HomeMy WebLinkAboutMeade Electric Company Inc 2018 FEE: $20.00
ACCOUNT# 100-0050-4972-00000
\6)ANNUAL EXCAVATION/WORK IN THE RIGHT-OF-WAY LICENSE
Application is made for a license to work within the Right-of-Way:
NAME: Heyer Se(v l el S, L Type of organization:
individual partnership
V I 1 L j corporation
ADDRESS: 1 10O`T 1 ' &.( U I au Dr State of Incorporation W
6reen1/ 1lL0 1 WI 5L01-0-
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: I l t011`b
EXPIRATION: l 2( 31 I l $ 1
\ /
BOND TERM: l \-( r• RECEIVED
INSURANCE TERM: L y r - 5120I l 1 ZOI18 FLAN 25 2018
DATE: I `�1 I CITY CLERKS OFFICE
J6UA A
Applicant's Signa re
q'20-73 /9 /
Telephone Number
Annual Work in the Right-of-Way License
4/19/05
• ANNUAL EXCAVATION/WORK IN RIGHT-OF-WAY BOND
PRINCIPAL(S) (Legal name(s) and business address(es)) Type of organization:
Meyer Services Inc. individual partnership
N1004 Tower View Dr ✓ corporation
Greenville,WI 54942
State of Incorporation WI
Surety(ies) (Names(s) and business address(es))
West Bend Mutual Insurance Company
PO Box 620976
Middleton.WI 53562
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 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 employ-
ment 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, 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 ttpcipal: For th Surety: Wet e d Mutual Insurance Company
Name Name
A're_sItlf,Nt Attorney-in-fact
Title Title
PO Box 620976 Middleton, WI 53562
Address
Any person signing in a representative capacity (e.g., an attorney-in-fact) must furnish evidence of authority if that repre-
sentative is not a member of the firm or partnership or an officer of the corporation involved.
Annual Excavation/Work in the Right-of-Way
04/15/05
WEST BEND THE SILVER LINING
A MUTUAL INSURANCE COMPANY
Bond No. 0845034
POWER OF ATTORNEY
Know all men by these Presents, That West Bend Mutual Insurance Company, a corporation having its principal office in the City of West
Bend, Wisconsin does make,constitute and appoint:
SHEILA M FENOLIO
lawful Attorney(s)-in-fact, to make,execute, seal and deliver for and on its behalf as surety and as its act and deed any and all bonds,
undertakings and contracts of suretyship, provided that no bond or undertaking or contract of suretyship executed under this authority
shall exceed in amount the sum of: Five Thousand Dollars ($5,000.00)
This Power of Attorney is granted and is signed and sealed by facsimile under and by the authority of the following Resolution adopted
by the Board of Directors of West Bend Mutual Insurance Company at a meeting duly called and held on the 21st day of December,
1999.
Appointment of Attorney-In-Fact. The president or any vice president,or any other officer of West Bend Mutual Insurance
Company may appoint by written certificate Attorneys-In-Fact to act on behalf of the company in the execution of and attesting of
bonds and undertakings and other written obligatory instruments of like nature. The signature of any officer authorized hereby
and the corporate seal may be affixed by facsimile to any such power of attorney or to any certificate relating therefore and any
such power of attorney or certificate bearing such facsimile signatures or facsimile seal shall be valid and binding upon the
company,and any such power so executed and certified by facsimile signatures and facsimile seal shall be valid and binding upon
the company in the future with respect to any bond or undertaking or other writing obligatory in nature to which it is attached.
Any such appointment may be revoked,for cause,or without cause, by any said officer at any time.
In witness whereof,the West Bend Mutual Insurance Company has caused these presents to be signed by its president undersigned
and its corporate seal to be hereto duly attested by its secretary this 22nd day of Se, tember, 2017.
