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BID BOND CITY OF OSHKOSH
RECEIVE[,
Contract Number 25-04 (Bay Shore Dr & Bay St Reconstruction) NOV 18 2024 Bond #481346
Date Bond Executed (Date of Contract or hater) 11/11/2024 DEPT OF PUBLIC WORKS
PRINCIPAL/CONTRACTOR (Legal Name and Business Address) Type of Organization
CARL BOWERS & SONS CONSTRUCTION CO INC Individual _Partnership
N1844 Maloney Rd X Corporation
Kaukauna, WI 54130
State of Incorporation
Wisconsin
Penal Sum of Bond
SURETY(IES) (Legal Name(s) and Business Address(es)) Pea of Bid Amount
MERCHANTS BONDING COMPANY (MUTUAL)
PO Box 14498
Des Moines, IA 50306-3498
OWNER (Legal Name and Business Address)
CITY OF OSHKOSH
215 Church Avenue
PO Box 1130
Oshkosh, Wisconsin 54903-1130
OBLIGATION
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 u1 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.
Page 1 of 2
y to an
Notice to the Contractor or Surety shall be deemed to have been given: (iwmo deliverin the United officer or person
entitled to such notice, if hand delivered; or (ii) two (2) business days followingdeposit
s mail,
postage prepaid; (iii) upon delivery by a commercial carrier that wc ltlransmf issionthe �Notices shall be prlovided to the
upon transmission if by facsimile, e-mail, or other form of electron
Owner, Surety, and/or Contractor at their address as specified on this be or to a for this purpose,
facsimile,
e-mail or other
electronic address that has been provided in writing to the otherpaty
on of this
nd. Winnebago
The laws of the State of Wisconsin shall govern the interpretation An coprovision yin this bondothat may conflict
County shall be the venue for all disputes arising under this Bo y
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.
lame of Principal/Contractor
See, Lai �11
Title
Name of Surety (Michael L Tiedt)
w-J �
e 4
,
Attorney -in -Fact
�t(j Srla s
Title
Page 2 of 2
Bond #: 431346
BONDING COMPANY, -
POWER OF ATTORNEY
Know All Persons By These Presents, that MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC.,
both being corporations of the State of Iowa, d/b/a Merchants National Indemnity Company (in California only) (herein collectively called the
"Companies") do hereby make, constitute and appoint, individually,
Michael L Tiedt
their true and lawful Attomey(s)-in-Fact, to sign Its name as surety(ies) and to execute, seal and acknowledge any and all bonds, undertakings,
contracts and other written Instruments in the nature thereof, on behalf of the Companies in their business of guaranteeing the fidelity of
persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions
or proceedings allowed by law.
hority of the following By -Laws adopted by the Board of
This Power-of-Attomey is granted and is signed and sealed by facsimile under and by aut
Directors of Merchants Bonding Company (Mutual) on April 23, 2011 and amended August 14, 2015 and April 27, 2024 and adopted by the Board of
Directors of Merchants National Bonding, inc., on October 16, 2015 and amended on April 27, 2024,
"The President, Secretary, Treasurer, or any Assistant Treasurer or any Assistant Secretary or any Vice President shall have power and
authority to appoint Attomeys-in-Fact, and to authorize them to execute on behalf of the Company, and attach the seal of the Company thereto,
bonds and undertakings, recognizances, contracts of indemnity and other writings obligatory in the nature thereof."
'The signature of any authorized officer and the seal of the Company may be affixed by facsimile or electronic transmission to any power of Attorney
or Certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligations of the
Company, and such signature and seal when so used shall have the same force and effect as though manually fixed"
In connection with obligations in favor of the Florida Department of Transportation only, it is agreed that the power and out hority hereby given to the
Attorney -in -Fact includes any and all consents for the release of retained percentages and/or final estimates on engineering and construction
contracts required by the State of Florida Department of Transportation. It is fully understood that consenting to the State of Florida Department
of Transportation making payment of the final estimate to the Contractor and/or its assignee, shall not relieve this surety company of any of
its obligations under its bond,
In connection with obligations in favor of the Kentucky Department of Highways only, it is agreed that the power and authority he
given
to the Attorney -In -Fact cannot be modified or revoked unless prior written personal notice of such intent has been given to the Commissioner -
Department of Highways of the Commonwealth of Kentucky at least thirty (30) days prior to the modification or revocation.
In Witness Whereof, the Companies have caused this instrument to be signed and sealed this 11th day of November 2024
ee'•"""++r • e ®" •a • • MERCHANTS BONDING COMPANY (MUTUAL)
••ee•*-11O Nqg °+e,+ G Q�•� •• MERCHANTS NATIONAL BONDING, INC.
