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HomeMy WebLinkAboutKoch's Telecommunications Service Inc 2018 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: iiOCAti.S I PIP.r` mmuniaakic 3 5enIty T•{ e . Type of organization: individual partnership 'corporation ADDRESS: y 11 I b G(it-C4-} State of Incorporation C„ fit1Sak lei 53031 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: /3 I / 0 n EXPIRATION: t3 1 .3 I /atO 1� BOND TERM: 9eCtr INSURANCE TERM: j0 /I l aC) DATE: - 090 " 1 Applijnt's Signature 9)0 - ?y9_ 3837 Telephone Number /P Annual Work in the Right-of-Way License '' 4/19/05 NOV l 7 201? CITY CLERK'S 424FriCE • *** OLD REPUBLIC SURETY COMPANY ***** POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS:That OLD REPUBLIC SURETY COMPANY,a Wisconsin stock insurance corporation,does make,constitute and appoint: Roberta S. Witherow of Brookfield, WI its true and lawful Attorney(s)-in-Fact, with full power and authority, not exceeding $10,000,000, for and on behalf of the company as surety. to execute and deliver and affix the seal of the company thereto (if a seal is required), bonds, undertakings, recognizances or other written obligations in the nature thereof, (other than bail bonds, bank depository bonds, mortgage deficiency bonds, mortgage guaranty bonds, guarantees of installment paper and note guaranty bonds, self-insurance workers compensation bonds guaranteeing payment of benefits, asbestos abatement contract bonds, waste management bonds,hazardous waste remediation bonds or black lung bonds),as follows: Effective Date: 12/31/2017 12:00:00 AM Bond Number:W150268511 Bond Amount: Five Thousand Dollars $5,000.00 Principal Name: Koch's Telecommunications Service, Inc. Obligee Name: City of Oshkosh of Oshkosh,WI and to bind OLD REPUBLIC SURETY COMPANY thereby. and all of the acts of said Attorneys-in-Fact, pursuant to these presents, are ratified and confirmed. This appointment is made under and by authority of the board of directors at a special meeting held on February 18, 1982. This Power of Attorney is signed and sealed by facsimile under and by the authority of the following resolutions adopted by GLe board of directors of the OLD REPUBLIC SURETY COMPANY on February 18.1982. RESOLVED that the president, any vice president or assistant vice president, in conjunction with the secretary or any assistant secretary, may appoint attorneys-in-fact or agents with authority as defined or limited in the instrument evidencing the appointment in each case,for and on behalf of the company to execute and deliver and affix the seal of the company to bonds, undertakings, recognizances, and suretyship obligations of all kinds; and said officers may remove any such attorney-in-fact or agent and revoke any Power of Attorney previously granted to such person. RESOLVED FURTHER that any bond,undertaking,recognizance.or suretyship obligation shall be valid and binding upon the Company (i) when signed by the president, any vice president or assistant vice president, and attested and sealed (if a seal be required) by any secretary or assistant secretary;or (ii) when signed by the president, any vice president or assistant vice president,secretary or assistant secretary,and countersigned and sealed (if a seal be required)by a duly authorized attorney-in-fact or agent;or (iii) when duly executed and sealed (if a seal be required) by one or more attorneys-in-fact or agents pursuant to and within the limits of the authority evidenced by the Power of Attorney issued by the company to such person or persons. RESOLVED FURTHER that the signature of any authorized officer and the seal of the company may be affixed by facsimile to any Power of Attorney or certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance,or other suretyship obligations of the company, and such signature and seal when so used shall have the same force and effect as though manually affixed. IN WITNESS WHEREOF, OLD REPUBLIC SURETY COMPANY has caused these presents to be signed by its proper officer,and its corporate seal to be affixed this 28th day of September 2017 sJ� suRer,, OLD REPUBLIC SUR TY COMPANY a� W co�ro,�r� �� z9 SEAL a i nt 1861 Assistant Secretary - President STATE OF WISCONSIN,COUNTY OF WAUKESHA-SS On this 28th day of September 2n17 ,personally came before me, Alan Pavlic and Jane E. Cherney ,to me known to be the individuals and officers of the OLD REPUBLIC SURETY COMPANY who executed the above instrument, and they each acknowledged the execution of the same, and being by me duly sworn, did severally depose and say that they are the said officers of the corporation aforesaid,and that the seal affixed to the above instrument is the seal of the corporation, and that said corporate seal and their signatures as such officers were duly affixed and subscribed to the said instrument by the authority of the board of directors of said corporation. :(4,olAAyv fin/ XelYVVOw'y(A 1 Notary Public My Commission Expires- 09/28/2018 CERTIFICATE (Expiration of notary's commission does not invalidate this instrument) I, the undersigned. assistant secretary of the OLD REPUBLIC SURETY COMPANY, a Wisconsin corporation, CERTIFY that the foregoing and attached Power of Attorney remains in full force and has not been revoked; and furthermore, that the Resolutions of the board of directors set forth in the Power of Attorney,are now in force. 0244544 °°wir"' ' '. 'J''" r�\`-1 s" 28th September 2017 ;= Signed and sealed at the City of Brookfield,WI this day of p ORSC 22262(3-06) i°'A"``\"` Assistant Secretary THE BREHMER AGENCY, INC