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AGREEMENT
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WHEREAS, thE! City of U.hko:;!i 'Wi, \1""'1.0", w ,he illvJerslgncJ D
within the street right-of-way a~ follows:
[0 pla(,(, :"n ob(,lruetlon
Installation of ground water mon;t"""g w"li\> W!!11iì1 the pub;;.; ,ì¡¡'"",¡.way ,,' FJonecr Drive,
per attachment fully incorporated withi" ,hi" Ag.""r'Mnt by
re<:,:iOIl
uid"rsiqnfi! ¡¡I'all become
Ih~ Î,nln\lgo:
WHEREAS, Slate law provides that I.:y it;
primarily responsible for damages 10 pelson '"
NOW, THEREFORE, in consld""Jt,o" of UK' 01 Oshi<Oi,i1, Corp',"';',)) granting
permission to the undersigned to place an ol¡;;i,ur'¡,Oii lh& ¡,tfC<)! !he ,mder",gn€d ¡¡grees
thai he/she/it is solely responsiblo lor his/hul,';!'; adi'illic:i lInder ihis ;311[<,,"" un(Jcr:;¡gned hHroby
releases the City of Oshkosh trom all ,1ell!, ~1"lrn5, (if;IPiJr\d,;, daf1liJV',i" ~nd e"""E!5 of mAlon
whatsoever which may result from the pl;:II,:emenl an nbs!ru(;tloi'! ','.('1 r'Ohlo! way by the
undersigned, Further, the undersigned ~9'œ:; 10 pIC;""') "nel ; ,Old thl: C¡'¡ 11é¡rr'n'c'c;s "!.Joins! <>11
actions, claims and demands of ""IY kind I.Ir N¡',dl~'O'Nljr which way i)li. cau$"d by Ihe
activities under this privilege by the undersIJ'""i IJ1 ¡"'¡ploy""'" vnrhl "i9",)<1 agrees
to Indemnify and refund to the C:ty ali such $ums Iii" Cíly Ü!,i'!,pHd or .",judged 10 pay,
including the City's attorney fees 'Jild çosts, on "UCII "cl,ÜIIS, elall11s or wlltlin 30 ()éIYS after written
request for such indemniflçation. The undersigned a¡;I"'ÆS that this pal au, '¡P" ,~; i') ::>e liberally Ç{)nstrued in
favor of the City of Oshkosh, in consideration of tllc privilege 9",ntnd by Ii", Ci/ "i,d.,,' this ",!)'eerne!1t.
This agreement and the privilege (;annot be assigilcd "'Itho'it the wnt(en ÇCI"",¡¡j ()i ¡he City of Ost¡kOS11, The
privilege is subject to all terms ¡;¡nd condition'" wntai¡l()(j in any aulhurízi"iJ '<eou;ul:OiJ adoptçd by the City of
Oshkosh Common Council, whit;11 is incolpomil;d i ~i,,'ell(", as if I,,!i)' recit,,] WllIlIf1 ¡hi" document. By
exeçuting this agreernent and [¡y using the pnv¡ieUH, Uildersrgncd agrr)e.s li,i a[¡ide by 51 ¡err terms and
conditions, including revocation upon wrrlterr 1101"::8 101 nonCOmpllil11CQ WI!', IÜS;Qllition <md this
agreement.
Dated this ';;:¡""'day of 'f(\a,<",-h , 2004,
:a::=~--
And:____.-.----.,----.,--,--.------.,-- ,--,.,..---
STATE OF WISCONSIN I
) SS.
WINNEBAGO COUNTY)
PeJ'SonJJily came before me this _:1_y.¡t-.-day of ~ '2UO4, tile ¡Jl)ove.narned
(' ~ ~~-~,._-_.,..__._._._,--- 10.'1'\"' rCflown !e 15£; ,l1e pe($on(s)
who executed the foregoing docurn ton behalf 01 smo ""-,I S" "',10,' Wi, " '" Sin" P, u- J, bIiC,"',',",',',V, ,";>", an(; a,,¡',,1OW, it;dged the
same, ~_<..:..."cZ.."-.,/..~
IJoiwv Put);";, Co" Wic.cons;/I .
My C':,mn IÌSSiofl_lfu..(J,_IG {..dcooý- -
Attachment:
Resol, #04-54 dated 3/09/04 or the O,liimsh Common Cue:",;;
w/attached "Exhibit A",
Form B (Additional Insured) Certificate Number: 101693
ASSOCIATED ELECTRIC & GAS INSURANCE SERVICES LIMITED
Hamilton, Bermuda
CERTIFICATE OF INSURANCE
(Excess Liability)
This Certificate is furnished to the Certificate Holder named below as a matter of information only, Neither this
Certificate nor the issuance hereof modifies the policy of insurance identified below (the "Policy") in any
manner, The Policy terms are solely as stated in the Policy or in any endorsement thereto, Any amendment,
change or extension of the Policy can only be effected by a specific endorsement issued by the Company and
attached to the Policy.
