HomeMy WebLinkAboutAffordable Concrete LLC 2018 . - . FEE: $20.00
ACCOUNT# 100-0050-4972-00000
ANNUAL SIDEWALK LAYERS /
CURB CUT CONTRACTORS LICENSE
Application is made fora license to perform sidewalk laying and curb cutting work within the City of Oshkosh:
NAME: A4JJ-e ( 4' (,L ( Type of organization:
/ individual Xispartnership
II ++ corporation
ADDRESS: 2_Tc V\ , t}Ur0✓\ S4'
State of Incorporation
Owrc', tiI - Sirg63
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.
Each individual project/address at which work will be performed requires a separate permit which may be
obtained from the office of the
1City Clerk.
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DATE ISSUED: -C(3"I6
EXPIRATION: 1-1. 3 -lt1
BOND TERM: \ L-'3) ' ICJ
INSURANCE TERM: t-I-aA0 - M
DATE: Cj - 11t7-' 1c?--)
•
Applic is Signature
CUO - 37 9 —(007
Telephone Number
Sidewalk Layers/Curb Cut Contractors
Annual License 4/19/053,,` 1
ANNUAL SIDEWALK LAYERS/CURB CUT CONTRACTORS BOND
Bond No. 63177017
PRINCIPAL(S)(Legal name(s)and business address(es)) Type of organization:
Xindividual partnership
Jason Sowls dba Affordable Concrete
corporation
225 W. Huron St. ,
Omro, WI 54 963 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 performing sidewalk laying/curb cutting work 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 or sidewalk 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 pa;me%t yy�=e'the penal sum of this bond shall not exceed$5000.
It ikst 4o a,eed by the Principal(s) and Surety(ies) that this bond supplements, but does not take the place of any
liar/ iris r q -'cj:to be carried by said Principal(s)herein by the City of Oshkosh policies or ordinances.
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i iZ-
�3., �i ti,stA over work performed from January 1 . 2018 (Date of Issuance)to December 31,
"TIFe arir it license period). This bond shall cover claims made for work performed during this annual license period
andtoj ii f l ti$ e,b'S year maintenance period beyond the expiration of this annual license period.
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SIGNATURES/SEALS:
For the Principal: For the Surety: 0 SURET MPANY
Affordable Concrete
Name Name 12-13-2017
/I— 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.
Sidewalk layers bond
4/15/05