HomeMy WebLinkAboutPascarella Construction LLC 2018 •
I
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:174.5 Ca r-e\\ a� L r+ r.}�T►e" 1,1-C- Type of organization:
individual partnership
•
51 PG NvV - sr corporation
ADDRESS:
r1 State of Incorporation L)_
tv-vn Corv.--12 tnxx 5`tcriS
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: Il7-a9-I
EXPIRATION: \ )
BOND TERM: 10--3 -18 i-o ti2-31-i 8
INSURANCE TERM: L1`(`1(g -to `1-to-t`t
DATE: KO ^(� I-Ikj kZiel>
Applicant's Signature
900-379- C37/
Telephone Number
Sidewalk Layers/Curb Cut Contractors
Annual License 4/19/05
RECEIVED.. ,
OCT 2 9 N18
CITY CLETRICS DICE
PASCA-1 OP ID:TB
Ao.rv- CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDfYYYY)
10/05/2018
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERIS), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les) must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT
Bock Insurance Agency Inc.
Bock Insurance Agency,Inc. PHONE 920.235 5737 FAX 920-235-7227
2337 Jackson Street (A/c No,_Exp: (A/C,No):
Oshkosh,WI 54901 n DRESS:brian.neveau@bockins.com
Brian Neveau
INSURERS)AFFORDING COVERAGE NA1C I -
INSURER A:State Auto Ins Co 25127
INSURED Pascarella Construction LLC INsuRERE•
5159 High Pointe Dr INSURER C:
Winneconne,WI 54986 - -
INSURER 0:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADOL SUB ( POLICYEFF POLICY EXP
LTR TYPE OF INSURANCE _INSR WVD POLICY NUMBER (MMJDO/YYYY)_(MMtDD/YYYY) LIMITS
GENERAL LIABILITY 1,000,000
EACH OCCURRENCE S
DAMAGE I O RENTED
A X COMMERCIAL GENERAL LIABILITY Y BOP2665632 I 04/06/2018 04/062019 PREMISES(Ee occurrence) S 300,000
CLAIMS-MADE n OCCUR MED EXP(Any one person) S 5,000
PERSONAL&ADV INJURY S 1,000,000
GENERAL AGGREGATE S 2,000,000
GEN.AGGREGATE OMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2,000,000
X1 OOLICY PE COT n LOC
AUTOMOBILE LIABILITY - COMBINED SINGLE LIMI` 1,000,000
(Ea occident _S
A ANY AUTO Y BAP2346036 04106/2018 04/062019 BODILY INJURY IPer perm') S
ALL OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOSAUTOS
X HIRED AUTOS X NN..OW PRO
PERTY OPERTY DAMAGE
AUTOS (PERACSIDEN')
UMBRELLA LIAR OCCUR � EACH OCCURRENCE
EXCESS LIAB �-CLAIMS-MADE AGGREGATE $
DED RETENTION S
WORKERS COMPENSATION WC STATU- OTH•
AM)EMPLOYERS'LIABILITY YIN TORY LIMITS ER
ANY PROPRIETOR/PARTNER/EXECUTIVE NIA E.L.EACH ACCIDENT
MI
OF-ICEREMBER EXCLUDED? -
(Mandatory In NH) E L DISEASE•EA EMPLOYEE S
Ir yes,describe Under
DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT S
DESCRPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Addltlenal Remarks Schedule,If more space Is required)
City of Oshkosh and its officers, council members, agents, employees, and
authorized volunteers listed as Additional Insureds_ Notice of Cancellation
Applies.
CERTIFICATE HOLDER CANCELLATION
OSHKOSH
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
of Oshkosh THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
CityACCORDANCE WITH THE POLICY PROVISIONS.
