HomeMy WebLinkAbout24-07 Doner Incfit``" CITY OF OSHKOSH
Contract Number 24-07
Date Bond Executed (Date of Contract or Later) 1/18/2024
PRINCIPAL/CONTRACTOR (Legal Name and Business Address)
DORNER, INC.
E506 Luxemburg Road
Luxemburg, WI 64217
SURETY(IES) (Legal Name(s) and Business Address(es))
Fidelity And Deposit Company Of Maryland
1299 Zurich Way, 5th Floor
Schaumburg, IL 60196-1056
OWNER (Legal Name and Business Address)
CITY OF OSHKOSH
215 Church Avenue
PO Box 1130
Oshkosh, Wisconsin 54903-1130
OBLIGATION
Type of Organization
BIndividual ❑Partnership
Corporation
State of Incorporation
I
Penal Sum of Bond
Five Percent Of Amount Bid
The Contractor and Surety, jointly and severally, bind themselves, their heirs, executors, administrators, successors
and assigns to the Owner for the amount of the penal sum identified above if the Owner accepts the bid of this
Contractor within the time specified in the bid documents or within such time period as may be agreed upon
between the Owner and the Contractor, and the Contractor shall fail to execute the Contract within. five (5) business
days of written notice to the Contractor and Surety of Owner's intent to make a claim upon this Bond,
The Surety hereby waives any notice of an agreement between the Owner and Contractor to extend the time in
which the Owner may accept the bid,
If the Contractor either enters into a contract with Owner in accordance with the terms of the bid and gives such
bond(s) that may be specified in the bidding documents for the faithful performance of the Contract and for the
prompt payment of labor, materials and supplies furnished for the purpose thereof, or pays to the Owner the
difference between the amount specified in the bid and such larger amount for which the Owner may in good faith
contract with another party to perform the work covered in such bid, then the Surety and the Contractor shall have
no obligation under this Bond.
Notice to the Contractor or Surety shall be deemed to have been given: (i) upon delivery to an officer or person
entitled to such notice, if hand delivered; or (ii) two' (2) business days following deposit in the United States mail,
postage prepaid; (iii) upon delivery by a commercial carrier that will certify the date and time of delivery; or (iv)
upon transmission if by facsimile, email or other form of electronic transmission. Notices shall be provided to the
Owner, Surety and/or Contractor at their address as specified on this Bond or to a facsimile, bmail or other
electronic address that has been provided in writing to the other party to be used for this purpose.
The laws of the State of Wisconsin shall govern the interpretation and construction of this Bond. Winnebago
County shall be the venue for all disputes arising under this Bond. Any provision in this Bond that may conflict
with statutory or other legal requirement shall be deemed deleted herefrom and provisions conforming to the
statutory or other legal requirement shall be deemed incorporated herein.
DORMER, INC. 6Oa4,
Name of Principal/Contractor ���� �EAV-11�111
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Title
Fidelity And Deposit Company Of Maryland
Name of S ety f
Title Connie Smith, Attorney -in -fact
ZURICH AMERICAN INSURANCE COMPANY
COLONIAL AMERICAN CASUALTY AND SURETY COMPANY
FIDELITY AND DEPOSIT COMPANY OF MARYLAND
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS: That the ZURICH AMERICAN INSURANCE COMPANY, a corporation of the State of New
York, the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, a corporation of the State of Illinois, and the FIDELITY
AND DEPOSIT COMPANY OF MARYLAND a corporation of the State of Illinois (herein collectively called the "Companies"), by
Robert D. Murray, Vice President, In pursuance of authority granted by Article V, Section 8, of the By -Laws of said Companies, which are
set forth on the reverse side hereof and are hereby certified to be in full force and effect on the date hereof, do hereby nominate, constitute,
and appoint Michael J. DOUGLAS, Connie SMITH, Chris STEINAGEL, Christopher M. ICEMP, Robert DOWNEY, Kory
MORTEL and Eliot MOTU, all of Hudson, Wisconsin, Its true and lawful agent and Attorney -in -Fact, to make, execute, seat and deliver,
for, and on its behalf as surety, and as its act and deed: any and all bonds and undertakings, and the execution of such bonds or
undertakings in pursuance of these presents, shall be as binding upon said Companies, as fully and amply, to all intents and purposes, as If
they had been duly executed and acknowledged by the regularly elected officers of the ZURICH AMERICAN INSURANCE COMPANY at
its office in New York, New York., the regularly elected officers of the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY
at its office in Owings Mills, Maryland., and the regularly elected officers of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND
at Its office in Owings Mills; Maryland,, in their own proper persons.