•' RPO/►; '®'. ; b•`Q1PQ9' a d/b/a MERCHANTS NATIONAL INDEMNITY COMPANY
�v__•aa . 4 a�J••.y • 2003
1933
a
By
®��!dea. •°a'jI •!Nv \• President
STATE OF IOWA Sol
COUNTY OF DALLAS ss.
On this 11th day of November 2024 before me appeared Larry Taylor, to me personally known, who being by me duly swom
did say that he is President of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC.; and that the
seals affixed to the foregoing instrument are the Corporate Seals of the Companies; and that thee -said instrument was signed and sealed in behalf
of the Companies by authority of their respective Boards of Directors,
AQ,' %P Penni Miller
O Commission Number 787952
a e • My Commission Expires
lowP January 20, 2027 Notary Public
(Expiration of notary s commission
does not invalidate this instrument)
1, Elisabeth Sandersfeld, Secretary of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC., do
hereby certify that the above and foregoing is a true and correct copy of the POWER -OF -ATTORNEY executed by said Companies,which is still
in full force and effect and has not been amended or revoked.
In Witness Whereof, I have hereunto set my hand and affixed the seal of the Companies on this 11th day of November 2024
•e.•ISION4t oXNG;Ga�,A
�o.
�' x ° ' Q•� 1933 �' Secretary
2003 :.mac off'•. C%::
POA 0018 (6/24) +•+••�°°o ....ee°ee• • • • ... e a
City
OfA
Oshkosh
TO: ALL CONTRACTORS
FROM: ENGINEERING DIVISION OF
CITY OF OSHKOSH DEPARTMENT OF PUBLIC WORKS
SUBJECT: DISCLOSURE OF OWNERSHIP FORM
RECEIVED
NOV 1 8 2024
DEFT OF PUBLIC WORKS
OSHKOSH, WISCONSIN
Please review the attached Department of Workforce Development Disclosure of Ownership form. If Item 3 on this
Disclosure of Ownership 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.
Printed Name
Title
liar% & '&1-s
Company Name
Date
I:\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 1130 Oshkosh, WI 54903-1130 http,//wvwv.ci.oshkosh.wi.us
State of Wisconsin Disclosure of Ownership
Department of Workfome Development
Equal Rights Division
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. Wisconsin
The use of this form is mandatory. The penalty for failing to complete this form is prescribed In Section 103.005(12),
Statutes. [Privacy Law, s. 15.04(1) (m), Wisconsin
Statutesj.
Personal information you provide may used for secondary purposes ta local
governmental unit, or
(1) On the date a contractorsubmitsletes negotiations wit
on as rroject subject to or Pto Section 66.0903, 66.0904 or03.49,W Wisconsin Statutes, the
developer, investor or o P
e agency, local overnmental unit, or developer, investor or owner, the name of
contractor shall disclose to such $twhich the eont actor, or a shareholder, officer or partner of the contractor, owns or
any `other construction business,
has owned within the preceding three (3) years.
(2) The term "other construction business" mend decorating of buildings, business n the
structures erection, facilities. r It ailso means remodeling,
repairing, demolition, altering or painting
business engaged in supplying mineral g 5D e o consnn excavated material or spoil as provided by Sections
66.0903(3), 66.0904(2), 103.49(2) and 103.50(2e
(2)
ental unit project owner, or
(3) This form mus.
st ONLY be filed, eth the publicly tate agency funded private ject owner, c construction uctionopraoject thamwilI be awarding the contract, if both
developer, investor or owner o
(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 withinreceding three
the p
(3) years.
nstruction
(B) The Wisconsin Department of Workforce wageDvlop Deor velopment
Dnd as Betealf the determined
that t the
basic rate of pay, for
business" has failed to pay the prevailing
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
3usiness Name /A
City State Zip Code
Street Address or P 0 Box
Business Name
City State Zip Code
c+roat Address or P 0 Box
Business Name
City State Zip Code
Street Address or P 0 Box
Name
State I Zip
Street Address or P 0 Box
I hereby state under penalty of perjury that the information, contained in this document, is true and
rint the Name of Authorized Officer
4uthorized Officer Signature
Corporation, Partnership or Sole Propri
Street Address or P 0 Box All q q
ERD-7777 (R. 0112011)
Date Signed
Aorship Name
Gail ;60
NoflvrIr%Y' Ripen
//// 1 /00z-,/
JG State Zip Code
City
if have any questions call (608) 266-6861
cito`
Oshkosh
TO: ALL CONTRACTORS
FROM: ENGINEERING DIVISION OF
CITY OF OSHKOSH DEPARTMENT OF PUBLIC WORKS
SUBJECT: SOIL AND GROUND WATER MANAGEMENT PLAN
CERTIFICATION
RECEIVED
NOV 1 S 2024
DEPT OF PUBLIC WORKS
OSI-IIr,OSH, WISCONSIN
I certify by my signature below that our firm has read the Soil mid Ground Water Management Plan
included in the Specifications and will comply with the requirements of the Plan.
