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Home My WebLink AboutFour-Way Construction of WI Inc 2018 FEE: $20.00 ACCOUNT# 100-0050-4972-00000 \41/3 ANNUAL EXCAVATION/WORK IN THE RIGHT-OF-WAY LICENSE Application is made for a license to work within the Right-of-Way: NAME: �d�!�- � -S • O " G�✓6 ��"� Type of organization: individual partnership "6-- 3? corporation ADDRESS: aC' /23 /1/ State of Incorporation Zee L/ 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: II EXPIRATION: L11,'J22\"_)?) RE FIV BOND TERM: \ DEC 0 4 2017 INSURANCE TERM: 31- 1S CITY Ci.tNRK%OFFICE DATE: \ -14 Applican s Si nature U Tao —14S Telephone Number Annual Work in the Right-of-Way License 4/19/05 Belld ANNUAL EXCAVATION/WORK IN RIGHT-OF-WAY BOND PRINCIPAL(S)(Legal name(s)and business address(es)) Type of organization: Four Way Construction of Wisconsin Inc. individual partnership X corporation N8659 Forest Ridge Road Berlin,WI 54923 Surety(ies)(Name(s)and business address(es)) State of Incorporation Wisconsin The Hanover Insurance Company 440 Lincoln St Worcester,MA 01653 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 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 30 days of written demand for payment,however the penal sum of this bond shall not exceed$5000. 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 12/31/2017 (Date of Issuance)to December 31,20 18 (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: Four Way Con coon of Wi in Inc. The Hanover Insurance Company "laretgoi-ef t Name N e Joseph L.Vigna,Attorney-in-Fact Title �; Title 4 J''o4Pr1RrT � � 330 E Kilboum Ave,Ste 650 Milwaukee,WI 53202- 51:�� ° �_ 3175 1972 ?v& Address ' f'�111111111151��` 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 • Bond Number BL11018049 THE HANOVER INSURANCE COMPANY MASSACHUSETTS BAY INSURANCE COMPANY CITIZENS INSURANCE COMPANY OF AMERICA POWER OF ATTORNEY 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. KNOW ALL PERSONS BY THESE PRESENTS: That THE HANOVER INSURANCE COMPANY and MASSACHUSETTS BAY INSURANCE COMPANY, both being corporations organized and existing under the laws of the State of New Hampshire, and CITIZENS INSURANCE COMPANY OF AMERICA, a corporation organized and existing under the laws of the State of Michigan,(hereinafter individually and collectively the"Company")does hereby constitute and appoint, Joseph L.Vigna Of Robertson Ryan and Assoc,Milwaukee,WI each individually, if there be more than one named, as its true and lawful attorney(s)-in-fact to sign,execute, seal,acknowledge and deliver for,and on its behalf,and as its act and deed any place within the United States, any and all surety bonds,recognizances, undertakings,or other surety obligations.The execution of such surety bonds,recognizances,undertakings or surety obligations, in pursuance of these presents, shall be as binding upon the Company as if they had been duly signed by the president and attested by the secretary of the Company,in their own proper persons.Provided however,that this power of attorney limits the acts of those named herein,and they have no authority to bind the Company except in the manner stated and to the extent of any limitation stated below: Excavation-Work in Right-of-Way Bond in the amount of: $5,000 00 That this power is made and executed pursuant to the authority of the following Resolutions passed by the Board of Directors of said Company, and said Resolutions remain in full force and effect: RESOLVED: That the President or any Vice President, in conjunction with any Vice President, be and they hereby are authorized and empowered to appoint Attorneys-in-fact of the Company,in its name and as it acts,to execute and acknowledge for and on its behalf as surety, any and all bonds,recognizances,contracts of indemnity,waivers of citation and all other writings obligatory in the nature thereof,with power to attach thereto the seal of the Company.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 in their own proper persons. RESOLVED:That any and all Powers of Attorney and Certified Copies of such Powers of Attorney and certification in respect thereto,granted and executed by the President or Vice President in conjunction with any Vice President of the Company.shall be binding on the Company to the same extent as if all signatures therein were manually affixed,even though one or more of any such signatures thereon may be facsimile. (Adopted October 7, 1981 —The Hanover Insurance Company;Adopted April 14, 1982—Massachusetts Bay Insurance Company;Adopted September 7,2001 —Citizens Insurance Company of America) IN WITNESS WHEREOF,THE HANOVER INSURANCE COMPANY,MASSACHUSETTS BAY INSURANCE COMPANY and CITIZENS INSURANCE COMPANY OF AMERICA have caused these presents to be sealed with their respective corporate seals,duly attested by two Vice Presidents, this 30`h day of January,2017. The Hanover Insurance Company The Hanover Insurance Company Massachusetts Bay Insulrance Company Massachusetts Bay Insurance Company Citizens Insurance Company of America C (ice V+ '914°4 Citizens Insurance Company of America 1874 John C Re the,EVP and President '•'.*.5' JamesH.Rawiecki,Vice President THE COMMONWEALTH OF MASSACHUSETTS COUNTY OF WORCESTER )ss. On this 30th day of January, 2017 before me came the above named Vice Presidents of The Hanover Insurance Company, Massachusetts Bay Insurance Company and Citizens Insurance Company of America,to me personally known to be the individuals and officers described herein,and acknowledged that the seals affixed to the preceding instrument are the corporate seals of The Hanover Insurance Company, Massachusetts Bay Insurance Company and Citizens Insurance Company of America,respectively,and that the said corporate seals and their signatures as officers were duly affixed and subscribed to said instrument by the authority and direction of said Corporations. • r •r �'� •• •. Diane J.. u.himary Puhlic My Commission Expires March4.2022 I,the undersigned Vice President of The Hanover Insurance Company,Massachusetts Bay Insurance Company and Citize ' I�� Company of America,hereby certify that the above and foregoing is a full,true and correct copy of the Original Power ofA�t�b /4SE • • 4,by said Companies, and do hereby further certify that the said Powers of Attorney are still in force and effect. � e • p O Rq r. :r Q 4z• F • GIVEN under my hand and the seals of said Companies, at Worcester, Massachusetts,this 31st day of December'261.7' •0 _ 97 w . CERTIFIED COPY /� �� cr4`4:, 5r h Theodor G.Martinez,Vice 'kAMP. T%� ♦ff�11{illlilA'44,61♦