Attest r
�vubt lux C. ' Altai- '" a. -U-
Christopher C. Z Bart ; GpRPORATF S. Kevin A. Steiner
Secretary Chief Executive Officer/President
State of Wisconsin
County of Washington
On the 22nd day of September, 2017, before me personally came Kevin A. Steiner, to me known being by duly sworn, did depose and
say that he resides in the County of Washington, State of Wisconsin; that he is the President of West Bend Mutual Insurance Company,
the corporation described in and which executed the above instrument; that he knows the seal of the said corporation;that the seal
affixed to said instrument is such corporate seal; that is was so affixed by order of the board of directors of said corporation and that he
signed his name thereto by like order. J• • BENG FO
NOTAgy• Juli A nedum
•,n,,'..PUSUG .. = Senior orporate Attorney
mil•......... �:
'•••FOF w s�°�' Notary Public,Washington Co.,WI
My Commission is Permanent
The undersigned, duly elected to the office stated below, now the incumbent in West Bend Mutual Insurance Company, a Wisconsin
corporation authorized to make this certificate, Do Hereby Certify that the foregoing attached Power of Attorney remains in full force
effect and has not been revoked and that the Resolution of the Board of Directors, set forth in the Power of Attorney is now in force.
Signed and sealed at West Bend, Wisconsin this\ate day of OS\vpA ,7_Aa\'b .
:774fea.. 0,9u4,0---.
- Heather Dunn
'�'� ~ Vice President—Chief Financial Officer
Notice: Any questions concerning this Power of Attorney may be directed to the Bond Manager at NSI, a division of West Bend
Mutual Insurance Company.
1900 S. 18"1" Ave. West Bend,\ 'I 53095 I ph (262) 334-6430 I 1-800-236-5004 I fax (262) 338-5058 I www.thesilverlining.com
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: V�J�
NAME: Meade Electric Company Inc. Type of organization:
individual partnership
xx corporation
9550 W 55th Street, Suite A
ADDRESS: State of Incorporation Illinois
McCook, Illinois 60525
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 "r -1 (-)J
EXPIRATION: \I-3\ `U r RECEIVED
BOND TERM: LI. `— lc& MAR 2 8. 2;
81
INSURANCE TERM: `� C�Sq31 CITY CLERK'S OFFICE
DAT- 2 0/18
Applicant's Signature
708-588-2500
Telephone Number
Annual Work in the Right-of-Way License
4/19/05
ANNUAL EXCAVATION/WORK IN RIGHT-OF-WAY BOND
Bond #8244-44-69
PRINCIPAL(S)(Legal name(s) and business address(es)) Type of organization:
Meade Electric Co., Inc. individual partnership
9550 W. 55' St. x corporation
McCook, IL 60525
Surety(ies) (Name(s) and business address(es)) State of Incorporation
Federal Insurance Company Illinois
15 Mountainview Road
Warren, NJ 07059
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 Sure C ///4� 1//f�
Mauree C. McDonald �L'fl/
Name • / Name
c Attorney-in-fact
Title Title
111 W. Jackson#1134, Chicago, IL 60604
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
STATE OF: ILLINOIS
COUNTY OF: COOK
On this 30'h day of October, 2017, before me personally appeared Brian T. McManus to
me known, who, being duly sworn, did depose and say: that she resides at Illinois that she is the
Attorney-in-Fact of Federal Insurance Company, the corporation described in and
which executed the annexed instrument; that she knows the corporate seal of said corporation; that the
seal affixed to said instrument is such corporate seal; that it was so affixed by order of the Board of
Directors of said corporation; that she signed her name thereto by like order; and that the liabilities of
said corporation do not exceed its assets as ascertained in the manner provided by law.
OFFICIAL SEAL ��►
MAUREEN CASEY MCDONALD 1/1,-(1-i-a6/ �I`4'`
NOTARY PUBLIC,STATE OF IWNOIS Notary Public in and for the above County and State
MY COMMISSION EXPIRES 08/07/2019
My commission expires: �� 7tgal�/'
•
Chubb POWER Federal Insurance Company Attn: Surety Department COF Vigilant Insurance Company 15 Mountain View Road
Surety ATTORNEY Pacific Indemnity Company Warren, NJ 07059
oHuss
Know All by These Presents, That FEDERAL INSURANCE COMPANY, an Indiana corporation, VIGILANT INSURANCE
COMPANY, a New York corporation, and PACIFIC INDEMNITY COMPANY, a Wisconsin corporation, do each hereby constitute and
appoint Maureen C McDonald and Brian T McManus of Chicago, Illinois
each as their true and lawful Attorney-in-Fact to execute under such designation In their names and to affix their corporate seals to and deliver for and on their behalf as surety
thereon or otherwise,bonds and undertakings and other writings obligatory in the nature thereof(other than bail bonds)given or executed in the course of business, and any
instruments amending or altering the same,and consents to the modification or alteration of any instrument referred to in said bonds or obligations.