The said Vice President does hereby certify that the extract set forth on the reverse side hereof is a true copy of Article V, Section 8, of
the By -Laws of said Companies, and is now in force.
IN WITNESS WHEREOF, the said Vice -President has hereunto subscribed his/tier names and affixed the Corporate Seals of the said
ZURICH AMERICAN INSURANCE COMPANY, COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and
FIDELITY AND DEPOSIT COMPANY OF MARYLAND, this 27th day of November, A.D. 2019,
ATTEST:
ZURICH AMERICAN INSURANCE COMPANY
COLONIAL AMERICAN CASUALTY AND SURETY COMPANY
FIDELITY AND DEPOSIT COMPANY OF MARYLAND
By: Robert D. Murray
Vice President
�Dcv,otr � ldwa> ----
By: Dawn E. Brown
Secretary
State of Maryland
County of Baltimore
On this 27th day of November, A.D. 2019, before the subscriber, allotary Public of the State of Maryland, duly commissioned and qualified, Robert D.
Murray, Vice President and Dawn E. Brown; Secretary of the Companies, to me personally, known to be the individuals and officers described in and who
executed the preceding Instrument, and acknowledged the execution of same, and being by me duly sworn, dcposeth and saith, that he/she is the said officer of
the Company aforesaid, and that the seals affixed to the preceding instrument are Ore Corporate Seals of said Companies, and that the said Corporate Seals and
the signature as such officer were duly affixed and subscribed to the said instrument by the authority and direction of the said Corporations,
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my Official Seal the day and year first above written.
Constance A. Dunn, Public
lhlli1111�,`
ly 9,2023
My Commission Expires: July
EXTRACT FROM BY-LAWS OF THE COMPANIES
"Article V, Section 8, •Attome, sy in-Facra The Chief Executive Officer, the President, or any Executive Vice President or Vice President
may, by written instrument under the attested corporate seal, appoint attorneys -in -fact with authority to execute bonds, policies,
recognizances, stipulations, undertakings, or other like instruments on behalf of the Company, and may authorize any officer or any such
attorney -in -fact to affix the corporate seal thereto; and may with or without cause modify of revoke any such appointment or authority at any
time."
CERTIFICATE
I, the undersigned, Secretary of the ZURICH AMERICAN INSURANCE COMPANY, the COLONIAL AMERICAN CASUALTY
AND SURETY COMPANY, and the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, do hereby certify that the foregoing
Power of Attorney is still in full force and effect on the date of this certificate; and I do further certify that Article V, Section 8, of the By -
Laws of the Companies is still In force,
This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of
Directors of the ZURICH AMERICAN INSURANCE COMPANY at a meeting duly called and held on the 15th day of December 1998.
RESOLVED: "That the signature of the President or a Vice President and the attesting signature of a Secretary or an Assistant Secretary
and the Seal of the Company may be affixed by facsimile on any Power of Attorney ... Any such Power or any certificate thereof bearing such
facsimile signature and seal shall be valid and binding on the Company."
This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of
Directors of the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at a meeting duly called and held on the 5th day of
May, 1994, and the following resolution of the Board of Directors of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at a
meeting duly called and held on the 10th day of May,1990.
RESOLVED: "That the facsimile or mechanically reproduced seal of the company and facsimile or mechanically reproduced signature
of any Vice -President, Secretary, or Assistant Secretary of the Company, whether made heretofore or hereafter, wherever appearing upon a
certified copy of any power of attorney issued by the Company, shall be valid and binding upon the Company with the'same force and effect
as though manually affixed.
IN TESTIMONY WIIEREOF, I have hereunto subscribed my name and affixed the corporate seals of the said Companies,
this 18th day of January , 2024 .
RAL
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♦y �4W*I���V,
By: Brian M. Hodges
Vice President
TO REPORT A CLAIM WITH. REGARD TO A SURETY BOND, PLEASE SUBMIT A COMPLETE DESCRIPTION
OF THE CLAIM INCLUDING THE PRINCIPAL ON THE BOND, THE BOND NUMBER, AND YOUR CONTACT
INFORMATION TO:
Zurich Surety Claims
1299 Zurich Way
Schaumburg, IL 60196-1056
www.reportsfolaims@zurichna.coin
800-626-4577
�a
City
Oshkosh
TO: ALL CONTRACTORS
FROM: ENGINEERING DIVISION OF
CITY OF OSHKOSH DEPARTMENT OF PUBLIC WORKS
SUBJECT: DISCLOSURE OF OWNERSHIP FORM
OSHK O,Srr,
Please review the attached Department of Workforce Development Disclosure of Ownership form, If Item 3 on this
Disclosure of Oznership form applies to your company, you must complete the Disclosure of Ownership form and
upload in the appropriate location on Quest V-Bid.
If Item 3 on the Disclosure of Ownership form does NOT apply to your company, you must complete the
information below and upload this page in the appropriate location on Quest V-Bid.
CERTIFICATION
I certify by my signature below that Item 3 of the attached Disclosure of Ownership form does NOT apply to my
firm, or a shareholder, officer, or partner of my firm.
Daniel Dorner
Printed Name
President
Title
Dorner Inc.
Company Name
2/5/24
Date
1;\ Engineering\Tracy Taylor\Public Works Contracts \Miscellaneous\ Disclosure of ownership Form_2-1- Page 1 of 1
17,docx
City Hall, 215 Church Avenue P.O, Box 1 130 Oshkosh, WI 54903-1 130 htip://www.cl.oshkosh.wl.us
State of Wisconsin
Department of Workforce Development
Equal Rights Division
Disclosure of Ownership
The statutory authority for the use of this form is prescribed in Sections 66.0903(12)(d), 66.0904(10)(d) and 103.49(7)(d), Wisconsin
Statutes.
The use of this form is mandatory. The penalty for failing to complete this form is prescribed in Section 103.005(12), Wisconsin
Statutes.
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(1) (m), Wisconsin Statutes],
(1) On the date a contractor submits a bid to or completes negotiations with a state agency, local governmental unit, or
developer, investor or owner on a project subject to Section 66.0903, 66.0904 or 103.49, Wisconsin Statutes, the
contractor shall disclose to such state agency, local governmental unit, or developer, investor or owner, the name of
any "other construction business," which the contractor, or a shareholder, officer or partner of the contractor, owns or
has owned within the preceding three (3) years.
(2) The term "other construction business" means any business engaged in the erection, construction, remodeling,
repairing, demolition, altering or painting and decorating of buildings, structures or facilities. It also means any
business engaged in supplying mineral aggregate, or hauling excavated material or spoil as provided by Sections
66.0903(3), 66.0904(2), 103.49(2) and 103,50(2), Wisconsin Statutes,
(3) This form must ONLY be filed, with the state agency project owner, local governmental unit project owner, or
developer, investor or owner of a publicly funded private construction project that will be awarding the contract, if both
(A) and (B) are met.
(A) The contractor, or a shareholder, officer or partner of the contractor:
(1) Owns at least a 25% interest in the "other construction business," Indicated below, on the date the contractor
submits a bid or completes negotiations; or
(2) Has owned at least a 25% interest in the 'other construction business" at any time within the preceding three
(3) years.
