HomeMy WebLinkAboutAnderson Brothers 2018 FEE: $20.00
ACCOUNT#100-0050-4972-00000
ANNUAL SIDEWALK LAYERS /
CURB CUT CONTRACTORS LICENSE
Application is made for a license to perform sidewalklaying and curb cutting work within the City of Oshkosh:
NAME: AL�L ( y\ 16Si?�\ /rt Type of organization:
individual partnership
corporation
ADDRESS: a--4-Oc6 r'r'l Sun State of Incorporation w►
DSc e\ U)\ S�CIO\
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 City Clerk.Cl
DATE ISSUED: .,7 ".441,'I�
EXPIRATION: \?
BOND TERM:
INSURANCE TERM:
DATE: S-- a` l U
pplicant's Signature
920 — 3 7 &loc
Telephone Number
Sidewalk Layers/Curb Cut Contractors
Annual License 4/19/05
RECEIVED_ ,
MAY
CIT`_'c Efltiti§�t.11
ANNUAL SIDEWALK LAYERS/CURB CUT CONTRACTORS BOND
PRINCIPAL(S)(Legal name(s)and business address(es)) Type of organization:
Anderson Brothers, Inc. individual partnership
2708 Harrison St Oshkosh,WI 54901-1610 ✓ corporation
State of Incorporation WI
Surety(ies)(Names(s)and business address(es))
West Bend Mutual Insurance Company
PO Box 620976
Middleton,WI 53562
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 employ-
ment 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 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 May 22,2018 (Date of Issuance)to December 31, 20 18
(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 Pr' I I: r t e S rety: West Ben utual Insurance Company
Name Name
Attorney-in-fact
Title Title
PO Box 620976 Middleton,WI 53562
Address
Any person signing in a representative capacity (e.g., an attorney-in-fact) must furnish evidence of authority if that repre-
sentative is not a member of the firm or partnership or an officer of the corporation involved.
Sidewalk layers bond
04/15/05
/1.----NEST BEND THE SILVER LINING°
A MUTUAL INSURANCE COMPANY'
Bond No. 2385592
POWER OF ATTORNEY
Know all men by these Presents,That West Bend Mutual Insurance Company, a corporation having its principal office in the City of West
Bend, Wisconsin does make,constitute and appoint:
MARLENE HOBBS
lawful Attorney(s)-in-fact, to make,execute, seal and deliver for and on its behalf as surety and as its act and deed any and all bonds,
undertakings and contracts of suretyship, provided that no bond or undertaking or contract of suretyship executed under this authority
shall exceed in amount the sum of: Five Thousand Dollars($5,000.00)
This Power of Attorney is granted and is signed and sealed by facsimile under and by the authority of the following Resolution adopted
by the Board of Directors of West Bend Mutual Insurance Company at a meeting duly called and held on the 21s,day of December,
1999.
Appointment of Attorney-In-Fact The president or any vice president,or any other officer of West Bend Mutual Insurance
Company may appoint by written certificate Attorneys-In-Fact to act on behalf of the company in the execution of and attesting of
bonds and undertakings and other written obligatory instruments of like nature. The signature of any officer authorized hereby
and the corporate seal may be affixed by facsimile to any such power of attorney or to any certificate relating therefore and any
such power of attorney or certificate bearing such facsimile signatures or facsimile seal shall be valid and binding upon the
company,and any such power so executed and certified by facsimile signatures and facsimile seal shall be valid and binding upon
the company in the future with respect to any bond or undertaking or other writing obligatory in nature to which it is attached.
Any such appointment may be revoked,for cause,or without cause,by any said officer at any time.
In witness whereof,the West Bend Mutual Insurance Company has caused these presents to be signed by its president undersigned
and its corporate seal to be hereto duly attested by its secretary this 22nd day of Se, tember, 2017.
Attest tivt.iitilluir C•
Christopher C.Zart ' cARP° ': Kevin A. Steiner
Secretary V SEAL44142100f % Chief Executive Officer/President
State of Wisconsin ..._..
County of Washington
On the 22nd day of September, 2017, before me personally came Kevin A. Steiner,to me known being by duly sworn,did depose and
say that he resides in the County of Washington, State of Wisconsin;that he is the President of West Bend Mutual Insurance Company,
the corporation described in and which executed the above instrument; that he knows the seal of the said corporation;that the seal
affixed to said instrument is such corporate seal;that is was so affixed by order of the board of directors of said corporation and that he
signed his name thereto by like order. 4....... . �.
NOTARY Juli A nedum
•w,,.,�'upuc,:'i; Senior orporate Attorney
�TFoc wisp°�' Notary Public,Washington Co.,WI
My Commission is Permanent
The undersigned, duly elected to the office stated below, now the incumbent in West Bend Mutual Insurance Company,a Wisconsin
corporation authorized to make this certificate, Do Hereby Certify that the foregoing attached Power of Attorney remains in full force
effect and has not been revoked and that the Resolution of the Board of Directors, set forth in the Power of Attorney is now in force.
Signed and sealed at West Bend, Wisconsin this A914y ofL. , AD i0th .
S AL ' / 01
o 7�s4
1 Heather Dunn
' Vice President—Chief Financial Officer
Notice: Any questions concerning this Power of Attorney may be directed to the Bond Manager at NSI, a division of West Bend
Mutual Insurance Company.
1900 S. 18,h Ave. West Bend,WI 53095 I ph(262) 334-6430 I 1-800-236-5004 I fax(262) 338-5058 I www.thesilverlining.com