In Witness Whereof,said FEDERAL INSURANCE COMPPNY,VIGILANT INSURANCE COMPANY,and PACIFIC INDEMNITY COMPANY have each executed and attested
these presents and affixed their corporate seals on this 31s day of March, 2016.
,,ee.........___
r
Dawn M.Chloros,Assistant Secretary :•vid B.Norris,Jr.,Vice Pre .••nt
(*) '100 ,J.)).)
1. 1 ..* API
STATE OF NEW JERSEY
ss.
County of Somerset
On this 31st day of March, 2016 before me,a Notary Public of New Jersey,personally came Dawn M.Chloros,to me known to be Assistant Secretary of FEDERAL
INSURANCE COMPANY,VIGILANT INSURANCE COMPANY,and PACIFIC INDEMNITY COMPANY,the companies which executed the foregoing Power of Attorney,and the
said Dawn M. Chloros, being by me duly sworn, did depose and say that she is Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE
COMPANY,and PACIFIC INDEMNITY COMPANY and knows the corporate seals thereof,that the seals affixed to the foregoing Power of Attorney are such corporate seals
and were thereto affixed by authority of the By-Laws of said Companies;and that she signed said Power of Attorney as Assistant Secretary of said Companies by like authority;
and that she is acquainted with David B. Norris,Jr.,and knows him to be Vice President of said Companies;and that the signature of David B.Norris,Jr.,subscribed to said
Power of Attorney is in the genuine handwriting of David B.Norris,Jr.,and was thereto subscribed by authority of said By-Laws and in deponent's presence.
Notarial Seal --,.z
1
(wiA .R), NOTARY PNBLCOFNo. gWJERSEY ��/J//` (/L
PUBLIC Commission Expires July 18,2019 Notary Public
y�'JERs, CERTIFICATION
Extract from the By-Laws of FEDERAL INSURANCE COMPANY,VIGILANT INSURANCE COMPANY,and PACIFIC INDEMNITY COMPANY:
'Except as otherwise provided in these By-Laws or try law or as otherwise directed by the Board of Directors,the President or any Vice President shall be authorized to
execute and deliver,in the name and on behalf of the Corporation,all agreements,bonds,contracts,deeds,mortgages,and other instruments,either for the Corporation's
own account or in a fiduciary or other capacity,and the seal of the Corporation,if appropriate,shall be affixed thereto by any of such officers or the Secretary or an Assistant
Secretary. The Board of Directors,the President or any Vice President designated by the Board of Directors may authorize any other officer,employee or agent to execute
and deliver, in the name and on behalf of the Corporation, agreements, bonds, contracts, deeds, mortgages, and other instruments, either for the Corporation's own
account or in a fiduciary or other capacity,and,if appropriate,to affix the seal of the Corporation thereto. The grant of such authority by the Board or any such officer may
be general or confined to specific instances.°
I,Dawn M.Chloros,Assistant Secretary of FEDERAL INSURANCE COMPANY,VIGILANT INSURANCE COMPANY,and PACIFIC INDEMNITY COMPANY(the'Companies')
do hereby certify that
(i) the foregoing extract of the By-Laws of the Companies is true and correct,
(ii) the Companies are duly licensed and authorized to transact surety business in all 50 of the United States of America and the District of Columbia and are
authorized by the U.S.Treasury Department;further,Federal and Vigilant are licensed in the U.S.Virgin Islands,and Federal is licensed in Guam,Puerto
Rico,and each of the Provinces of Canada except Prince Edward Island;and
(iii) the foregoing Power of Attorney is true,correct and in full force and effect.
Given under my hand and seals of said Companies at Warren,NJ this
3/4400. tó� -_=.
au,
Dawn M.Chloros,Assistant Secr tary
IN THE EVENT YOU WISH TO NOTIFY US OF A CLAIM,VERIFY THE AUTHENTICITY OF THIS BOND OR NOTIFY US OF ANY OTHER MATTER,PLEASE CONTACT US AT ADDRESS
LISTED ABOVE,OR BY Telephone(908)903-3493 Fax(908)903-3656 oanaii: surety@tchubb.com
Form 15-10.0225B-U GEN CONSENT(rev.07-15)