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Home My WebLink AboutWolf River Asphalt & Sealcoating 2019 t ' FEE: $20.00 // d J 2 COCOA" 4lF C,Otr�>�lir SINGLE-SITE RIGHT-OF-WAY EXCAVATION LICENSE Application, `iso adze for a license to work within the Right-of-Way: La1)�,� `i.tom` NAME: WO 1 Qlv vricf0V 'f a SeaICnl l7 gInc Type of organization: ` S L /� individual _partnership A�v E-MAIL: V h C p h C rI aq nu I toVY) 7 corporation State of Incorporation 9 Q.P ADDRESS: N 5a rAX�r a va W S\lac�iAb \ 1i(Th Right-of-Way Permit#: 2019035y(0 (To Be Completed by City Staff) 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 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-20 19 EXPIRATION: r�IZ -31r Z019 BOND TERM: T-I-2a9 To 12/3( I2o1`l INSURANCE TERM: 3-kn-2dq TO 3 -I(n-ZoZO DATE: -1- 1!f q f\ Applicant's Signature quo-ct8,9-31G Telephone Number L\Engineering\ROW Permits\Single-Site ROW Excavation Bond&License_1-8-19.doc Bond No. 6970524_8 SINGLE-SITE RIGHT-OF-WAY EXCAVATION BOND PRINCIPAL(S)(Legal name(s)and business address(es)) Wolf River Asphalt & Sealcoating Inc Type of organization: individual partnership N5206 Rexford Rd _X__corporation Shiocton, WI 54170 Wi State of Incorporation sconsin Surety(ies)(Name(s)and business address(es)) WESTERN SURETY COMPANY P.O. Box 5077 Sioux Falls, SD 57117-5077 Penal Sum of Bond: $5,000.00 Right-of-Way Permit#: Zrel 03Skyto (To Be Completed by City Slam 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 Oshkoah pursuant to the right-of-way permit specified above. 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. y tltr w -t The P , '`�� . eriod beginning on the date of issuance of this bond through a two(2)year period from the expiration date of the , nee ilato *fend, and hold harmless the City of Oshkosh from and against any and all claims, damages, coats, and expeiusia,.d_symIsincl.brAnitracter arising out of or resulting, however remotely, from the work performed by the Principal under the atteefgd i ,Bell i bgbut not limited to, all accidents and damages caused by any failure to erect and maintain sufficient barriers or Irg1144ti the place where licensee has placed obstruction or performed work, or by failure to guard against injury to persons passing uputilhe street or sidewji't ,or by failure to promptly remove all tools, implements, refuse, and unused materials from said right-of- SIVIcipet shall.indemnify and refund to the City of Oshkosh all sums which it may become obligated to pay, including danff8gt8f'punvb dauialiy. attorney fees, and court costs, within thirty (30)days of written demand for payment; however, the penal sum oftlSa.and•shdll‘ob,-exceed$5,000. It is underiftotdd Add agreed by the Principal(s)and Surety(ies) that this bond supplements, but does not take the place of, any liability insurance required to be carried by said Principal(s)herein by the City of Oshkosh policies or ordinances. TERM OF BOND: This bond shall cover work performed in accordance with the approved right-of-way permit from July 1st, 2019 (Date of Issuance)to December 31, 2019 (Date of Expiration)for the specified right-of-way permit number listed on this form. This bond shall cover claims made for work performed under the license and corresponding right-of-way permit and for an additional two (2) year maintenance period beyond the expiration date. The principal agrees to correct all maintenance issues brought to the attention of the Principal(s)upon receiving notice from the City of Oshkosh written the two(2)year maintenance period. SIGNATURES/SEALS: For the Principal: Fort. ty: WESTERN SURETY COMPANY 2_71 7:g° 19 Signature Signature 07/01/2019 I.UUrtn id-kr Paul T. Bruflat Name� Name \1 ra WtSi(+�Pn+ Vice President Title Title P.O. Box 5077 Sioux Falls, SD 57117-5077 Address Any person signing in a representative capacity (e.g., an attorney-in-fact) must furnish evidence of authority if that representative is not a member of the firm or partnership or an officer of the corporation involved. I.\Engmeenng\ROW Permtte\Singe-Site ROW Excavation Bond&Ltcense_I$-19.doc 9 6. Western Surety Company 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 Daknta , 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 Single-Site Right-of-Way Exca••ation City of Oshkosh bond with bond number 64705298 for Wolf River Asphalt & Sealcoating Inc as Principal in the penalty amount not to exceed: $ 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 duty adopted and now in force,to-wit: Section 7. All 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 its Vice President with the corporate seal affixed this _ 1st_ day of July 2019 . ATTEST WESTEE URET COMPANY By L.Nelson,Assistant Secretary Paul ruflat,,Vice President ;ems.. 44/ qQQ tI R,�� .111 STATE OF SOUTH DAKOTA ) 3 S. .�ss �;jAz C :E't 'ti '., COUNTY OF MINNEHAHA /J so�rH r„ DP, On this 1st day of July 2 019 , before me, a Notary Public, personally appeared Paul T. Bruflat and L. Nelson 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. }4M4Mhw99tititih599Sy4%%%%%%% + J. MOHR ab NOTARY PUBLIC a i SOUTH DAKOTA i + My Commission Expires June 23, 2021 Notary Public To validate bond authenticity,go to www.cnasurety.com >Owner/Obligee Services>Validate Bond Coverage. Form F1975-1-2016