HomeMy WebLinkAboutWisconsin Technology Networking 2018 FEE: $20.00
ACCOUNT# 100-0050-4972-00000
ANNUAL EXCAVATION/WORK IN THE RIGHT-OF-WAY LICENSE S
Application is made for a license to work within the Right-of-Way:
IIU NAME: l5Co �St r l6m0\003 c inType of organization:
J individual partnership
`F corporation
ADDRESS: It (in 1\01/4)1/4JVC)t;-,5- Cx
State of Incorporation la yV
2.00
1\JgLUpCi r-k- P5ers.eir G IAS ct�LQ(10
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: \t-31— I RECEIVED
BOND TERM: l 3t 1`?3 JAN S 5 2018
II ( 1 CITY CLERICS OFFICEINSURANCE TERM: 1\ -\ I 1
DATE: '"'" 5�l
Applicant's Signature �fz'� �tL��ElL
Telephone Number
Annual Work in the Right-of-Way License
4/19/05
ANNUAL EXCAVATION/WORK IN RIGHT-OF-WAY BOND• Bond No. 1849568
PRINCIPAL Type of organization:
Wisconsin Technology Networking, LLC individual partnership
660 Newport Center Drive, Suite 200
Newport Beach, CA 92660 _corporation
State of Incorporation
Surety
The Hanover Insurance Company
440 Lincoln Street
Worcester, MA 01653
Penal Sum of Bond: $5000.00
OBLIGATION:
We, Wisconsin Technology Networking. LLC, the Principal and The Hanover Insurance Company, Surety, 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 and Surety 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 31st, 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 Principal : For the Su ety:
Wisconsin Techn y Networking, LLC T e Ha ve e Company
Name re,9 t M Name aniell ckabay
Vice Pres i�en+, Con-{-re- f)fy-- Attorne -ir-Fact
Title Title
4 Lincoln Street, Worcester, MA 01653
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.
ACKNOWLEDGMENT
A notary public or other officer completing this
certificate verifies only the identity of the individual
who signed the document to which this certificate is
attached, and not the truthfulness, accuracy, or
validity of that document.
State of California
County of Orange
On December 31, 2017 before me, Melissa Ann Williams, Notary Public
(insert name and title of the officer)
personally appeared Greg Lawson
who proved to me on the basis of satisfactory evidence to be the person(s)whose name(s) is/ace(
subscribed to the within instrument and acknowledged to me that he/UttOltiVy executed the same in
his/Ixeid.their authorized capacity(iea(), and that by his/bitxhtkeir signature(s) on the instrument the
person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing
paragraph is true and correct.
MELISSA ANN WILLIAMS
'411. Commission +r 2133409
WITNESS my hand and official seal. •.; ?� Notary Public California
I It/ Orange County
M Comm. Ex ires Nov 9,2019
Signatu (,Seal)
ACKNOWLEDGMENT
A notary public or other officer completing this
certificate verifies only the identity of the individual
who signed the document to which this certificate is
attached, and not the truthfulness, accuracy, or
validity of that document.
State of California
County of Orange
On December 31st, 2017 before me, Karen L. Ritto, Notary Public
(insert name and title of the officer)
personally appeared Daniel Huckabay
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/abet
subscribed to the within instrument and acknowledged to me that he/ttednyexecuted the same in
hishbeottbeisauthorized capacity(kss), and that by his/keec eissignature(s) on the instrument the
person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing
paragraph is true and correct.
KAREN L.RITTO
WITNESS my hand and official seal. COMM.#2138527 el
o.,4.
•"-Ak.. Notary Public-California ce
- x I ORANGE COUNTY
My Comm.Expires Dec 30,2019 c
Signature OC\
(Seal)
Karen L. Ritto
Bond No. 1849568
• II
THE HANOVER INSURANCE COMPANY
MASSACHUSETTS BAY INSURANCE COMPANY
CITIZENS INSURANCE COMPANY OF AMERICA
POWER OF ATTORNEY
THIS Power of Attorney limits the acts of those named herein,and they have no authority to bind the Company except in
the manner and to the extent herein stated.