(B) The Wisconsin Department of Workforce Development (DWD) has determined that the "other construction
business" has failed to pay the prevailing wage rate or time and one-half the required hourly basic rate of pay, for
hours worked in excess of the prevailing hours of labor, to any employee at any time within the preceding three (3)
years.
Other Construction Business
Business Name
Street Address or P 0 Box
City
State
Zip Code
Business Name
Street Address or P 0 Box
City
State
Zip Code
Business Name
Street Address or P 0 Box
City
State
Zip Code
Business Name
Street Address or P 0 Box
City
State
Zip Code
1 hereby state under penalty of perjury that the information, contained in this document, is true and
accurate according to my knowledge and belief.
Print the Name of Authorized Officer
Authorized Officer Signature
Date Signed
Corporation, Partnership or Sole Proprietorship Name
Street Address or P 0 Box
City
State
Zip Code
If you have any questions call (608) 266-6861
ERD-7777 (R. 01/2011)
CONTRACT 24-07
ATTACHMENT A
LIST OF SUBCONTRACTORS
Pursuant to Section 66.29(7), Wisconsin Statutes, the Bidder, as part of this Proposal, submits this full and
complete list of all the Subcontractors and the class of work to be performed by each. The
CONTRACTOR will be permitted to sublet a portion of the Contract, but shall perform with their
organization work amounting to at least thirty percent (30%) of the original Contract amount.
Work performed by the CONTRACTOR for any Bid Item that had been subcontracted will not be
included towards the thirty percent (30%) calculation.
If the CONTRACTOR shall sublet any part of this Contract, the CONTRACTOR shall be as fully
responsible to the CITY for the acts and omissions of their Subcontractor and of the persons either directly
or indirectly employed by their Subcontractor as they are by acts or omissions of persons directly
employed by themselves. All Subcontractors, if any, shall be listed in the spaces provided on the
Proposal Form and said list shall not be added to or altered without the written consent of the CITY.
Signed, final waivers of lien will need to be provided to the CITY prior to the release of the final retainage
to the CONTRACTOR.
When a Subcontractor and the class of work to be performed are not listed, it shall be considered that the
Bidder will perform the work themselves.
NA``M,, E OF SUBCONTRACTOR
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CLASS OR ITEMS OF WORK
//Sfis/IF7L L
PERCENT OF
CONTRACTAMOUNT
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I hereby certify that the use of the name(s) of the above Subcontractor(s) was with the knowledge and
consent of the said Subcontractor(s).
Da.J4-tf�
Signature of Bidder
Page 19 of 22
CONTRACT 24-07
PROPOSAL
t x "'ON�,tlti,
The undersigned will begin work as specified after award of the Contract and complete as specified.
I hereby certify that all statements are made in behalf of
Dorner Inc.
(Name of Corporation, Partnership, or Person Submitting Bid)
a corporation organized and existing under the laws of the State of Wisconsin
a Partnership consisting of ; or
an individual trading as
the City of
State of
of
That I have examined and carefully prepared this Proposal from the Plans and Specifications and have
checked the same in detail before submitting this Proposal; that I have full authority to make such
statements and submit this Proposal in (its) (their) behalf; and that said statements are time and correct.
n " o 1)
Subscribed and sworn to before me this
Notary Public, or other authorized to
President
Signature
(Title, if any)
of -- L Ld, car u 20_ a `'11
TqR y ` I
' steP, IC r
oF ' •...........••
,y�41iWISCQ���.
(Bidder should not add any conditions or qualifying statements to this Proposal as otherwise the Proposal
may be declared irregular as not being responsive to the Advertisement.)
Accompanying this Proposal is a Bid Bond in the amount of 5 % of the total amount of the Bid, as
called for in the Official Notice to Contractors.
Page 22 of 22