HomeMy WebLinkAboutAugust Winter & Sons 2018 FEE: $20.00 .3g yo
ACCOUNT# 100-0050-4972-00000
ANNUAL STREET/SIDEWALK OBSTRUCTION LICENSE
Application is made for a license to maintain street/sidewalk obstruction:
NAME: August Winter&Sons, Inc.
ADDRESS: 2323 N Roemer Rd
Appleton,WI 54911
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 for street or sidewalk obstruction.
Each individual project/address at which an obstruction will be placed requires a separate permit which may be
obtained from the office of the City Clerk.
DATE ISSUED: —\-- \CIS
EXPIRATION: 1 JI V
BOND TERM: `2' 3\ I \
INSURANCE TERM: IWILV �I
JAN 0 1 NIS
DATE: 12-26-17
A lica 's Signature
PP 9
920-739-8881
Telephone Number
Street/Sidewalk Annual Obstruction License
11-27-02
ANNUAL STREET/SIDEWALK OBSTRUCTION BOND
PRINCIPAL(S)(Legal name(s)and business address(es))
Type of organization:
August Winter& Sons, Inc. _individual partnership
2323 N. Roemer Road, PO Box 1896,Appleton, WI 54912-1896 X corporation
Surety(ies)(Name(s)and business address(es)) State of Incorporation WI
Ohio Farmers Insurance Company 735173
P.O. Box 5001, Westfield Center, OH 44251-5001 Bond#
Penal Sum of Bond: $5000.00 ( Five Thousand and no/100 Dollars )
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 placing an obstruction within street or sidewalk 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 street, sidewalk, terrace or other public area to as good a condition as it was in before excavation or
obstruction; 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 (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 Principal: For the Surety:
August Winter& Sons, Inc. Ohio Farmers Insurance Company
Name Name
By. �L� ' By: [,L//)5 �i /
Title �� z� ✓ / � Title i Swanson Attorney-in-Fact
P.O.8 x 5001
Westfield Center, OH 44251-5001
Address Surety Phone No.
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 Street/Sidewalk Obstruction bond
4/15/05
•
Surety Acknowledgement
State of Minnesota }
} ss.
County of Hennepin }
On this 13th day of December , 2017 , before me personally
came Jill N. Swanson , to me known, who, being by me duly sworn, did depose and say that he is an
attorney-in-fact of Ohio Farmers Insurance Company the corporate seal of said corporation; that the
seal affixed to the within instrument is such corporate seal, and that he signed the said instrument and
affixed the said seal as Attorney in Fact by authority of the Board of Directors of said corporation and by
authority of this office under the Standing Resolutions thereof.
Notary is
`y4 NICOLE CATHERINE LANGER
1�; ` Notary Public
( '4 : Minnesota
���:y My Commission Expires
Jan 31,2023
1 THIS POWER OF ATTORNEY SUPERCEDES ANY PREVIOUS POWER BEARING THIS SAME
POWER#AND ISSUED PRIOR TO 09/27/13, FOR ANY PERSON OR PERSONS NAMED BELOW.
POWER NO. 2263612 01
General
Power Westfield Insurance Co.
of Attorney Westfield National Insurance Co.
Ohio Farmers Insurance Co.
CERTIFIED COPY Westfield Center, Ohio
Know Ail Men by These Presents, That WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO
FARMERS INSURANCE COMPANY, corporations, hereinafter referred to Individually as a "Company" and collectively as "Companies," duly
organized and existing under the laws of the State of Ohio, and having its principal office in Westfield Center, Medina County,Ohio,do by these
presents make,constitute and appoint
DENNIS LOOTS, LAURIE PFLUG, NINA E.WERSTEIN, BRIAN D.CARPENTER, NICOLE(ANGER,CRAIG OLMSTEAD,
JESSICA HOFF, MICHELLE SYLVESTER, HEATHER R.GOEDTEL,JILL N.SWANSON, JOINTLY OR SEVERALLY
of MINNEAPOLIS and State of MN its true and lawful Attorney(s)-in-Fact,with full power and authority hereby conferred in its name,
place and stead, to execute, acknowledge and deliver any and all bonds, recognizances, undertakings, or other instruments or contracts of
suretyship- -
LIMITATION: THIS POWER OF ATTORNEY CANNOT BE USED TO EXECUTE NOTE GUARANTEE, MORTGAGE DEFICIENCY, MORTGAGE
GUARANTEE,OR BANK DEPOSITORY BONDS.
