HomeMy WebLinkAboutNovak Excavating 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: rN O V ec k Cpqija ,�` l,,c . Type of organization:
r.G
�/ individual partnership
)(corporation
ADDRESS: P.c, 6ox .3 Pi S LS �sn S t, State of Incorporation W1-
'F`��', 1..i r S`l 971
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 whic may be
obtained from the Public Works Department.
REC ' IVED
DATE ISSUED: i)/Ji/i 7
JAN 16 2018
EXPIRATION: 0/3/ 1 / F
CITY CLERK'S OFFICE
BOND TERM: / 2 rwror iy
INSURANCE TERM:
DATE: v - 1
icant's i ature
”61- /0-1.s/,2-
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:
Novak Excavating Inc individual partnership
PO Box 389 ✓ corporation
Ripon,WI 54971
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 December31,2017 (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 the r cipal: 1 74heSu?)
% Ikedest end Mutual Insurance Company
a Name
/ Attorney-in-fact
itle 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
04/15/0 5