KNOW ALL PERSONS BY THESE PRESENTS:
That THE HANOVER INSURANCE COMPANY and MASSACHUSETTS BAY INSURANCE COMPANY, both being corporations
organized and existing under the laws of the State of New Hampshire, and CITIZENS INSURANCE COMPANY OF AMERICA, a
corporation organized and existing under the laws of the State of Michigan,(hereinafter individually and collectively the"Company")does
hereby constitute and appoint,
Daniel Huckabay,Arturo Ayala, Dwight Reilly, Drew Ebright,Andrew Waterbury, Michael Castaneda and/or Shaunna
Rozelle Ostrom
Of Commercial Surety Bond&Insurance Agency Inc.,of Orange,CA each individually, if there be more than one named,as its true
and lawful attorney(s)-in-fact to sign, execute, seal, acknowledge and deliver for, and on its behalf, and as its act and deed any place
within the United States,any and all surety bonds,recognizances, undertakings,or other surety obligations.The execution of such surety
bonds, recognizances, undertakings or surety obligations, in pursuance of these presents, shall be as binding upon the Company as if
they had been duly signed by the president and attested by the secretary of the Company, in their own proper persons. Provided
however,that this power of attorney limits the acts of those named herein;and they have no authority to bind the Company except in the
manner stated and to the extent of any limitation stated below:
Any such obligations in the United States, not to exceed Twenty Five Million and No/100($25,000,000) in any single
instance
That this power is made and executed pursuant to the authority of the following Resolutions passed by the Board of Directors of said
Company, and said Resolutions remain in full force and effect:
RESOLVED: That the President or any Vice President, in conjunction with any Vice President, be and they hereby are authorized and
empowered to appoint Attorneys-in-fact of the Company,in its name and as it acts,to execute and acknowledge for and on its behalf as surety,
any and all bonds,recognizances,contracts of indemnity,waivers of citation and all other writings obligatory in the nature thereof,with power to
attach thereto the seal of the Company.Any such writings so executed by such Attorneys-in-fact shall be binding upon the Company as if they
had been duly executed and acknowledged by the regularly elected officers of the Company in their own proper persons.
RESOLVED:That any and all Powers of Attorney and Certified Copies of such Powers of Attorney and certification in respect thereto,granted
and executed by the President or Vice President in conjunction with any Vice President of the Company,shall be binding on the Company to the
same extent as if all signatures therein were manually affixed,even though one or more of any such signatures thereon may be facsimile.
(Adopted October 7, 1981 —The Hanover Insurance Company;Adopted April 14, 1982—Massachusetts Bay Insurance Company;Adopted
September 7,2001 —Citizens Insurance Company of America)
IN WITNESS WHEREOF,THE HANOVER INSURANCE COMPANY,MASSACHUSETTS BAY INSURANCE COMPANY and CITIZENS
INSURANCE COMPANY OF AMERICA have caused these presents to be sealed with their respective corporate seals,duly attested by
two Vice Presidents, this 30th day of November, 2016.
THE HANOVER INSURANCE COMPANY
M MASSACHUSETTS BAYINSURANCE COMP
® Sliti rs. �a CITIZENS SURANCE COMPANY OF AMERICA
% 1 :';'....j
ANY
S� Robert Thomas.V:e Pr.,a Jeer.
THE HANOVER INSURANCE COMPANY
MA SA HUSETT SAY I RA CE COMPANY
CIT EN I ISUR CE OF AMERICA
THE COMMONWEALTH OF MASSACHUSETTS )
COUNTY OF WORCESTER )ss. _I ^ I e N/I • es nt
On this 30th day of November, 2016 before me came the above named Vice Presidents f The Hanover Insurance Company,
Massachusetts Bay Insurance Company and Citizens Insurance Company of America,to me personally known to be the individuals and
officers described herein,and acknowledged that the seals affixed to the preceding instrument are the corporate seals of The Hanover
Insurance Company, Massachusetts Bay Insurance Company and Citizens Insurance Company of America, respectively, and that the
said corporate seals and their signatures as officers were duly affixed and subscribed to said instrument by the authority and direction of
said Corporations.
- DIANE J. MANINO '
1 l.. . Naen hleMeco
(1 __li _
I �_� WY c .e belerell t+�... Diane,.. a ,.V«3r}Public
Meer ' _ - My Commrasion Expires Munch 4.2O22
I,the undersigned Vice President of The Hanover Insurance Company,Massachusetts Bay Insurance Company and Citizens Insurance
Company of America, hereby certify that the above and foregoing is a full,true and correct copy of the Original Power of Attorney issued
by said Companies, and do hereby further certify that the said Powers of Attorney are still in force and effect.
GIVEN under my hand and the seals of said Companies, at Worcester, Massachusetts, this 31 St day of December, 2017
CERTIFIED COPY
or
` Theodore G.Martinez Vice President,
C-