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HomeMy WebLinkAboutCD Smith Construction Inc 2018 FEE: $20.00 ACCOUNT#100-0050-4972-00000 �p ANNUAL SIDEWALK LAYERS / CURB CUT CONTRACTORS LICENSE Application is made for a license /�to-" perform sidewalk laying and curb cutting work within the City of Oshkosh: NAME: 0- 1) 5m i�� ic S ryialitrn J - Type of organization: individual partnership k corporation ADDRESS: ' aD kvi,S cry. S+` State of Incorporation Vkl I �mt cQ cL �� kc 15 i 3 5 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. Q DATE ISSUED: L— - \ v R1_C '1VE 1 EXPIRATION: - `� \ DEC 1 5 2017 BOND TERM: ‘C61 CITY CLERK'S OFFICE INSURANCE TERM: 10—\ — ` 6 DATE: 1 .. I S- Applicant's Signature Telephone Number Sidewalk Layers/Curb Cut Contractors Annual License 4/19/05 ANNUAL SIDEWALK LAYERS/CURB CUT CONTRACTORS BOND Bond No. 8245-61-18 ' PRINCIPAL(S)(Legal name(s)and business address(es)) Type of organization: C. D. Smith Construction, Inc. 889 E. Johnson Street individual partnership Fond du Lac,WI 54935 _X_corporation State of Incorporation_Wisconsin Surety(ies) (Name(s)and business address(es)) Federal Insurance Company 202E Halls Mill Road PO Box 1650 Whitehouse Station, NJ 08889-1650 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 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, 2017 (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 Pri ipal • For the Surejy: n ,9:311Ath 1 ea. Name Na e Sarah . Gantner Attorney-in-Fact Title Title 101 Camelot Dr Ste 2C, Fond du Lac,WI 54935 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 CHUBB' Power of Attorney Federal Insurance Company I Vigilant Insurance Company I Pacific Indemnity Company Know All by These Presents,That FEDERAL INSURANCE COMPANY,an Indiana corporation.VIGILANT INSURANCE COMPANY,a New York corporation,and PACWIC INDEMNITY COMPANY,a Wisconsin corporation,do each hereby constitute and appoint Donna F. Bardenwerper, Sarah C. Gantner, Matthew M. Spaude and Michael J.Spaude of Fond du Lac,Wisconsin each as their true and lawful Attorney-in-Fact to execute under such designation in their names and to affix their corporate seals to and deliver for and on their behalf as surety thereon or otherwise,bonds and undertakings and other writings obligatory in the nature thereof(other than bail bonds)given or executed in the course of business,and any instruments amending or altering the same,and consents to the modification or alteration of any instrument referred to in said bonds or obligations. In Witness Whereof,said FEDERAL INSURANCE COMPANY.VIGILANT INSURANCE COMPANY,and PACIFIC INDEMNITY COMPANY have each executed and attested these presents and affixed their corporate seals on this 10's d:iv of May,2017. Itivat \I(phi s'i St phcn M.11;tnEy.Vice President crI oto STATE OF NEW JERSEY County of Hunterdon u' On this 10°day of May,2017 before me,a Notary Public of New Jersey,personally came Dawn M.Chloros,to me known to be Assistant Secretary of FEDERAL INSURANCE COMPANY,VIGILANT INSURANCE COMPANY,and PACIFIC INDEMNITY COMPANY,the companies which executed the foregoing Power of Attorney,and the said Dawn M. Chloros,being by me duly sworn,did depose and say that she is Assistant Secretary of FEDERAL INSURANCE COMPANY.VIGILANT INSURANCE COMPANY,and PACIFIC INDEMNITY COMPANY and knows the corporate seals thereof,that the%Pals affixed to the foregoing Power of Attorney are such corporate seals and were thereto affixed by authority of said Companies;and that she signed said Power of Attorney as Assistant Secretary of said Companies by like authority;and that she is acquainted with Stephen M. Haney,and knows him to be Vice President of said Companies;and that the signature of Stephen M.Haney,subscribed to said Power of Attorney is in the genuine handwriting of Stephen M.Haney,and was thereto subscribed by authority of said Companies and in deponent's presence. Notarial Seal t(AlllIMMA AAR NOTARY MUM NN JERSEY , ebm1raaton E#a+y ts.2019 ;(/L✓ !�~--Jronr�rP�e 1 , CERTIFICATION Resolutions adopted by the Boards of Directors of FEDERAL INSURANCE COMPANY,VIGILANT INSURANCE COMPANY,and PACIFIC INDEMNITY COMPANY on August 30.2016: "RESOLVED,that the following authorizations relate to the execution,for and on behalf of the Company,of bonds,undertakings,recognizance%,contracts and other written commitments of the Company entered into in the ordinary course of business(each a"Written Commitment"): (I) Each of the Chairman,the President and the Vice Presidents of the Company is hereby authorized to execute any Written Commitment for and on behalf of the Company,under the seal of the Company or otherwise. (2) Each duly appointed attorney-in-fact of the Company is hereby authorized to execute any Written Commitment for and on behalf of the Company,under the seal of the Company or otherwise,to the extent that such action is authorized by the grant of powers provided for in such persons written appointment as such attorney-in-fact. (3) Each of the Chairman,the