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Home My WebLink AboutWisconsin Public Service Corp 20181st FEE: $20.00 ACCOUNT#100-0050-4972-00000 ANNUAL STREET/SIDEWALK OBSTRUCTION LICENSE Application ism,made for a license to maintain street/sidewalk obstruction: NAME: uv�SI�U�S �1 \CJ CU\C.-Q. (C( p ADDRESS: o[ \\). 'f\(\C.t A ( J)-- r05\(\\w\r) \ -)u40 \ 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: 1 v — EXPIRATION: \ r 31 - U BOND TERM: ` Z INSURANCE TERM: \ V — l DATE: f V pplicant's Si ature Q , om�' YD Ste " �2L CD Telephone Number Street/Sidewalk Annual Obstruction License 11-27-02 • s . • ANNUAL STREET/SIDEWALK OBSTRUCTION BOND Bond No. 106584082 PRINCIPAL(S)(Legal name(s)and business address(es)) Type of organization: WISCONSIN PUBLIC SERVICE CORPORATION individual partnership 700 NORTH ADAMS STREET GREEN BAY,WI 54301 X corporation Surety(ies) (Name(s) and business address(es)) State of Incorporation Wisconsin Travelers Casualty and Surety Company of America One Tower Square Hartford,CT 06183 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. T he 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 sk ill; 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, side walk,terrace or other public area to as good a condition as it was in before excavation or obstruction; and pay tot he City of Oshkosh any amounts due for services or mat erials 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 Os hkosh from and against any and all claims, damages, costs, and expenses of a ny 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 tothe 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 December 31,21117 (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 :sl lu UYUV YDmec (URPUR.CMN For the Surety: Iravelc s Cacoaity And Siircn•Company of America Name �1 e, • TR FNSJ R ame To ooker Title Attorney-in-Fact Title 20975 Swenson Drive, Suite 175, Waukesha, WI 53186 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 • • , ; •' WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER 40111k POWER OF ATTORNEY 'TRAVELERS J Farmington Casualty Company St.Paul Mercury Insurance Company Fidelity and Guaranty Insurance Company Travelers Casualty and Surety Company Fidelity and Guaranty Insurance Underwriters,Inc. Travelers Casualty and Surety Company of America St.Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company St.Paul Guardian Insurance Company Attorney-In Fact No. 231353 Certificate No.0 0 6 9 7 6 76 9 KNOW ALL MEN BY THESE PRESENTS: That Farmington Casualty Company, St. Paul Fire and Marine Insurance Company,St. Paul Guardian Insurance Company,St.Paul Mercury Insurance Company,Travelers Casualty and Surety Company,Travelers Casualty and Surety Company of America,and United States Fidelity and Guaranty Company are corporations duly organized under the laws of the State of Connecticut,that Fidelity and Guaranty Insurance Company is a corporation duly organized under the laws of the State of Iowa,and that Fidelity and Guaranty Insurance Underwriters,Inc.,is a corporation duly organized under the laws of the State of Wisconsin(herein collectively called the"Companies"),and that the Companies do hereby make,constitute and appoint Anthony S.Von Rueden,Todd Looker,and Robert E Flath of the City of Milwaukee/Waukesha ,State of Wisconsin ,their true and lawful Attorney(s)-in-Fact, each in their separate capacity if more than one is named above,to sign,execute,seal and acknowledge any and all bonds,recognizances,conditional undertakings and other writings obligatory in the nature thereof on behalf of the Companies in their business of guaranteeing the fidelity of persons,guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. IN WITNESS WHEREOF,the Companies have caused this instrument to be signed and their corporate seals to be hereto affixed,this 16th day of September 2016 Farmington Casualty Company St.Paul Mercury Insurance Company Fidelity and Guaranty Insurance Company Travelers Casualty and Surety Company Fidelity and Guaranty Insurance Underwriters,Inc. Travelers Casualty and Surety Company of America St.Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company St.Paul Guardian Insurance Company ry • e L _Y M �•u rom., y f{RE y' �N..:.!!S�9 J.n.INSUq y 9JplTY ANO�` ors ZZ'y 4 1Y% S (, V �9 -ahccrirgin-,.. „' = !PP:"/�m Y4 iY'�OAMC';r'= ns q, q� Y -vl 1982 o P O, n' z i n i UP HARTFORD, H0.9MR f 1951 a «21A ALA' '; o w ca+H. 7t coHH. 2 N < 'cy +ecr4 aD i `t o. 'J`. �' ��!.r!$�,�:.t 'm y its .�'+ AN" r' ' raj *� a'• .. ,^„�cT` r S.AN4'a �a �,Ar) NIS`_ State of Connecticut By: ii42s City of Hartford ss. Robert L.Raney,Senior Vice President On this the- 16th day of September 2016 before me personally appeared Robert L.Raney,who acknowledged himself to be the Senior Vice President of Farmington Casualty Company, Fidelity and Guaranty Insurance Company,Fidelity and Guaranty Insurance Underwriters,Inc.,St.Paul Fire and Marine Insurance Company,St.Paul Guardian Insurance Company,St.Paul Mercury Insurance Company,Travelers Casualty and Surety Company,Travelers Casualty and Surety Company of America,and United States Fidelity and Guaranty Company,and that he,as such,being authorized so to do,executed the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. G•T17 In Witness Whereof,I hereunto set my hand and official seal. Ii 1 A \.04A4.Al CMy Commission expires the 30th day of June,2021. *sALBLIG * Marie C.Tetreault,Notary Public C. 58440-5-16 Printed in U.S.A. WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER