HomeMy WebLinkAboutJim Fischer Inc 2018 FEE: $20.00
ACCOUNT# 100-0050-4972-00000
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: J t YV\ rk 4)C.AN..12-3( I lir\( ) Type of organization:
individual _partnership
rr corporation
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ADDRESS: v�-1.D S . Ca5a, 0 rn° -
State of Incorporation l.(.)ISO)ki 51 r4(
tee it W ( 549ILT]'
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.
DATE ISSUED: t -acl- vie,
EXPIRATION: ,Z- - 1(6
BOND TERM: \2r31 19D
INSURANCE TERM: 3 ) - It
DATE: t�a° - 1I
/ ppli nt's Signature Ka.,�, A R5c.J.oir
CIZv 734 O ( i
Telephone Number
Sidewalk Layers/Curb Cut Contractors ! /
Annual License 4/19/05
AN s o 32.nla
ANNUAL SIDEWALK LAYERS/CURB CUT CONTRACTORS BOND
•
PRINCIPAL(S)(Legal name(s)and business address(es)) Type of organization:
individual partnership
corporation
Surety(ies)(Name(s)and business address(es)) State of Incorporation
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 (Date of Issuance)to December 31, 20 (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:
Name Name
Title Title
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