Loading...
HomeMy WebLinkAboutMichels Corporation 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: M\chel s Corpo ra-h on Type of organization: individual partnership X corporation ADDRESS: S(1 a n ed- State of Incorporation @cownSU.k e / CAM. SZO36 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: EXPIRATION: BOND TERM: \7. 3I - (B INSURANCE TERM: DATE: -7' ` O ateer IA ppli•:nt's Signature aao. sg3. 32a 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: Michels Corporation individual partnership 817 West Main Street, P.O. Box 128 X corporation Brownsville,WI 53006 Surety(ies)(Name(s)and business address(es)) State of Incorporation WI Western Surety Company Bond No. 30044156 151 North Franklin Street Chicago, IL 60606 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 July 5, 2018 (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 Princi I: Michels Corporation For the urety: Western Surety Company Vc:e, / R. SJ,.4<I Kelly Bruopeman,Attorn -in-Fact Title Title �SS's7�•+7 8400 Normandale Lake Blvd, Suite 1700, Bloomington, MN 55437 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 . s Surety Acknowledgment State of Minnesota } } ss. County of Hennepin } On this 5th day of July 2018, before me personally came Kelly Bruggeman, to me known,who being by me duly sworn,did depose and say that she is the Attorney-in-Fact of Western Surety Company described in and which executed the above instrument; that she knows the seal of said corporation; that the seal affixed to said instruments is such corporate seal, that it was so affixed by order of the Board of Directors of said corporation,and that she signed her name to it by like order. y BLAKE S. BOHLIG Notary Pu is NOTARY PUBLIC-MINNESOTA Commission Number 31076680 '+oi`,0 My Comnission Evires January 31,2021 • Western Surety Company POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY-IN-FACT Know All Men By These Presents,That WESTERN SURETY COMPANY,a South Dakota corporation.is a duly organized and existing corporation having its principal office in the City of Sioux Falls.and State of South Dakota.and that it does by virtue of the signature and seal herein affixed hereby make,constitute and appoint Laurie Pflug, Jill N. Swanson, Brian D. Carpenter, Jessica Hoff, Heather R. Goedtel, Nicole Langer, Craig Olmstead, Kelly Bruggeman, Michelle Halter, Individually of Minneapolis,MN,its true and lawful Attorney(s)-in-Fact with full power and authority hereby conferred to sign,seal and execute for and on its behalf bonds,undertakings and other obligatory instruments of similar nature - In Unlimited Amounts - and to bind it thereby as fully and to the same extent as if such instruments were signed by a duly authorized officer of the corporation and all the acts of said Attorney,pursuant to the authority hereby given,arc hereby ratified and confirmed. This Power of Attorney is made and executed pursuant to and by authority of the By-Law printed on the reverse hereof,duly adopted.as indicated,by the shareholders of the corporation. In Witness Whereof, WESTERN SURETY COMPANY has caused these presents to he signed by its Vice President and its corporate seal to be hereto affixed on this 21 st day of February.2018. WESTERN SURETY COMPANY aul T.BruFlat,Vice President State of South Dakota JT ss County of Minnehaha On this 2I st day of February.2018.before me personally came Paul T.Brufat,to me known,who,being by me duly sworn,did depose and say: that he resides in the City of Sioux Falls. State of South Dakota:that he is the Vice President of WESTERN SURETY COMPANY described in and which executed the above instrument:that he knows the seal of said corporation:that the seal affixed to the said instrument is such corporate seal:that it was so affixed pursuant to authority given by the Board of Directors of said corporation and that he signed his name thereto pursuant to like authority. and acknowledges same to be the act and deed of said corporation. My commission expires .. ' J.MOHR ) June 23,2021 1Np"se r /y / ,fAvA(-./J J.Mohr.Notary Public CERTIFICATE I,L. Nelson.Assistant Secretary of WESTERN SURETY COMPANY do hereby certify that the Power of Attorney hereinabove set forth is still in force,and further certify that the By-Law of the corporation printed on the reverse hereof is still in force. In testimony whereof I have hereunto subscribed my name and affixed the seal of the said corporation this 5th day of July , 2018 WESTERN SURETY COMPANY e� .......,,.cod tiro .^;�oa4oa,r,sa L.Nelson.Assistant Secretary Form F4280-7-2012 Go to www.cnasurety.com>Owner/Obligee Services>Validate Bond Coverage,if you want to verify bond authenticity.