HomeMy WebLinkAboutNaslund, Nels 2018 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: jh A1J
ADDRESS:
jd/ A" l! e7
DSh ,4 k
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: r `f7--
EXPIRATION: \,' 1i 1(6
�l - e), RECEIVED
�{ OCT082018
INSURANCE TERM: 1CITY CLERK'S IO C E
BOND TERM:
DATE: W- YD1Q1
Apphlcant's Signature
Telephone Number
Street/Sidewalk Annual Obstruction License
11-27-02
•
ANNUAL STREET/SIDEWALK OBSTRUCTION BOND
Bond No. 63826245
PRINCIPAL(S)(Legal name(s)and business address(es)) Type of organization:
X individual partnership
Nels Naslund corporation
301 N. Sawyer St
Oshkosh, WI 54902 State of Incorporation
Surety(ies)(Name(s)and business address(es))
WESTERN SURETY COMPANY
101 S. Reid St. , Ste. 300
Sioux Falls, SD 57103-7046
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 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.
;,.Zy1
TERF BOND::
&ais gihd %over work performed from October 5th, 2018 (Date of Issuance)to December 31,
al license period). This bond shall cover claims made for work performed during this annual license period
andfp, rl'iir,' o-year maintenance period beyond the expiration of this annual license period.
SIGNATURES/SEALS:
For the P c I For the Surety: .I yn' RN SURE COMPANY
- Name October 4th, 2018
Paul T. Bruflat, Vice President
Title Title
101 S. Reid St. , Ste. 300
Sioux Falls, SD 57103-7046
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.
Annual Street/Sidewalk Obstruction bond
4/15/05
•
Western Surety Company
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS:
That WESTERN SURETY COMPANY, a corporation organized and existing under the laws of the State of South Dakota, and
authorized and licensed to do business in the States of Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut,
Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine,
Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey,
New Mexico, New York, North Carolina. North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina,
South Dakota, Tennessee, Texas, Utah. Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming, and the United
States of America, does hereby make,constitute and appoint
Paul T. Bruflat of Sioux Falls
State of South Dakota , its regularly elected Vice President
as Attorney-in-Fact, with full power and authority hereby conferred upon him to sign, execute, acknowledge and deliver for and on
its behalf as Surety and as its act and deed,the following bond:
One Street/Sidewalk Obstruction City of Oshkosh
bond with bond number 63826245
for Nels Naslund
as Principal in the penalty amount not to exceed: $ 5,000.00
Western Surety Company further certifies that the following is a true and exact copy of Section 7 of the by-laws of Western Surety Company
duly adopted and now in force,to-wit:
Section 7. All bonds, policies. undertakings. Powers of Attorney, or other obligations of the corporation shall be executed in the corporate
name of the Company by the President, Secretary. any Assistant Secretary, Treasurer, or any Vice President, or by such other officers as the
Board of Directors may authorize. The President. any Vice President, Secretary. any Assistant Secretary, or the Treasurer may appoint
Attorneys-in-Fact or agents who shall have authority to issue bonds, policies, or undertakings in the name of the Company. The corporate seal is
not necessary for the validity of any bonds, policies. undertakings,Powers of Attorney or other obligations of the corporation. The signature of any
such officer and the corporate seal may be printed by facsimile.
In Witness Whereof. the said WESTERN SURETY COMPANY has caused these presents to be executed by its
Vice President with the corporate seal affixed this 4 th day of October
2018
ATTEST WESTEE URET COMPANY
94141-1771--/ By G.. /.
L.Nelson,Assistant Secretary Paul T ruflat•Vice President
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STATE OF SOUTH DAKOTA � � � . �,�`t pV :'* ram
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COUNTY OF MINNEHAHA ) G fp� atj .
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On this 4th day of October 2018 , before me, a Notary Public, personally appeared
Paul T. Bruflat and L. Nelson
who, being by me duly sworn, acknowledged that they signed the above Power of Attorney as Vice President
and Assistant Secretary. respectively, of the said WESTERN SURETY COMPANY, and acknowledged said instrument to be the
voluntary act and deed of said Corporation.
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J. MOHR
s NOTARY PUBLIC 8E
s SOUTH DAKOTA T - .r Notary Public
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To validate bond authenticity, go to www.cnasurety.com >Owner/Obligee Services>Validate Bond Coverage.
Form F1975-1-2016