President and the Vice Presidents of the Company is hereby authorized,for and on behalf of the Company,to appoint in writing any person the attorney- in-fact of the Company with full power and authority to execute,for and on behalf of the Company,under the seal of the Company or otherwise,such Written Commitments of the Company as may be specified in such written appointment,which specification may be by general type or lass of Written Commitments or by specification of one or more particular Written Commitments. (4) Each of the Chairman,the President and the Vice Presidents of the Company is hereby authorized,for and on behalf of the Company.to delegate in writing to any other officer of the Company the authority to execute,for and on behalf of the Company, under the Company's seal or otherwise,such Written Commitments of the Company as are specified in such written delegation,which specification may be by general type or dass of Written Commitments or by specification of one or more particular Written Commitments. (5) The signature of any officer or other person executing any Written Commitment or appointment or delegation pursuant to this Resolution.and the seal of the Company,may be affixed by facsimile on such Written Commitment or written appointment or delegation. FURTHER RESOLVED,that the foregoing Resolution shall not be deemed to be an exclusive statement of the powers and authority of officers,employees and other persons to act for and on behalf of the Company,and such Resolution shall not limit or otherwise affect the exercise of any such power or authority otherwise validly granted or vested." I,Dawn M.Chloros,Assistant Secretary of FEDERAL INSURANCE COMPANY,VIGILANT INSURANCE COMPANY,and PACIFIC INDEMNITY COMPANY(the"Companies")do hereby certify that (i) the foregoing Resolutions adopted by the Board of Directors of the Companies are true,correct and in full force and effect, (II) the Companies are duly licensed and authorized to transact surety business in all 50 of the United States of America and the District of Columbia and are authorized by the U.S.Treasury Department;further,Federal and Vigilant are licensed in the U.S.Virgin Islands,and Federal is licensed in Guam.Puerto Rico. and each of the Provinces of Canada except Prince Edward Island;and (Ill) the foregoing Power of Attorney is true,correct and in full force and effect n Q , t 4� Q t,�. �L. , 2011 Given under my hand and seals of said Companies at Whitehouse Statiun,NJ,this ei day ' . Ian Al.Chtom.ANsrttant scerisaril IN THE EVENT YOU WISH TO NOTIFY US OF A CLAIM.VERIFY THE AUTHENTICITY OF THIS BOND OR NOTIFY US OF ANY OTHER MATTER PLEASE CONTACT US AT: Telephone(908)903-3493 Fax(908)903.3656 e-mail:surery@chubb.com Form 15-10-02250-U GEN CONSENT(rev.12-16) FEDERAL INSURANCE COMPANY STATEMENT OF ASSETS, LIABILITIES AND SURPLUS TO POLICYHOLDERS Statutory Basis DECEMBER 31,2016 (in thousands of dollars) LIABILITIES AND ASSETS SURPLUS TO POLICYHOLDERS Cash and Short Term Investments $ (86,990) Outstanding Losses and Loss Expenses $ 11,482,308 United States Government,State and Unearned Premiums 2,723,875 Municipal Bonds 8,135,311 Ceded Reinsurance Premiums Payable 566,868 Other Bonds 5,471,330 Provision for Reinsurance 29,339 Stocks 130,689 Other Liabilities 1,144,976 Other Invested Assets 1,289,903 TOTAL INVESTMENTS 14,940,243 TOTAL LIABILITIES 15,947,366 Investments in Affiliates: Chubb Investment Holdings, Inc. 3,727,406 Capital Stock 20,980 Pacific Indemnity Company 2,926,619 Paid-In Surplus 3,106,809 Executive Risk Indemnity Inc 1,250,965 Unassigned Funds 8,296,020 Great Northern Insurance Company 504,162 Vigilant Insurance Company 319,505 Chubb European Investment Holdings,SLP. 277,361 SURPLUS TO POLICYHOLDERS 11,423,809 Chubb Custom Insurance Company 214,956 Chubb National Insurance Company 162,929 Chubb Indemnity Insurance Company 163,668 Other Affiliates 70,204 Premiums Receivable 1,510,107 Other Assets 1,303,050 TOTAL LIABILITIES AND SURPLUS TOTAL ADMITTED ASSETS $ 27,371,175 TO POLICYHOLDERS $ 27,371,175 Investments are valued in accordance with requirements of the National Association of Insurance Commissioners. At December 31,2016, investments with a carrying value of$565,702,495 were deposited with government authorities as required by law. State,County&City of New York, — ss: Dawn M. Chloros, Assistant Secretary of the Federal Insurance Company being duly sworn, deposes and says that the foregoing Statement of Assets, Liabilities and Surplus to Policyholders of said Federal Insurance Company on December 31,2016 is true and correct and is a true abstract of the Annual Statement of said Company as filed with the Secretary of the Treasury of the United States for the 12 months ending December 31,2016. Subscribed and sworn to before me this March 3, 2017. r / JEANETTE SHIPSEY Assistant Secretary Notary Public,State of New York Notary Public No.02SH5074142 Qualified in Nassau County Commission Expires March 10,2019 Form 15-10-0313A(Rev.3/17)