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Home My WebLink AboutCD Smith Construction 2019 FEE: $20.00 ANNUAL RIGHT-OF-WAY EXCAVATION LICENSE Application is made for a license to work within the Right-of-Way: NAME: CD Smith Construction Type of organization: / ,/ individual partnership E-MAIL: -'-h/vna�°'/I A e c- s i ii \t''` ,e "° ''t x corporation 125 Camelot Drive State of Incorporation WI ADDRESS: Fond Du Lac, WI 54935 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: 'I I I1Q 12011 EXPIRATION: PC 31 , 20 ICI BOND TERM: q lU�1 1 _ 12131(j C( INSURANCE TERM: (0( 11 DATE: 9/ICPI/9 Applicant's Signature 9a7o-9a4/-.29oo Telephone Number I:\Engineering\ROW Permits\Annual ROW Excavation Bond&License_1-8-19.doc ANNUAL RIGHT-OF-WAY EXCAVATION BOND Bond No.8252-51-68 PRINCIPAL(S)(Legal name(s)and business address(es)) Type of organization: C.D.Smith Construction,Inc. _individual partnership 125 Camelot Drive Fond du Lac,WI 54935 x corporation Surety(ies)(Name(s)and business address(es)) State of Incorporation Wisconsin Federal Insurance Company 202B Halls Mill Rd,PO Box 1650 Whitehouse Station,NJ 08889-1650 Penal Sum of Bond: $25,000.00 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 work within the right-of-way area(s)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, sidewalk, terrace, or other public right-of-way, vacated right-of-way, or City easement areas in accordance with the current edition of the Standard Specifications for City of Oshkosh, Wisconsin; and pay to the City of Oshkosh any amounts due for services or materials furnished in connection therewith within one(1)month 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 thirty(30)days of written demand for payment;however,the penal sum of this bond shall not exceed$25,000. 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 September 10,2019 (Date of Issuance) to December 31, 2019 (the annual license period). This bond shall cover claims made for work performed during this annual license period and for an additional two(2)year maintenance period beyond the expiration of this annual license period. The principal agrees to correct all maintenance issues brought to the attention of the Principal(s)upon receiving notice from the City of Oshkosh within the two(2)year maintenance period. SIGNATURES/SEALS: For the Pr' ipal: Forrr the Sure O• Y g S : Signature r gnatu e PO 4 74— se':Ie/ _ Ellen C.Chapman Name Name CFO Attorney-in-Fact Title Title 101 Camelot Drive Suite 2B,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. 1:\Engmeering\ROW Permits Annual ROW Excavation Bond&License_]-8-19.doc 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 PACIFIC INDEMNITY COMPANY, a Wisconsin corporation, do each hereby constitute and appoint Donna F. Bardenwerper, Ellen C. Chapman, 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 corporatete seals� onw this 30th�day ofJuly,2019. e A,, at„, Iliwn M.Chlorin Awcict:mt Secretary Stephen M.1 fancy.Vice President 1 ii t ♦41P) . t •STATE OF NEW JERSEY County of Hunterdon ss. On this 30th day ofJuly,2019,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 seals 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 � KATHERINE J.ADELAAR AVM NOTARY PUBLIC OF NEW JERSEY No.2316685 4P1181.tG Expires Exres July 16,2024 Notary Public 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,recognizances,contracts and other written commitments of the Company entered into in the ordinary course of business(each a"Written Commitment"): (D 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 person's 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 class 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 class 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 foregoing Power of Attorney is true,correct and in full force and effect. Given under my hand and seals of said Companies at Whitehouse Station,NJ,this { day o f ,.-th'\ry fii fx , 2U 1 _ e � ( •` ,i�• `_A rain-h. e . &8‘ Dawn M.Chkx. .`,zictant Sen.etar? IN THE EVENT YOU WISH TO 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 a-malt surety@chubb.com FED-VIG-PI(rev.08-18) FEDERAL INSURANCE COMPANY STATEMENT OF ASSETS,LIABILITIES AND SURPLUS TO POLICYHOLDERS Statutory Basis DECEMBER 31,2018 (in thousands) LIABILITIES AND ASSETS SURPLUS TO POLICYHOLDERS Cash and Short Term Investments $ (360,335) ,Outstanding Losses and Loss Expenses 5 6,523,482 United States Government,State Reinsurance Payable on Losses and Expenses 1,490,981 and Municipal Bonds 5,736,426 Unearned Premiums 1,914,190 Other Bonds 3,916,616 Ceded Reinsurance Premiums Payable 405,271 Stocks 100,774 Other Liabilities 565,865 Other Invested Assets 959,127 TOTAL INVESTMENTS 10,354,608 TOTAL LIABILITIES 10,699,789 Investments in Affiliates: Capital Stock 20,980 Great Northern Ins.Co. 384,987 Paid-In Surplus 2,711,474 Vigilant Ins.Co. 333,743 Unassigned Funds 2.057,388 Chubb Indemnity Ins.Co. 176,202 Chubb National Ins.Co. 176,647 SURPLUS TO POLICYHOLDERS 4,789,842 Chubb European Inv.Holdings,SLP 120,469 Other Affiliates 99,299 Premiums Receivable 1,281,368 Other Assets 2,762.308 TOTAL LIABILITIES AND TOTAL ADMITTED ASSETS 5 15,689,631 SURPLUS $15,689,631 Investments are valued in accordance with requirements of the National Association of Insurance Commissioners,At December 31,2018, investments with a carrying value of 5566,806,856 were deposited with government authorities as required by law. STATE OF PENNSYLVANIA COUNTY OF PHILADELPHIA John Taylor.being duly sworn.says that he is Senior Vice President of Federal Insurance Company and that to the best of his knowledge and belief the foraying is a true and correct statement of the said Company's financial condrlion as of the 31 st day of December,2018. Sworn before me s y r I&J&GL t uI enior ce 'dent q ILD-t...4..SSid- 0-1 1 niNUS—i. Notary Public My comrrssion expires COMMONWEALTH OF PENNSYLVANIA 1 NOTARIAL SEAL Diane Wright, Notary Public City of Philadelphia, Philadelphia County My Commission Expires Aug. 8, 2019 EMBER,PENNSYLVANIA ASSOCIAT IQN OF NOTARiE