HomeMy WebLinkAboutGet R Done Paving 2019 FEE: $20.00
ANNUAL RIGHT-OF-WAY EXCAVATION LICENSE RECEIVED
AUG 2 8 2019
Application is made for a license to work within the Rightf-Way: DEPT OF PUBLIC WORKS
OSHKOSH, WISCONSIN
NAME: �G 4- r pa/7�4(/,/IG, / -�� Type of organization:
�/ dividual partnership
E-MAIL: G . PG e/ ,,k 'G/4/16. , . c�j/y —corporation
r U
ADDRESS: 3 7 2 ).... Yl i//7 /f / // State of Incorporation b►?=,
I (We) further agree to provide the City of Oshkosh with a surety bond issued by a company licensed in the State of
Wisconsin in the amount of Twenty Five Thousand Dollars($25,000.00).
I(we)further agree to secure a Commercial General Liability Policy with limits of:
(a) $500,000 each occurrence
(b) $500,000 personal liability and advertising injury
(c) $500,000 general aggregate
(d) $500,000 products—completed operations aggregate
and shall name the City of Oshkosh, its officers, council members, agents, employees, and authorized volunteers as an
additional insured thereon. Proof of said coverage in the form of an insurance certificate shall be submitted to the City of
Oshkosh prior to issuance of any permit to perform work within the right-of-way.
Each individual project/address at which work will be performed requires a separate permit which may be obtained from
the City of Oshkosh Public Works Department-Engineering Division.
DATE ISSUED: S.411311
EXPIRATION: r2-11.1 (10(1
BOND TERM: $C2?dl'll to t Z•at•?d`y
INSURANCE TERM: 1•t 2ot9 -to t•1•7/s?o
DATE: %•28•2OI
App icant's Signature
Telephone Number
1:\Engineering\ROW Permits\Annual ROW Excavation Bond do License_1-8-19.doc
ANNUAL SIDEWALK LAYERS/CURB CUT CONTRACTORS BOND
RECEIVED
PRINCIPAL(S)(Legal name(s)and business address(es))
Type of organization:
Charles Swartz DBA Git-R-Done Pacing )(
WIindividual partnership,U G
I I f; 2 8 2019
3322 State Highway 13,Wisconsin Dells, 63965 corporation H
Surety(ies)(Name(s)and business address(es)) State of Incorporation Ohio'
OF PUBLIC WORKS
Nationwide Mutual Insurance Company US I I K OS FI, W'I SCON SIN
1100 Locust St.,Dept.2006,Des Moines,IA 50391-2006
i
Penal Sum of Bond: $5000.00 Bond No. 0000761335
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
1 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 August 13,2019 (Date of Issuance)to December 31, 2U19 (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.
iff
SIGNATURES/SEALS:
For the P. al : Charles Swartz DBA Git-R-Done Pacing For flee Su tyi--Nationwide Mutual Insurance Company
Name Name Randal Mark Troike
l 'iley Attorney in Fact Ir ll
'
Title 0•.SEAL:•
4"llfy ' ,
1100 Locust St.,Dept.2006,Des Moines,IA 50391.2006 ,' =fir
ff
Address
Any person signing in a representative capacity(e.g., an attorney-in-fact)must fumish 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
r 4/15/05
Power of Attorney
KNOW ALL MEN BY THESE PRESENTS THAT:
Nationwide Mutual Insurance Company,an Ohio corporation
hereinafter referred to severally as the"Company"and collectively as'the Companies"does hereby make,constitute and appoint
Randal Mark Troike
each in their individual capacity,its true and lawful attorney-in-fact,with full power and authority to sign,seal.and execute on its behalf any and all bonds and
undertakings,and other obligatory instruments of similar nature,in penalties not exceeding the sum of
Five Thousand and NO/100 Dollars ($5,000.00)
and to bind the Company thereby,as fully and to the same extent as if such instruments were signed by the duly authorized officers of the Company;and all acts
of said Attorney pursuant 10 the authority given are hereby ratified and confirmed
This power of attorney is made and executed pursuant to and by authority of the following resolution duly adopted by the board of directors of the Company:
"RESOLVED,that the president or any vice president be,and each hereby is,authorized and empowered to appoint attorneys-in-fact of the Company.
and to authorize them to execute and deliver on behalf of the Company any and all bonds,forms.applications,memorandums,undertakings.
recognizances.transfers,contracts of indemnity.policies.contracts guaranteeing the fidelity of persons holding positions of public or private trust,and other
writings obligatory in nature that the business of the Company may require:and to modify or revoke,with or without cause,any such appointment or
authority;provided,however,that the authority granted hereby shall in no way limit the authority of other duly authorized agents to sign and countersign any
of said documents on behalf of the Company."
"RESOLVED FURTHER,that such attorneys-in-fact shall have full power and authority to execute and deliver any and all such documents and to bind the
Company subject to the terms and limitations of the power of attorney issued to them and to affix the seal of the Company thereto;provided,however,that
said seal shall not be necessary for the validity of any such documents."
This power of attorney s signed and sealed under and by the following bylaws duly adoptec by the board of directors of the Company
Execution of Instruments.Any vice president,any assistant secretary or any assistant treasurer shall have the power and authority to sign or attest all
approved documents,instruments,contracts,or other papers in connection with the operation of the business of the company in addition to the chairman of
the board,the chief executive officer,president.treasurer or secretary,provided,however,the signature of any of them may be printed.engraved.or
stamped on any approved document,contract.instrument.or other papers of the Company.
IN WITNESS WHEREOF,the Company has caused this instrument to be sealed and duly attested by the signature of its officer the 27°i day of February 2019
Antonio C.Albanese.Vice President of Nationwide Mutual Insurance Company
401%1 ACKNOWLEDGMENT
4140.1M••• • , STATE OF NEW YORK,COUNTY OF NEW YORK ss
� On this 27"day of February.2019,before me came the above-named officer for the Company
u+-,L++ 0 aforesaid.to me personally known to be the officer described in and who executed the preceding
4.:
s.•.• x instrument,and he acknowledged the execution of the same,and being by me duly sworn,deposes
and says.that he is the officer of the Company aforesaid.that the seal affixed hereto is the
corporate seal of said Company,and the said corporate seal and his signature were duly affixed
and subscribed to said instrument by the authority and direction of said Company
sitranm C n«n
*rimy Vupt.State of NO.,ON. // y
No 020E6120M
Qunihed WosuMsty town,. C'�..it :i,t t,• L(.tom,(r /�
CCmottbn Etpnes Se°ten6e•16.171: • .7 wewra,w•c
aaY Cawtn,uon too•et
SeelMoa•11.Y°71
CERTIFICATE
I.Laura B.Guy,Assistant Secretary of the Company.do hereby certify that the foregoing is a full.true and correct copy of the original power of attorney issued
by the Company,that the resolution included therein is a true and correct transcript from the minutes of the meetings of the boards of directors and the same has
not been revoked or amended in any manner:that said Antonio C.Albanese was on the date of the execution of the foregoing power of attorney the duly elected
officer of the Company,and the corporate seal and his signature as officer were duly affixed aria subscribed to the said instrument by the authority of said board
of directors and the foregoing power of attorney is still in full force and effect.
IN WITNESS WHEREOF.I have hereunto subscribed my name as Assistant Secretary.and affixed the corporate seal of said Company this 13th day of
August 20 t 9
(xa,„,ta. e
Assistant Secretary
BDJ 1(02-19)00