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HomeMy WebLinkAboutNortheast Asphalt 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: !I NAME: ortheo,s.t ha(-b, Inc . Type of organization: individual partnership r , Qr� .^'1 I�� )( corporation ADDRESS: W�3 0 O ��I Y1 LN State of incorporation Gcnvi(L ) l9 91./a 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 /r Works Department. l�c DATE ISSUED: l(Q EXPIRATION: g,) I Q.01 F BOND TERM: Li2ILQ Zo\t- INSURANCE TERM: 3111 ot01Y — 3I 11a otej DATE: CoICo/zot�3 Applicant's Signature s- - Telephone Number Annual Work in the Right-of-Way License ��--_ 4/19/05 __. :. », JUN p 8:2( 0g C7TY CL�RI{' h�.lc I, • f • ANNUAL EXCAVATION/WORK IN RIGHT-OF-WAY BOND Bond No. 30038759 PRINCIPAL(S)(Legal name(s) and business address(es)) Type of organization: ' NORTHEAST ASPHALT, INC. individual partners V i s v 4 W6380 Design Drive x corporation Greenville,WI 54942 State of Incorporation WI Surety(ies) (Name(s) and business address(es)) WESTERN SURETY COMPANY • 151 N. 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 June 6,2018 (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 : NORTHEAST ASPHALT, INC. For the Surety: WESTER yilJR TY COMPANY Name ian C. EndG1f �T J, /te Name C1 Kelly Cody,Attorney-in-Fact Title Title 151 N.Franklin Street,Chicago, IL 60606 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 • 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 Kelly Cody, Roxanne Jensen, Christopher Hoyden, Individually of Green Bay, Wisconsin Trudy A. Szalewski, Christopher H. Kondrick, Brian Krause, Individually of Milwaukee, Wisconsin its true and lawful Attomey(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,are 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 be signed by its Vice President and its corporate seal to be hereto affixed on this 24th day of January,2018. '� Er,c �T,�rt WESTERN SURETY COMPANY 4.4i47— aul T.Bruflat,Vice President State of South Dakota JT ss County of Minnehaha On this 24th day of January,2018,before me personally came Paul T.Bruflat,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 ,, t��qq sPuBuc June 23,2021 �ir� r � oon,uwoa J.Mohr,Notary Public CERTIFICATE 1, 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 h eof is still in force. In testimony whereof I have hereunto subscribed my name and affixed the seal of the said corporation this 'I S4 day of ,c VNNi .Q( ,AID/dam. Frc WESTERN SURETY COMPANY R t _ "1;�sf A0'v L.Nelson,Assistant Secretary Form F4280-7-2012 Go to www.cnasuretv.com>Owner/Obligee Services>Validate Bond Coverage,if you want to verify bond authenticity. - ANNUAL EXCAVATION/WORK IN RIGHT-OF-WAY BOND Bond No. 30038759 PRINCIPAL(S)(Legal name(s) and business address(es)) Type of organization: NORTHEAST ASPHALT,INC. individual partnership W6380 Design Drive x corporation Greenville,WI 54942 State of Incorporation WI Surety(ies) (Name(s) and business address(es)) WESTERN SURETY COMPANY 151 N. 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: June 6,2018 of to to December 31, 20 18 (The annual This bond shall cover work performed from (DateIssuance) 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 : NORTHEAST ASPHALT, INC. For the Surety: WESTE R TY COMPANY Nam Nameen'ari C. e(J1 Ac9ent tt22 Kelly Cody,Attorney-i -Fact Title Title 151 N. Franklin Street,Chicago, IL 60606 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 • 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 Kelly Cody, Roxanne Jensen, Christopher Hoyden, Individually of Green Bay, Wisconsin Trudy A. Szalewski, Christopher H. Kondrick, Brian Krause, Individually of Milwaukee, Wisconsin 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 hind 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,are 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 be signed by its Vice President and its corporate seal to be hereto affixed on this 24th day of January,2018. .,,,-... WESTERN SURETY COMPANY �SNR..... _.V4 ram:=. T.Brullat.Vice Presidcm State of South Dakota JT ss County of Minnehaha On this 24th day of January,2018,before me personally came Paul T. Bruflat,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 he the act and deed of said corporation. My commission expires J.MOHR NOTARY waoc , -���� June 23.2021 � rsoun+oA�coTA� 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 h cof islstill in force. In testimony whereof I have hereunto subscribed my name and affixed the seal of the said corporation this I 54 day of Wei t/h r , ! /P. as""..E.....oy WESTERN SURETY COMPANY=W; :=i y0f'!ti oa •µ°1�" L.Nelson,Assistant Secretary Form F4280-7-20I2 Go to www.cnasurety.com>Owner/Obligee Services>Validate Bond Coverage, if you want to verify bond authenticity.