P.O. Box 1130
Oshkosh,WI 54903-1130 AUTHORIZED REPRESENTATIVE
Brian Neveau
O 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD
ANNUAL SIDEWALK LAYERS/CURB CUT CONTRACTORS BOND
Bond No. 63825616
PRINCIPAL(S)(Legal name(s)and business address(es)) Type of organization:
individual partnership
Pascarella Construction LLC X corporation
5159 High Pointe Dr Wisconsin
Winneconne, WI 54986 State of Incorporation
Su rety(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 payme.c.010wgyer the penal sum of this bond shall not exceed$5000.
It ivarcrtgeSlood,dticlitixeed by the Principal(s) and Surety(ies) that this bond supplements, but does not take the place of any
lia li�yinsu req et to be carried by said Principal(s) herein by the City of Oshkosh policies or ordinances.
1 BONEf -
IStil=17ciectsh.a1't5Yer work performed from October 3, 2018 (Date of Issuance)to December 31,
t eF . '(4-tie ar tizri cense period). This bond shall cover claims made for work performed during this annual license period
an fei xp -year maintenance period beyond the expiration of this annual license period.
•4te44iSs.tottott**4-
SIGNATURES/SEALS:
For the Principal: For the Surety: ON SURETY MPANY
Paso 11 C., ruction T C 7
Nam Name 10-26-2018
Paul T. Bruflat, Vice President
Title Title 101 S. Reid St. , Ste. 300
o��(�j, 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
Western SuretyCompany
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS:
That WESTERN SURETY COMPANY, a corporation organized and existing under the laws of the State of South Dakota, and
authorized and licensed to do business in the States of Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut,
Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine,
Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New
Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South
Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming, and the
United States of America, does hereby make, constitute and appoint
Paul T. Bruflat Of Sioux Falls
State of South Dakota , its regularly elected Vice President
as Attorney-in-Fact, with full power and authority hereby conferred upon him to sign, execute, acknowledge and deliver for and on
its behalf as Surety and as its act and deed, the following bond:
One PAVER (SIDEWALK) CITY OF OSHKOSH
bond with bond number 63825 616
for PASCARELLA CONSTRUCTION LLC
as Principal in the penalty amount not to exceed: S5.000.00 _
Western Surety Company further certifies that the following is a true and exact copy of Section 7 of the by-laws of Western Surety Company duly
adopted and now in force,to-wit:
Section 7. All bonds,policies,undertakings, Powers of Attorney,or other obligations of the corporation shall be executed in the corporate name of
the Company by the President, Secretary, any Assistant Secretary, Treasurer, or any Vice President, or by such other officers as the Board of
Directors may authorize. The President, any Vice President, Secretary, any Assistant Secretary, or the Treasurer may appoint Attorneys-in-Fact or
agents who shall have authority to issue bonds, policies, or undertakings in the name of the Company. The corporate seal is not necessary for the
validity of any bonds, policies, undertakings, Powers of Attorney or other obligations of the corporation. The signature of any such officer and the
corporate seal may be printed by facsimile.
In Witness Whereof, the said WESTERN SURETY COMPANY has caused these presents to be executed by
Vice President _ with the corporate seal affixed this 26th day of October
2018
ATTEST WEST SURET COMPANY
CT By /
L.Nelson,Assistant Secretary Paul T. at,Vice President
f - i
STATE OF SOUTH DAKOTA 'ss
•:
COUNTY OF MINNEHAHA
4
_}_2iith t 5,-•
On this_ 26th day of _ October 2018 -_ , before me, a Notary Public, personally appeared
Paul T. Bruflat and L. Nelson
who, being by me duly sworn, acknowledged that they signed the above Power of Attorney as Vice President
and Assistant Secretary, respectively, of the said WESTERN SURETY COMPANY, and acknowledged said instrument to be the
voluntary act and deed of said Corporation.
+ +
J. MOHR
NOTARY PUBLIC SEAL i _ `_
i SOUTH DAKOTA i•
47llLJ
+e�44h4ebhh4h4b4Sb4tiy4.ti4} My Commission Expires June 23, 2021 Notary Public
To validate bond authenticity,go to www.cnasurety.com >Owner/Obligee Services>Validate Bond Coverage.
Form F1975-1-2016