
I:\Engineering\ROW Permits\Annual ROW Excavation Bond k License_1-8-19.dac
4
ANNUAL RIGHT-OF-WAY EXCAVATION BOND Bond#6097559
PRINCIPAL(S)(Legal name(s)and business address(es)) Type of organization:
J.C.SANTY CONSTRUCTION,LLC _individual _partnership
3184 S SAINT AUGUSTINE DR
PULASKI,WI 54162-8949 X corporation [�
Surety(ies)(Name(s)and business address(es)) Mate of Incorporation 1itr+—
Federated Mutual Insurance Company RECEIVED
PO Box 328
Owatonna MN 55060 MAR 1 4 2019
Penal Sum of Bond: $25,000.00 DEP I OF PUBLIC WORKS
OBLIGATION: OSHKOSH, WISCONSIN
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 February 5,2019 (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:
e Principal For the Surety: Feder ual Insurance Company
Signature Signature
'brad ` Shelly Rohwer
Name Name
Ot,\n/�I.C. � � Can Attorney-in-Fact
Title`�' Title
PO Box 328 Owatonna MN 55060
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.
1.1 Engineering\ROW Permits Annual ROW Excavation Bond&License_1-8-19.doc
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS:
That FEDERATED MUTUAL INSURANCE COMPANY, a corporation duly organized and existing
under the laws of the State of Minnesota, and having its principal office in the City of Owatonna, State of
Minnesota, does hereby constitute and appoint:
SHELLY ROHWER of the City of OWATONNA State
of MINNESOTA its true and lawful attorney for the following purposes:
To sign its name as surety to, and to execute, affix the seal, acknowledge and deliver any and all surety
bonds and penalties not exceeding:
ONE HUNDRED THOUSAND DOLLARS ($100,000) EACH
J. C. SANTY CONSTRUCTION, LLC PULASKI, WI
The execution of such bonds or undertakings in pursuance of these presents shall be binding upon the
Company as if they had been executed and acknowledged by the regularly elected officers of the Company.
This Power of Attorney granted by Federated Mutual Insurance Company shall terminate when the
designee ceases to be:
1) Employed by Federated Mutual Insurance Company or
2) Employed by Federated Mutual Insurance Company in a job for which such Power of
Attorney is required.
IN WITNESS WHEREOF,the said FEDERATED MUTUAL INSURANCE COMPANY has caused
this instrument to be signed and its corporate seal to be affixed by its Executive Vice President and Assistant
Secretary this the 8TH day of APRIL , 2016
FEDERATED MUTUAL INSURANCE2 COMPANY
BY 472,0144 4. 7:l�✓�)
(SEAL) Ece\ cutive Vice resident
and BY
sistant Secretary
STATE OF MINNESOTA
COUNTY OF STEELE
On this 8TH day of APRIL 2016 personally appeared before me, the undersigned notary
public, James A. Thon and Jonathan R. Hanson to me personally known, who, each being duly sworn by me, did
say that they are respectively the Executive Vice President and Assistant Secretary of the FEDERATED MUTUAL
INSURANCE COMPANY and that the seal affixed to this instrument is the corporate seal of said Corporation and
that this instrument was signed and sealed of behalf of said Corporation by authority of its Board of Directors and
said James A. Thon and Jonathan R. Hanson acknowledge said instrument to be the free act and deed of said
corporation.
e. KELLY J. HAGEN
II NOTARY PUBLIC-MINNESOTA
(SEAL) My Commission Expires Jan.31,20207,/, 4 9
COPY OF RESOLUTION
"BE IT RESOLVED that the President or any Vice President in conjunction with the Secretary is hereby
authorized and empowered under the corporate seal of the Company, to appoint any person or persons as attorney
or attorneys-in-fact, or agent or agents of the Company, in its name and as its act to execute and deliver, anywhere
in the United States or Canada, any and all bonds and undertakings of suretyship and other documents that the
ordinary course of surety business may require."
"BE IT FURTHER RESOLVED that the Power of Attorney or other document appointing such person or
persons as attorney or attorneys-in-fact or agent or agents of the Company may either be personally signed by the
President, any Vice President, the Secretary or may be executed by said officers by means of facsimile signatures.
The said personal signatures or facsimile signatures shall not require the Company seal or any other seal and shall
be valid and binding on the company if executed either by personal signature or facsimile signature and with or
without the Company seal being affixed thereto."
I, the undersigned, hereby certify that I am a Executive Vice President of the FEDERATED MUTUAL
INSURANCE COMPANY, a Corporation duly organized and existing under the laws of the State of Minnesota and
that the foregoing is a true and complete copy of the original Power of Attorney given by said Company to:
SHELLY ROHWER of OWATONNA, MINNESOTA
authorizing and empowering such person to sign bonds as therein set forth, which Power of Attorney has never
been revoked and is still in full force and effect.
I further certify that said Power of Attorney was given in pursuance of a resolution adopted at a regular
meeting of the Board of Directors of said Company duly called and held at the office of the Company in the City of
Owatonna,Minnesota on the 20th day of April, 19 82 at which meeting a quorum was present and that the foregoing
is a true and correct copy of said resolution, and the whole thereof as recorded in the minutes of the said meeting.
PURSUANT to the By-Laws of Federated Mutual Insurance Company, Article 8, Section 1; in the absence
of or inability of the Secretary to act, his duties shall be performed by the Assistant Secretaries in the order of their
rank.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of the FEDERATED
MUTUAL INSURANCE COMPANY this the 5TH day of FEBRUARY _, 2019
FEDERATED MUTUAL INSURANCE COMPANY
(SEAL)
E ecutive Vice President