�i �� 30W ors
Printed Name
tPGre4arq a ee.'-
Title
Gall Lue.15 t ions
Company Name
U//f /To Zee
Date
1: \ Engineering\Tracy Taylor\Public Works Contracts \Miscellaneous\Boll&Groundwater
Management Plan Certification_2-1-17.doot
Page 1 of 1
City Hall, 215 Church Avenue P.O. Box 1130 Oshkosh, WI 54903-1130 http://www.ci.oshkosh.Wi.us
RECENED
CONTRACT 25-04 NOV 18 2024
ATTACHMENT A
DEPT OF PUBLIC WORKS
LIST OF PROPOSED SUBCONTRACTORS O HKOSVI. WISCONSIN
Pursuant to Section 66.29(7), Wisconsin Statutes, the Bidder, as part of this Proposal, submits this full and
complete list of all the Proposed 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.
NAME OF PROPOSED
SUBCONTRACTOR
/,/7- -�Oe
Ar l; x
CLASS OR ITEMS OF WORK
4F10- -Wyl /,(
A SAO 1
PERCENT OF
CONTRACT AMOUNT
S �4
I hereby certify that the use of the name(s) of the above Proposed Subcontractor(s) was with the
knowledge and consent of the said Subcontractor(s).
Page 16 of 19 (Revised)
RECEIVED
CONTRACT 25-04
PROPOSAL
NOV 18 2024
DEPT OF PUI3LIC WORKS
OSHKOSH, WISCONSIN
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
Carl flo w /9 .5y'-2 9
(Name of Corporation, Partnership, or Person Submitting Bid)
a corporation organized and existing under the laws of the State of L✓i,5 G &-2 --S�d
a Partnership consisting of ; or
an individual trading as of
the City of ; State 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 true and correct.
Signature
5.0 ar r r
(Title, if any)
,p +h
Subscribed and sworn to before me this �O day of N'09 �l Zti�
.�� ADAM CARL BOWERS
Notary Public, or other authorized to administer Notary Public
State of Wisconsin
(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 r % of the total amount of the Bid, as
called for in the Official Notice to Contractors.
Page 19 of 19 (Revised)
�41
RECEIVED
NOV 18 2024 CITY OF OSHKOSH
DFPT (.
(�''T I,` ;'SCONSIN
Contract Number 25-04 Bond Number NA
Date Bond Executed (Date of Contract or Later) November 18, 2024
PRINCIPALICONTRACTOR (Legal Name and Business Address)
PTS CONTRACTORS, INC.
4075 Eaton Road
Green Bay, WI 54311
SURETY(IBS) (Legal Name(s) and Business Address(es))
LIBERTY MUTUAL INSURANCE COMPANY
175 Berkeley Street
Boston, MA 02116
OWNER (Legal Name and Business Address)
CITY OF OSHKOSH
215 Church Avenue
PO Box 1130
Oshkosh, Wisconsin 54903-1130
OBLIGATION
Type of Organization
_ individual —partnership
}� Corporation
State of 111corporation
Wisconsin
Penal Sum of Bond
Five Percent of Amount Bid
(5% 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 sucn 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 uponbetween
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.
Page 1 of 2
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,
hostage prepaid; (iii) upon delivery by a commercial carrier that will certify the date and time of delivery; or (iv)
upon transmission if by facsimile, e-mail, 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, e-mail 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. Wirmebago 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.
ITS CONTRACTORS, INC.
Name of Principal/Contractor
Title Stev,�,g4kWji7 Vice -President
C; o •,,
\\\ ••� .H..N. •- A
V..G _7 • V.
: ': Z
SEAT,
7972t::������`
LIBERTY MUTUAL INSURANCE COMPANY
Name of Surety
1N8up
Fo
J�JP°oape�r�y�'
c�
�1912y 0
Title Roxanne Jensen, Attorney -in -Pact soai�. s s
Page 2 of 2
j0
1 TO
N
0
Liberty
Mutual.
SURETY
This Power of Attorney limits the acts of those named herein, and they have no authority to
bind the Company except in the manner and to the extent herein stated.
