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HomeMy WebLinkAboutWisconsin Independent Network LLC 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: Wisconsin Independent Network, LLC Type of organization: individual _partnership corporation ADDRESS: 800 Wisconsin St, Building 2, Ste. 219, MB 107 State of Incorporation LU l Eau Claire, WI 54703 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: a I • le EXPIRATION: ' L BOND TERM: L 2 ' ' U 1 j INSURANCE TERM: ' t ' t FEB 1 3 2018 2, 1 i CITY C t)i ICL DATE: l Applicant's Signature (920) 376-2996 Telephone Number Annual Work in the Right-of-Way License 4/19/05 ANNUAL EXCAVATION/WORK IN RIGHT-OF-WAY BOND—#91 BSBHU9795 PRINCIPAL Type of organization: Wisconsin Independent Network, LLC individual partnership 800 Wisconsin Street, Bdg D2, Suite 219, MB#107 Eau Claire, WI 54703 _corporation Surety State of Incorporation Hartford Fire Insurance Company One Hartford Plaza Hartford, CT 06155 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 January 1,2018 to December 31,2018.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 : Wisc sin Independent Network LLC For the Surety: Hartford Fire Insurance Company ttmAt Name SCOTT 1 n Name—Robert L. R ynoldson Title «-0 Title—Attorney in Fact 1128 Lincoln Mall, Suite 200, Lincoln, NE 68508 Any person signing in a representative capacity(e.g.,an attorney-in-fact)must furnish evidence of auth:,rity:f 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 Direct Inquiries/Claims to: POWER OF ATTORNEY THE HARTFORD Bond T-12 One Hartford Plaza Hartford,Connecticut 06155 email:bond.claims@thehartford.com call:888-266-3488 I fax:860-757-5835 KNOW ALL PERSONS BY THESE PRESENTS THAT: Aaencv Code: 91-913 54 0 I Hartford Fire Insurance Company,a corporation duly organized under the laws of the State of Connecticut l 1 Hartford Casualty Insurance Company,a corporation duly organized under the laws of the State of Indiana X Hartford Accident and Indemnity Company,a corporation duly organized under the laws of the State of Connecticut r--i Hartford Underwriters Insurance Company,a corporation duly organized under the laws of the State of Connecticut F-1 Twin City Fire Insurance Company,a corporation duly organized under the laws of the State of Indiana Hartford Insurance Company of Illinois,a corporation duly organized under the laws of the State of Illinois Hartford Insurance Company of the Midwest,a corporation duly organized under the laws of the State of Indiana Hartford Insurance Company of the Southeast,a corporation duly organized under the laws of the State of Florida having their home office in Hartford, Connecticut(hereinafter collectively referred to as the"Companies")do hereby make, constitute and appoint, up to the amount of Unlimited • Robert L. Reynoldson, Mary E . Kent, Richard C. Stoakes, J. Scott Nelson, Tracy Abbott of LINCOLN, Nebraska their true and lawful Attorney(s)-in-Fact,each in their separate capacity if more than one is named above,to sign its name as surety(ies)only as delineated above by®,and to execute,seal and acknowledge any and all bonds,undertakings,contracts and other written instruments in the nature thereof,on behalf of the Companies in their business of guaranteeing the fidelity of persons,guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. In Witness Whereof, and as authorized by a Resolution of the Board of Directors of the Companies on August 1, 2009, the Companies have caused these presents to be signed by its Vice President and its corporate seals to be hereto affixed, duly attested by its Assistant Secretary. Further, pursuant to Resolution of the Board of Directors of the Companies, the Companies hereby unambiguously affirm that they are and will be bound by any mechanically applied signatures applied to this Power of Attorney. :\ 'g . 4�n�, eau...... ---. .) ,:."-r'.. .. Z olori uk /p i.K -I4 1(s.. eZr el, _ t # . -{ iyr . ...`ff 4, .) --(i4k YADT John Gray,Assistant Secretary M. Ross Fisher, Vice President STATE OF CONNECTICUT ss. Hartford COUNTY OF HARTFORD On this 12th day of July, 2012, before me personally came M. Ross Fisher,to me known,who being by me duly sworn,did depose and say:that he resides in the County of Hartford,State of Connecticut;that he is the Vice President of the Companies,the corporations described in and which executed the above instrument;that he knows the seals of the said corporations;that the seals affixed to the said instrument are such corporate seals;that they were so affixed by authority of the Boards of Directors of said corporations and that he signed his name thereto by like authority. .ems'' Y • . Kathleen T.Maynard CERTIFICATE Notary Public My Commission Expires July 31,2016 I,the undersigned,Vice President of the Companies,DO HEREBY CERTIFY that the above and foregoing is a true and correct copy of the Power of Attorney executed by said Companies,which is still in full force effective as of January 1, 2018 Signed and sealed at the City of Hartford. 6 .., .0""4,,, -.1--7-•,-, -, .) , , -,,a.: 7,, 4.1 ,..7 = z.- = : ff,E0'(..-. .. it !-----. is- 1 chit."` Kevin Heckman,Assistant Vice President POA 2012