The undersigned hereby certifies that the Policy has been issued by Associated Electric & Gas Insurance
Services Limited (the "Company") to the Named Insured identified below for the coverage described and for the
policy period specified,
Notwithstanding any requirements, terms or conditions of any contract or other document with respect to which
this Certificate may be issued orto which it may pertain, the insurance afforded by the Policy is subject to all of
the terms of the Policy,
NAME OF INSURED: Wisconsin Public Service Corporation
PRINCIPAL ADDRESS: 700 North Adams Street, Green Bay, Wisconsin 54301
POLICY
NUMBER: X0215A1A97
POLICY
PERIOD:
From: 11/15/03
To: 11/15/04
RETROACTIVE DATE: November 15, 1986
DESCRIPTION
OF COVERAGE:
Claims-First-Made Excess Liability Policy covering claims for Bodily Injury, Property
Damage and Personal Injury arising from the operations described below.
LIMIT OF
LIABILITY:
$2,000,000.00 per occurrence and in the aggregate, where applicable
ADDITIONAL
INSURED:
Tbe Certificate Holder is an additional insured under the Policy but only (i) to such
extent and for such Limits of Liability (subject always to the terms and Limits of Liability of
the Policy) as the Named Insured has agreed to provide insurance for the Certificate Holder
under the following contract: Wisconsin Public Service to install ground water monitoring
wells within the public right-of-way of Pioneer Drive in Oshkosh, Wisconsin per Resolution
#04-54 dated 3/9/04 of the Oshkosh Common Council and (ii) with respect to the following
operations: Wisconsin Public Service to install ground water monitoring wells within the
public right-of-way of Pioneer Drive in Osbkosh, Wisconsin per Resolution #04-54 dated
3/9/04 of the Oshkosh Common Council.
Should the Policy be cancelled, assigned or changed in a manner that is materially adverse to the Insured(s)
under the Policy, the undersigned will endeavor to give 30 days advance written notice thereof to the
Certificate Holder; but failure to give such notice will impose no obligation or liability of any kind upon the
Company, the undersigned or any agent or representative of either,
DATE:
ISSUED TO:
March 16, 2004
City of Oshkosh
215 Church Avenue
P.O. Box 1130
Oshkosh, WI 54903
("Certificate Holder")
AEGIS INSURANCE SERVICES. INC,
BY:
l.A~
I'J Jersey City, New Jersey
9001 (8187)
Copies: White--Certificate Holder; Canary--Aegis Insurance Services, Inc.; Pinko-Insured; Goldenrod--Broker
MARCH 9, 2004
04-54
RESOLUTION
(CARRIED 6-0
LOST
LAID OVER
WITHDRAWN
PURPOSE:
GRANT PRIVILEGE IN STREET / PIONEER DRIVE
INITIATED BY:
NATURAL RESOURCE TECHNOLOGY & WISCONSIN PUBLIC
SERVICE
PLAN COMMISSION RECOMMENDATION: Approved w/conditions
WHEREAS, Natural Resource Technology has requested the Common Council
to grant them the privilege of installing ground water monitoring wells within the right-of-
way of Pioneer Drive, per the attached "Exhibit A"; and
WHEREAS, Section 66.0425, Wis. Stats., provides for the granting of a privilege
in a right-of-way; and
WHEREAS, the Plan Commission has approved of this request with conditions.
NOW, THEREFORE, BE IT RESOLVED by the Common Council of the City of
Oshkosh that the proper City officials are hereby authorized and directed to grant
Natural Resource Technology the privilege of installing monitoring wells within the right-
of-way of Pioneer Drive, per the attached "Exhibit A", contingent upon the following:
1 )
2)
The monitoring well be installed in a manner that is approved by the Department
of Public Works.
If no longer needed, the monitoring well be properly abandoned and removed in
accordance with City standards and under the direction of the Department of
Public Works.
Any problem which may arise as a result of the placement of the monitoring well
be the responsibility of the petitioners to correct in coordination with the
Department of Public Works,
All appropriate permits be obtained prior to the start of boring or excavation work.
The monitoring well be modified or removed immediately upon the request of the
City.
The petitioners secure and submit to the City Clerk a separate insurance policy
which names the City as an additional insured with a minimum coverage of
$200,000 per person and $500,000 in general aggregate.
It is the responsibility of the petitioners to file in a timely manner a new insurance
certificate with the City Clerk upon expiration of an existing certificate. Failure to
do so will result in the revocation of the privilege in street within 10 days of
notice.
The petitioners execute a hold harmless agreement with the City.
City Administration reserves the right to approve final location of the monitoring
well.
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