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FEE: $20.00
SINGLE -SITE RIGHT-OF-WAY EXCAVATION LICENSE REcEtv>lD
DEC - 5 2022
Application is made for a license to work within the Right -of -Way:
_1 j ( A / r DEPT OF PUBLIC WORKS
NAME: IUe�( I�n;7 ��GV�L"f6�((�3 1 �ii)l TC%tU�rj Ii�C.. Type of organization: OSHKOSH,WISCONSIN
_ individual _partnership
E-MAIL: C1�C f_�CCelSi�tC�1- C.t%Yy-\ corporation
-� Stato of inc ornnratinn
ADDRESS: I C1 ("l I
Right -of -Way Permit #:
(To Be Completed by City Staff)
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 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
(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: a
EXPIRATION: 3
BOND TERM: /,�, - 3 l - A(>a 1.
INSURANCE TERM: Z - /S" t;6_2 3
DATE:
Applicant's Signa e
-�1535B 2-5b�
Telephone Number
L\ Engineering\ ROW Permits\Single-Site ROW Excavation Bond & License_1-8-19.doc
SINGLE -SITE RIGHT-OF-WAY EXCAVATION BOND
OOLGOOL/
PRINCIPAL(S)(Legal name(s) and business address(es))
Stack Bros. Mechanical Contractors, Inc.
3119 Hill Ave
Superior, WI 54880 RECEWW
Surety(ies) (Name(s) and business address(es))
United Fire & Casualty Company DEC — 2022
118 Second Avenue SE
Cedar Rapids, IA 52407 DEPT OF PUBLIC WORKS
Penal Sum of Bond: $5,000.00 OSHKOSH, WISCONSIN
OBLIGATION:
Type of organization:
individual _ partnership
x corporation
State of Incorporation WI
Right -of -Way Permit #: -
(fo He Completed by City Staff)
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 pursuant to the right-of-way
permit specified above.
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 $5,000.
It is understood and agreed by the Principals) 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 in accordance with the approved right-of-way permit from 11/28/2022 (Date of
Issuance) to December 31, 20 23 (Date of Expiration) for the specified right-of-way permit number listed on this form. This bond
shall cover claims made for work performed under the license and corresponding right-of-way permit and for an additional two (2)
year maintenance period beyond the above expiration date. The principal agrees to correct all maintenance issues brought to the
attention of the Principyil(s) upon receiving notice from the City of Oshkosh within the two (2) year maintenance period.
SIGNATURES/SF-ALS;
For the Pr in For the Su ety:
Signatur y� Signature0
m .�2
Name Name //
i �� is .vl iGd�✓
Title Title
314o. MAI 5s8o2
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.
1:1Enginecring\RO%V Petnnits\Single-Site ROW Excavation (fond & Licemse 1-8-19.doc
UNITED FIRE & CASUALTY COMPANY, CEDAR RAPIDS, IA Inquiries• Surety Deparhnent.
UNITED FIRE & INDEMNITY COMPANY, WEBSTER, TX 118 Second Ave SE
uf gufl FINANCIAL PACIFIC INSURANCE COMPANY, LOS ANGELES, CA Cedar Rapids, IA 52401
INSURANCE CERTIFIED COPY OF POWER OF ATTORNEY
(original on file at Home Office of Company — See Certification)
KNOW ALL PERSONS BY THESE PRESENTS, That United Fire & Casualty Company, a corporation duly organized and existing under the laws
of the State of Iowa; United Fire & Indemnity Company, a corporation duly organized and existing under the laws of the State of Texas; and Financial
Pacific Insurance Company, a corporation duly organized and existing under the laws of the State of California (herein collectively called the
Companies), and having their corporate headquarters in Cedar Rapids, State of Iowa, does make, constitute and appoint
BENJAMIN P. WASCHE, MARY LOU OLSON, INDIVIDUALLY
their true and lawful Attomey(s)-in-Fact with power and authority hereby conferred to sign, seal and execute in its behalf all lawful bonds,
undertakings and other obligatory instruments of similar nature provided that no single obligation shall exceed $50 , 000, 000.00
and to bind the Companies thereby as Rilly and to the same extent as if such instruments were signed by the duly authorized officers of the Companies
and all of the acts of said Attorney, pursuant to the authority hereby given and hereby ratified and confirmed.
