HomeMy WebLinkAboutJeff Foust Excavating Inc 2018 FEE: $20.00
ACCOUNT# 100-0050-4972-00000
v
ANNUAL SIDEWALK LAYERS /
CURB CUT CONTRACTORS LICENSE
Application isJeff
for a license to perform sidewalk laying and curb cutting work within the City of Oshkosh:
NAME: Foust F)vrivcdinfilit Type of organization:
individual partnership
2rtC
X corporationcADDRESS: 2 �1`1 CICU ry i it State of Incorporation J �ll
62-1(30'1
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:
EXPIRATION: 1 2r. 61 - 18
BOND TERM: 1 .�-JI-17 'thy l� 31-I9
INSURANCE TERM: J / l7 117tv J-3/ -/8
DATE: , j -8.17
(47.A.1
Applicant's Signature
q210-2/ (0 -5300
Telephone Number
Sidewalk Layers/Curb Cut Contractors 9"Ck'
Annual License 4/19/05 --
RE 111 _
JAN 0 2 2018
CITY CLERWS OFFICE
ANNUAL SIDEWALK LAYERS/CURB CUT CONTRACTORS BOND
BOND NO. 3782356
PRINCIPAL(S)(Legal name(s)and business address(es)) Type of organization:
Jeff Foust Excavating, Inc.
2824 Clairville Rd. individual partnership
Oshkosh,WI 54904 X corporation
Surety(ies)(Name(s)and business address(es)) State of Incorporation Wisconsin_
The Ohio Casualty Insurance Company
175 Berkeley Street
Boston, MA 02116
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 Principal: Jeff Foust Excavating, Inc. F tie�urety: The Ohio sualty Insurance Company
Nam e )IC e7` Name Connie Smith
Attorney-in-Fact
Title Title
175 Berkeley Street, Boston, MA 02116
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
THIS POWER OF ATTORNEY IS NOT VALID UNLESS IT IS PRINTED ON RED BACKGROUND.
This Power of Attorney limits the acts of those named herein,and they have no authority to bind the Company except in the manner and to the extent herein stated.
Certificate No 7809966
Liberty Mutual Insurance Company
The Ohio Casualty Insurance Company West American Insurance Company
POWER OF ATTORNEY
KNOWN ALL PERSONS BY THESE PRESENTS:That The Ohio Casualty Insurance Company is a corporation duly organized under the laws of the Stale of New Hampshire,that
Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts, and West American Insurance Company is a corporation duly
organized under the laws of the State of Indiana(herein collectively called the"Companies"),pursuant to and by authority herein set forth,does hereby name,constitute and appoint,
Chris Steinagel;Christopher M.Kemp;Connie Smith;Michael J.Douglas;Robert Downey
all of the city of Hudson ,state of WI each individually if there be more than one named,its true and lawful attorney-in-fact to make,execute,seal,acknowledge
and deliver,for and on its behalf as surety and as its act and deed,any and all undertakings,bonds,recognizances and other surety obligations,in pursuance of these presents and shall
be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper persons.
IN WITNESS WHEREOF.this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed
thereto this 20th day of June , 2017 . >,
ro
IS
oX INSU ,,,INSUR N1NSUq
,.oP�avx.,,F�1y^ J"••J�`v,roira44'r. �P 7.oa'r`Jwr,4�'r The Ohio Casualty Insurance Company y
✓ m n o Liberty Mutual Insurance Company a>
O 1919 0 > 1912 °° Q 1991 c
z a West merican Insurance Company •N
•07 O 11AM{'~it'al7 gym)ir�ACH11a F 3 3YbAN! 9 , a
ti� �� * * By: d � >,
c STATE OF PENNSYLVANIA ss David M.Care ,Assistant Secretary m
++,- COUNTY OF MONTGOMERY c
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cn On this 20th day of June , 2017,before me personally appeared David M.Carey,who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance v t—
✓ d Company, The Ohio Casualty Company, and West American Insurance Company, and that he, as such, being authorized so to do, execute the foregoing instrument for the purposes >,(/)
11-C 2 therein contained by signing on behalf of the corporations by himself as a duly authorized officer. (1)W
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d > IN WITNESS WHEREOF,I have hereunto subscribed my name and affixed my notarial seal at King of Prussia,Pennsylvania,on the day and year first above written. O a
' rG P PAS COMMONWEALTH OF PENNSYLVANIAidtd14)
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.13 wQ os'='or+w4--re ( Notarial Seal '►�.�
C V(A )- a = \ , Teresa Pasteila.Notary Public By: .O
0 tt d OF 1 Upper MerionTwp.,Montgomery County Teresa Pastella,Notary Public c e
L '% �Q I My Commission Expires March 28,2021 3 fC
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O foo, Member,Pennsylvania.lssociaEion el Notaries d
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c R This Power of Attorney is made and executed pursuant to and by authority of the following By-laws and Authorizations of The Ohio Casualty Insurance Company, Liberty Mutual Cl)• o
a, Insurance Company,and West American Insurance Company which resolutions are now in full force and effect reading as follows: r 0
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as 2 ARTICLE IV-OFFICERS-Section 12.Power of Attorney.Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President,and subject 0 c
Cn�; to such limitation as the Chairman or the President may prescribe,shall appoint such attorneys-in-fact,as may be necessary to act in behalf of the Corporation to make,execute,seal, Z,c
0.c acknowledge and deliver as surety any and all undertakings,bonds,recognizances and other surety obligations. Such attorneys-in-fact,subject to the limitations set forth in their respective a 3
E a powers of attorney,shall have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so �a N
`O R executed,such instruments shall be as binding as if signed by the President and attested to by the Secretary.Any power or authority granted to any representative or attomey-in-fact under >
v ", the provisions of this article may be revoked at any time by the Board,the Chairman,the President or by the officer or officers granting such power or authority. t ve
«�� 2 ARTICLE XIII-Execution of Contracts-SECTION 5.Surety Bonds and Undertakings.Any officer of the Company authorized for that purpose in writing by the chairman or the president,
> e and subject to such limitations as the chairman or the president may prescribe,shall appoint such attorneys-in-fact,as may be necessary to act in behalf of the Company to make,execute, I M
O j seal,acknowledge and deliver as surety any and all undertakings,bonds,recognizances and other surety obligations. Such attorneys-in-fact subject to the limitations set forth in their e"00
Z v respective powers of attorney,shall have full power to bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the Company. When so v o
executed such instruments shall be as binding as if signed by the president and attested by the secretary. 0(a
Certificate of Designation-The President of the Company,acting pursuant to the Bylaws of the Company,authorizes David M.Carey,Assistant Secretary to appoint such attorneys-in- ~
fact as may be necessary to act on behalf of the Company to make,execute,seal,acknowledge and deliver as surety any and all undertakings,bonds,recognizances and other surety
obligations.
Authorization-By unanimous consent of the Company's Board of Directors,the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the
Company,wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds,shall be valid and binding upon the Company with
the same force and effect as though manually affixed.
I, Renee C. Llewellyn, the undersigned, Assistant Secretary, The Ohio Casualty Insurance Company. Liberty Mutual Insurance Company, and West American Insurance Company do
hereby certify that the original power of attorney of which the foregoing is a full, true and correct copy of the Power of Attomey executed by said Companies, is in full force and effect and
has not been revoked.
IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed the seals of said Companies this !W* day of 6 ,20 ) 1 .
a 1919 n g 1912 ° 1991 o By: � �
3.o ." Renee C.Llewe , ssistant Secretary
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300 of 500
LMS_12873_022017