and to bind any of the Companies thereby as fully and to the same extent as If such bonds were signed by the President,sealed with the corporate
seal of the applicable Company and duly attested by its Secretary, hereby ratifying and confirming all that the said Attorney(s)-in-Fact may do in
the premises. Said appointment is made under and by authority of the following resolution adopted by the Board of Directors of each of the
WESTFIELD INSURANCE COMPANY,WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY:
"Be It Resolved,that the President,any Senior Executive,any Secretary or any Fidelity& Surety Operations Executive or other Executive shall
be and is hereby vested with full power and authority to appoint any one or more suitable persons as Attomey(s)-in-Fact to represent and act for
and on behalf of the Company subject to the following provisions:
The Attorney-in-Fact may be given full power and authority for and in the name of and on behalf of the Company,to execute,acknowledge and
deliver,any and all bonds, recognizances, contracts,agreements of indemnity and other conditional or obligatory undertakings and any and all
notices and documents canceling or terminating the Company's liability thereunder, and any such instruments so executed by any such
Attorney-in-Fact shall be as binding upon the Company as if signed by the President and sealed and attested by the Corporate Secretary."
"Be it Further Resolved,that the signature of any such designated person and the seal of the Company heretofore or hereafter affixed to any
power of attorney or any certificate relating thereto by facsimile,and any power of attorney or certificate bearing facsimile signatures or facsimile
seal shall he valid and binding upon the Company with respect to any bond or undertaking to which it is attached." (Each adopted at a meeting
held on February 8,2000).
in Witness Whereof,WESTFIELD INSURANCE COMPANY,WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE
COMPANY have caused these presents to be signed by their National Surety Leader and Senior Executive and their corporate seals to be hereto
affixed this 27th day of SEPTEMBER A.D.,2013 .
Corporate r' 4SUR't4 ,,,..InNA_/, , •„ WESTFIELD INSURANCE COMPANY
Seals irQi'.•.-•••.•.0.0N .•a?;•.• •.!}',SG,•• ;'�S•• • C"s WESTFIELD NATIONAL INSURANCE COMPANY
Affixed Jivi ra+ n r o: -•1' '•es OHIO FARMERS INSURANCE COMPANY
-Ski,SEAL i ti .'"E SEAL
SEAL :° `"�1� �
' ,�v. �./ : . . . 1848 .: o/�A ` ? K‘,. .1(i •
-
State of Ohio �"" " " Dennis P. Baus, National Surety Leader and
County of Medina ss.: Senior Executive
On this 27th day of SEPTEMBER A.D.,2013 , before me personally came Dennis P. Baus to me known,who, being by me duly sworn,did
depose and say, that he resides In Wooster, Ohio;that he is National Surety Leader and Senior Executive of WESTFIELD INSURANCE
COMPANY,WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY,the companies described in and which
executed the above instrument;that he knows the seals of said Companies;that the seals affixed to said instrument are such corporate seals;that
they were so affixed by order of the Boards of Directors of said Companies;and that he signed his name thereto by like order.
Note ria I w..........«.,,, .
Seal ''' /(,) ' •
\Al L
Affixed Off• \...............
..!r// r
2�
William J. Kahelin, A rney at Law, Notary Public
State of Ohio =d+ "Vo My Commission Does Not Expire(Sec. 147.03 Ohlo Revised Code)
County of Medina ss.: <•:y r�. ,
rE o c o
I, Frank A.Carrino, Secretary of WESTFIELD INSURANCE COMPANY,WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS
INSURANCE COMPANY, do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney, executed by said
Companies,which is still in full force and effect;and furthermore,the resolutions of the Boards of Directors,set out in the Power of Attorney are
in full force and effect.
In Witness Whereof, I have hereunto set my hand and affixed the seals of said Companies at Westfield Center, Ohio, this 13th day of
December A.D., 2017 •
4
t��br..C7.L II: :,ten; SEAL -- - - - :�_ >� ` Secretary
�11•• ran /'ee --: ::0 R:.1848 •:� Frank A.Carrino, Secretary
. -' .. / -
BPOAC2(combined) (06-02)