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FEE: $20.00
ACCOUNT#100-0050-4972-00000
ANNUAL STREET/SIDEWALK OBSTRUCTION LICENSE
Application is made for a license to maintain street/sidewalk obstruction:
NAME: ? I TJ llA H (\4 A
ADDRESS: 2 5 I O F R A S ER n R .
OSNKOSH WI 54Q0ti
(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:
EXPIRATION:
RECEIVED_
BOND TERM: JUL 1 3 2018
INSURANCE TERM:
CITY CLERICS OFFICE
DATE: TU Ly 1 3, ).-o I rb
Applicant's Signature
(5 -1 ) ) ) 9 -G 179
Telephone Number
Street/Sidewalk Annual Obstruction License
11-27-02
Bond Number 32S587973
ANNUAL STREET/SIDEWALK OBSTRUCTION BOND
PRINCIPAL(S)(Legal name(s)and business address(es)) Type of organization:
RITU DAHIYA ✓/
individual partnership
2510 Fraser Dr Oshkosh,WI 54904 corporation
State of Incorporation
Surety(ies)(Name(s)and business address(es))
The Ohio Casualty Insurance Company
62 Maple Avenue,Keene,New Hampshire 03431
Penal Sum of Bond: S5,000.00
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 placing an obstruction within the 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 July 13,2018 (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 addition
two-year maintenance period beyond the expiration of this annual license period.
SIGNATURE/SEALS:
For the Principal: RITU DAHIYA For the Surety:
T V 1,A Ff 14 A The Ohio Casualty Insurance Company
Name Name
Title Title AND E EAULIEU Attorney In Fact
62 Maple Avenue, Keene, New Hampshire 03431
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. SY ins&
Street/Sidewalk Obstruction Bond G ool"o"+).°4y�
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LMS-15703 04/10
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.
The Ohio Casualty Insurance Company
POWER OF ATTORNEY
Surety Bond Number:32S587973 Principal: RITU DAHIYA
Bond Amount:($5,000.00 )hive Thousand Dollars And Zero Cents
KNOW ALL PERSONS BY THESE PRESENTS:that The Ohio Casualty Insurance Company,a corporation duly organized under the laws of the State of New Hampshire(herein
collectively called the'Company"),pursuant to and by authority herein set forth,does hereby name,constitute and appoint, ANDREW BEAULIEU
all in the city of WI LLIAMSVILLE ,state of NY each individually if there be more than one named,its true and lawful attorney-in-fact to make,execute,
seal,acknowledge and deliver,for and on its behalf as surety and as its act and deed,any and all undertakings,bonds,recognizances and other surety obligations,in pursuance of
these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Company in their own proper
persons.
IN WITNESS WHEREOF,this Power of Attorney has been subscribed by an authorized officer or official of the Company and the corporate seal of the Company has been affixed
thereto this 26th day of September , 2016 .
‘,Z t INst, The Ohio Casualty Insurance Company
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a i David M.Carey.Assistant Secretary _.0
STATE OF PENNSYLVANIA ss c.)ai
=0 3 COUNTY OF MONTGOMERY co,E
3 On this 26th day of September , 2016 ,before me personally appeared David M.Carey,who acknowledged himself to be the Assistant Secretary of The Ohio 8-6
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Casualty Insurance Company and that he, as such, being authorized so to do, execute the foregoing instrument for the purposes therein contained by signing on behalf of the <c
corporations by himself as duly authorized officer. o as
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yIN WITNESS WHEREOF,I have hereunto subscribed my name and affixed my notarial seal at King of Prussia,Pennsylvania,on the day and year first above written. o1-
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o ci O Ql4 Moew gT5r COMMONWEALTH OF PENNSYLVANIA d E
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Notarial Seal L d
O 2,, o OF 1 Teresa Pastella.Notary Public H�i c[^Ri 0
C Et Upper Merlon Twp.,Montgomery County By: (:&LI-SX" "at"'
Mysi Commission Expires March 28,2021 IL:
;� Yg�rx,�L�Pa Teresa Pastella,Notary Public 42a
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Member.Pennsylvania Association of Notanes . c
oC This Power of Attorney is made and executed pursuant to and by authority of the following By-law and Authorizations of The Ohio Casualty Insurance Company,which is now in full >c
E y force and effect reading as follows: .=o
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10 >,ARTICLE IV—OFFICERS—Section 12.Power of Attorney.Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President,and E c
• 2 subject to such limitation as the Chairman or the President may prescribe,shall appoint such attorneys-in-fact, as may be necessary to act in behalf of the Corporation to make, E ai
• m execute,seal,acknowledge and deliver as surety any and all undertakings,bonds,recognizances and other surety obligations.Such attorneys-in-fact,subject to the limitations set col
o ' forth in their respective powers of attorney,shall have full power to bind the Corporation by their signature and executed,such instruments shall be as binding as if signed by the oar'
Z President and attested to by the Secretary.Any power or authority granted to any representative or attorney-in-fact under the provisions of this article may be revoked at any time by ~
the Board,the Chairman,the President or by the officer or officers granting such power or authority.
Certificate of Designation—The President of the Company, acting pursuant to the Bylaws of the Company, authorizes David M. Carey, Assistant Secretary to appoint such
attorneys-in-fact as may be necessary to act on behalf of the Company to make,execute,seal,acknowledge and deliver as surety any and all undertakings,bonds,recognizances
and other surety obligations.
Authorization—By unanimous consent of the Company's Board of Directors,the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of
the Company, wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds, shall be valid and binding upon the
Company with the same force and effect as though manually affixed.
I,Renee C.Llewellyn,the undersigned,Assistant Secretary,of The Ohio Casualty Insurance Company do hereby certify that the original power of attorney of which the foregoing is a
full,true and correct copy of the Power of Attorney executed by said Company,is in full force and effect and has not been revoked.
IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed the seals of said Company this 13th day of July , 2018
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cc r <O m By: w c.l«uf�--
O i 1919 o Renee C.Llewellyn,Assistant Secretary
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