HomeMy WebLinkAboutHoltger Bros Inc. 2018 FEE: $20.00 VV.
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: C(-
Type of organization:
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NAME: Holtger Bros., Inc. YP individual s ership 2008
_X_corporation NIR
OVVICE
ADDRESS: 950 West Main Ave State of Incorporation_WI Y CLE?tl�
De Pere, WI 54115
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: 12/31/17
EXPIRATION: 12/31/18
BOND TERM: 12/31/18
INSURANCE TERM: 7/1/18
DATE: "7/5 1/1
"3-41/
Applicant's Signature
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Telephone Number
Annual Work in the Right-of-Way License
4/19/05
ANNUAL EXCAVATION/WORK IN RIGHT-OF-WAY BOND
Bond No. SY27306
PRINCIPAL(S) (Legal name(s) and business address(es)) Type of organization:
Holtger Bros., Inc. individual partnership
950 W. Main Avenue
DePere,WI 54115 X corporation
Surety(ies) (Name(s) and business address(es)) State of Incorporation Wisconsin
IMT Insurance Company
4445 Corporate Drive
West Des Moines, IA 50266
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 December 31, 2017 (Date of Issuance)to December 31, 2018 (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:
Holtger Bros., Inc.
IMT Insurance Company
� !�„ Name
Name Title Cry,Attorney-in-Fact
/61je I) C O West Des Moines, I
Title 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
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INSURANCE
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POWER OF ATTORNEY No. 9 3 6 0 4
Notice: The warning found elsewhere in this Power of Attorney affects the validity thereof.Please review carefully.
Know All Persons By These Presents,that IMT Insurance Company a corporation duly organized under the laws of the State of Iowa,and having
its principal office in the City of West Des Moines,County of Polk,State of Iowa,hath made,constituted and appointed,and does by these presents
make,constitute and appoint
John Bednarz and Seth Cary
of West Des Moines and State of Iowa its true and lawful Attorney-in-Fact,with full power and
authority hereby conferred in its name,place and stead,to sign,execute,acknowledge and deliver in its behalf as surety any and all bonds,under-
takings,
r57 recognizances or other written obligations in the nature thereof,subject to the limitation that any such instrument shall not exceed the
amount of:
***********Unlimited Amount***********
and to bind IMT Insurance Company thereby as fully and to the same extent as if such bond or undertaking was signed by the duly authorized
officers of IMT Insurance Company,and all such acts of said Attorney-in-Fact,pursuant to the authority herein given,are hereby ratified and rj
confirmed. e5
This Power-of-Attorney is made and executed pursuant to and by authority of the following By-Laws adopted by the Board of
Directors of IMT Insurance Company on December 18, 1998.
ARTICLE VIII,SECTION 4.-The President or any Vice President or Secretary shall have the authority to appoint Attorneys In Fact and
to authorize them to execute on behalf of the Company,and attach thereto the Corporate Seal,bonds,undertakings,recognizances,con-
tracts
of indemnity or other obligatory writings,excluding insurance policies and endorsements.
ARTICLE VIII,SECTION 5.-The signature of any authorized officer and the Corporate Seal may be affixed by facsimile to any Power
of Attorney authorizing the execution and delivery of any of the instruments described in Article VIII,Section 4 of the By-Laws. Such Ij
facsimile signature and seal shall have the same force and effect as though manually affixed.
In Witness Whereof, IMT Insurance Company has caused these presents to be signed by its President and its corporate seal to
be hereto affixed,this 10th day of October , 2017 •
IMT Insurance Company
Sean Kenned ,President
WARNING: THIS POWER IS INVALID IF NOT PRINTED WITH RED BORDER AND RED LOGO.
STATE OF IOWA ss:
COUNTY OF POLK } S
On this 10th day of October , 2017 ,before me appeared Sean Kennedy,to me personally known,
who being by me duly sworn did say that he is President of the IMT Insurance Company,the corporation described in the foregoing instrument, Crj
15j and that the Seal affixed to the said instrument is the Corporate Seal of the said Corporation and that the said instrument was signed and sealed in
rj behalf of said Corporation by authority of its Board of Directors. rj
In Testimony Whereof,I have hereunto set my hand and affixed my Official Seal at the City of West Des Moines,Iowa,the day and year
first above written. SETH CARY
at
COMMISSION NO. 783929 �,
• ' MY COMMISSION EXPIRES Notary Public,Polk ✓•unty,Iowa
s-�- 2.010
CERTIFICATE
I,Dalene Holland,Secretary of the IMT Insurance Company do hereby certify that the above and foregoing is a true and correct copy of
the POWER-OF-ATTORNEY,executed by said the IMT Insurance Company,which is still in force and effect.
In Witness Whereof, I have hereunto set my hand and affixed the Seal of the Company on 10th day of
October , 2017 - II
WCUS/L.C4- USX • YJC-Ul aad
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Dalene Holland,Secretary
SY 06 06(O1/07)
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