HomeMy WebLinkAboutBerndt Excavating 2018 WI
FEE: $20.00
ACCOUNT# 100-0050-4972-00000
ANNUAL EXCAVATION/WORK IN THE RIGHT-OF-WAY LICENSE
Application is made for a license to work within the Right-of-Way:
NAME: . / ,A((C&VCXh () Type of organization:
individual partnership
"� ll r �, ,— y corporation
ADDRESS: �.\(�"1 C--O I 1 FF State of Incorporation
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I (We)further agree to provide the City 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 for Bodily Injury and Property Damage Liability
(b) $500,000 personal injury
(c) $500,000 general aggregate
(d) $500,000 products/completed operation aggregate
and shall name the City of Oshkosh, its employees and officers, as an additional insured thereon. Proof of
said coverage in the form of an insurance certificate shall be submitted to the City prior to issuance of any
permit to perform work within the right-of-way.
Each individual project/address at which work will be performed requires a separate permit which may be
obtained from the Public Works
Department.
DATE ISSUED: ` ` v RE, ECYEL
EXPIRATION: l� 1 1 ?j JAN 0$ 2017
BOND TERM: L" 31 - 1 CITY CLERICS OFFICE
INSURANCE TERM:
DATE: 2-
J_,, t_„iL e
Applicant's Signature
C ° ) d. 33 333 )
Telephone Number
Annual Work in the Right-of-Way License
4/19/05
• ANNUAL EXCAVATION/WORK IN RIGHT-OF-WAY BOND
Bond No. 60897421
PRINCIPAL(S)(Legal name(s)and business address(es)) Type of organization:
individual partnership
Berndt Excavating, Inc. corporation
2430 W. Waukan Ave. , Oshkosh, WI 54904
State of Incorporation Wisconsin
Surety(ies)(Name(s)and business address(es))
WESTERN SURETY COMPANY
P.O. Box 5077
Sioux Falls, SD 57117-5077
Penal Sum of Bond: $5000.00
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 area within the right-of-way to as good a condition as it was in prior to Principal's activities; and
pay to the City of Oshkosh any amounts due for services or materials furnished in connection therewith within one week 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 un[jder, a attached license, including but not limited to, all accidents and damages caused by any failure to erect and
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mainti�ilA � barriers or lights at the place where licensee has placed obstruction or performed work, or by failure to guard
again WI "to`persons passing upon the street or sidewalk, or by failure to promptly remove all tools, implements, refuse and
ur 6 Ifs from said right-of-way. The Principal shall indemnify and refund to the City of Oshkosh all sums which it may become
oEli :•tii.'pay,including damages, punitive damages,attorney fees,and court costs,within 30 days of written demand for payment,however the
p • ' of this bond sh altt exceed$5000.
3%. 'rCw
It ub•ers a m yr py the Principal(s)and Surety(ies)that this bond supplements, but does not take the place of any liability insurance
req >•C•;'•'..carriedmham Principal(s)herein by the City of Oshkosh policies or ordinances.
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TERM 6 BOND! '
This bond shall cover work performed from _J7a ivary_1_, 2018 (Date of Issuance)to December 31, 018
(The annual license period). This bond shall cover claims made for work performed during this annual license period and for an additional
two-year maintenance period beyond the expiration of this annual license period.
SIGNATURES/SEALS:
For the Principal: For the Surety: 0 SURET MPANY
Berndt Excavating, Inc. C.-/�—
Name Name
11-29-2017
_ Paul T. Bruflat, Senior 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.
Annual Excavation/Work in the Right-of-Way
4/15/05