HomeMy WebLinkAboutRJ Albright Inc 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: R.J. Albright, Inc.
5711 Green Valley Rd. ` S/
Oshkosh, WI 54904
ADDRESS:
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:
EXPIRATION: 1, 1-` 1 ftt3,
BOND TERM: L^L 3\ \ \,16
INSURANCE TERM:
DATE: \11A \\(6 /16._
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Applicant's ignature
Telephone Number
Street/Sidewalk Annual Obstruction License
11-27-02
ANNUAL STREET/SIDEWALK OBSTRUCTION BOND
Bond No. 24864069
PRINCIPAL(S)(Legal name(s)and business address(es)) Type of organization:
individual partnership
R.J. Albright, Inc. X corporation
5711 Green Valley Road, Oshkosh, WI 54904
State of Incorporation Wisconsin
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,
ng out of or
ulting, however
he work
y the
Princiwilifeeues of any f949ched license, ncludingrbut not limited to, allsaccidents and damagesy, from causedtby any failure to erect and
matoStrffitiO ... i,iers or lights at the place where licensee has placed obstruction or performed work, or by failure to guard
ac '; • f.-•+is s passing upon the street or sidewalk, or by failure to promptly remove all tools, implements, refuse and
U. >:-.•CVerials 0- said right-of-way. The Principal shall indemnify and refund to the City of Oshkosh all sums which it may
be4, ;obligated to pawilcluding damages, punitive damages, attorney fees, and court costs, within 30 days of written demand
fo �i�mgStG ever.ft "penal sum of this bond shall not exceed $5000.
G v,.
4biIt i' gd.and agreed by the Principal(s) and Surety(ies) that this bond supplements, but does not take the place of any
liabilif 'tt) r required to be carried by said Principal(s)herein by the City of Oshkosh policies or ordinances.
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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: SURET MPANY
4,40t
R.J. Albright, Inc. 7—
Name Name
10-9-2017
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