The Authority hereby granted shall expire the 19th day of February, 2023 unless sooner revoked by United Fire & Casualty Company,
United Fire & Indemnity Company, and Financial Pacific Insurance Company.
This Power of Attorney is made and executed pursuant to and by authority of the following bylaw duly adopted by the Boards of Directors of United
Fire & Casualty Company, United Fire & Indemnity Company, and Financial Pacific Insurance Company.
"Article VI — Surety Bonds and Undertakings"
Section 2, Appointment of Attomey-in-Fact. "The President or any Vice President, or any other officer of the Companies may, from time to time, appoint by written certificates
attorneys -in -fact to act in behalf of the Companies in the execution of policies of insurance, bonds, undertakings and other obligatory instruments of like nature. The signature
of any officer authorized hereby, and the Corporate seal, may be affixed by facsimile to any power of attorney or special power of attorney or certification of either authorized
hereby; such signature and seal, when so used, being adopted by the Companies as the original signature of such officer and the original seal of the Companies, to be valid
and binding upon the Companies with the same force and effect as though manually affixed. Such atoomeys-in-fact, subject to the limitations set of forth in their respective
certificates of authority shall have full power to bind the Companies by their signature and execution of any such instruments and to attach the seal the Companies thereto.
The President or any Vice President, the Board of Directors or any other officer of the Companies may at any time revoke all power and authority previously given to any
�w atomey-in-fact.
IN WITNESS WHEREOF, the COMPANIES have each caused these presents to be signed by its
",plool�p vice president and its corporate seal to be hereto affixed this 19t h day of February, 2021
`4o�yus[lyt c i o`��,•G�FIG tIR Sb ,, ```aQ 0.-QA,�''
oa QP,.-pAPdAgt., O„ ` . UNITED FIRE & CASUALTY COMPANY
�` °.' UNITED FIRE &INDEMNITY COMPANY
�+ CORYORAIR
=
SEAL t Z' Isss a' a FINANCIAL PACIFIC INSURANCE COMPANY
SE
q+ iiuiiili
/1411RIpP\� „ By: r
State of Iowa, County of Linn, ss: Vice President
OfeAMIkO, ioCbAe9 h%QZYily s` 9911; dWL9B9b M W#lQVW 11cXiM%@CQ&l gUPiA, SRatOPMA; that he is a Vice President of United Fie
& Casualty Company, a Vice President of United Fire & Indemnity Company, and a Vice President of Financial Pacific Insurance Company the
corporations described in and which executed the above instrument; that he knows the seal of said corporations; that the seal affixed to the said instrument
is such corporate seal; that it was so affixed pursuant to authority given by the Board of Directors of said corporations and that he signed his name thereto
pursuant to like authority, and acknowledges same to be the act and deed of said corporations.
W",
µ.LJudith A. Jones
Iowa Notarial Seal
Commission number 173041 Notary Public
My Commission Expires 4/23/2024 y15M1y*C11iS`SI
ion expires: 4/23/2024
I, Mary A. Bertsch, Assistant Secretary of United Fire & Casualty Company and Assistant Secretary of United Fire & Indemnity Company, and Assistant
Secretary of Financial Pacific Insurance Company, do hereby certify that I have compared the foregoing copy of the Power of Attorney and affidavit, and
the copy of the Section of the bylaws and resolutions of said Corporations as set forth in said Power of Attorney, with the ORIGINALS ON FILE IN THE
HOME OFFICE OF SAID CORPORATIONS, and that the same are correct transcripts thereof, and of the whole of the said originals, and that the said
Power of Attorney has not been revoked and is now in full force and effect.
In testimony whereof I have hereunto subscribed my name and affixed the corporate seal of the said Corporations
this 28 day of November 2022
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By: `I YJn� A ZvO&b
Assistant Secretary,
OF&C & OF&I & FPIC
BPOA0045 122017