Liberty Mutual Insurance Company
The Ohio Casualty Insurance Company
West American Insurance Company
POWER OF ATTORNEY
Certificate No: 8209723.364019
KNOWN ALL PERSONS BY THESE PRESENTS: That The Ohio Casualty Insurance Company is a corporation duly organized under the laws of the Slate of New Hampshire, that
Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts, and West American Insurance Company Is a corporation duly organized
under the laws of the State of Indiana (herein collectively called the °Companies'), pursuant to and by authority herein set forth, does hereby name, constitute and appoint, Brian
Krause Kelly Cody Marc Sacht Roxanne Jensen Trudy A Szolewski
all of the city of Milwaukee state of Wt each individually if there be more than one named, its true and lawbi attorney -in -fact to make,
execute, seal, acknowledge and deliver, for and on its behalf as surety and as its act and deed, any and all undertakings, bonds, recognizances and other surety obligations, in pursuance
of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and allesled by the secretary of the Companies in their own proper
persons.
IN WITNESS WHEREOF, this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed
thereto this 3rd `day of April , 2023 ,
Liberty Mutual Insurance Company
P� 1Nst/� PvtY INsp 1NSQO, The Ohio Casualty Insurance Company
AJ ion°OR+r '!p yJ 4oAPOR4r�y \JP �oHPOR4r�,y0 West American insurance Company
�1912 0 ° y1919�0 s 1991 on
�dj1�dICHUS' da y°� N�Ha6�'�da� Ys �•vouH� .dad B/
n.vi i m rarov ecclelons .Q rrofn-
State of PENNSYLVANIA
County of MONTGOMERY ss
this 3rd day of April , 2023 before me personally appeared David M. Carey, who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance
npany, The Ohio Casualty Company, and West American Insurance Company, and that he, as such, being authorized so to do, execute the foregoing instrument for the purposes
rein contained by signing on behalf of the corporations by himself as a duly authorized officer,
IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my notarial seal at Plymouth Meeting, Pennsylvania, on the day and year first above written.
`5�, PA&T,
,%olAvc-, CommorrrmallhoiPcnnsyNania•Nolaryaeal
Tessa PasomNotary PAW
orMonlgomeryCounty
MyoommisstoneWvesMarch 28,2025 By:
c commission number 1126044
P LA Member, Member,PenmylvarvaAuociationofNolaries Teresa Pastella, Notary Public
°rnBv P�ya
This Power of Attorney is made and executed pursuant to and by authority of the following Bylaws and Aulhorizations of The Ohio Casualty Insurance Company,
Insurance Company, and West American Insurance Company which resolutions are now in full force and effect reading as follows:
Liberty Mutual
ARTICLE IV —OFFICERS: Section 12. Power of Attorney.
Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President, and subject to such limitation as the Chairman or the
President may prescribe, shall appoint such afiorneys•in•fact, as may be necessary to act in behalf of the Corporation to make, execute, seal, acknowledge and deliver as surety
any and all undertakings, bonds, recognizences and other surety obligations. Such attomeys•in•facl, subject to the limitations set forth in their respective powers of attorney, shall
have full power to bind the Corporation by their signature and execution of any such Instruments and to attach thereto the seal of the Corporation. When so executed, such
Instruments shall be as binding as if signed by the President and attested to by the Secretary. Any power or authority granted to any representative or attomeyin-fact under the
provisions of this article may be revoked at any time by the Board, the Chairman, the President or by the officer or officers granting such power or authority.
ARTICLE XIII — Execution of Contracts: Section 5. Surety Bonds and Undertakings.
Any officer of the Company authorized for that purpose in writing by the chairman or the president, and subject to such limitations as the chairman or the president may prescribe,
shall appoint such attomays•in•fact, as may be necessary to act in behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings,
bonds, recognizances and other surety obligations. Such attomeys•in•fact subject to the limitations set forth in their respective powers of attorney, shall have full power to bind the
Company by their signature and execution of any such instruments and to attach thereto the seal of the Company, When so executed such instruments shall be as binding as if
signed by the president and attested by the sacretary,
Certificate of Designation — The President of the Company, acting pursuant to the Bylaws of the Company, authorizes David M. Carey, Assistant Secretary to appoint such attomeys•in-
fact as may be necessary to act on behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety
obligations.
Authorization — By unanimous consent of the Company's Board of Directors, the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the
Company, wherever appearing upon a certified copy of any power of attorney Issued by the Company in connection with surety bonds, shall be valid and binding upon the Company with
(he same force and effect as though manually affixed.
I, Renee C. Llewellyn, the undersigned, Assistant Secretary, The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and West American Insurance Company do
hereby certify that the original power of attorney of which the foregoing is a full, true and correct copy of the Power of Attorney executed by said Companies, is in full force and effect and
has not been revoked.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this 181%y of /yW 2024 .
INSU
INS
j 3cA °�r�y�m �J ePHvo'PZI1� uP a ae+royniA
1912 p t 1919 0 ` 1991 0
cHus aria y°� a Nvs`` �a� YS !NDIAH� da°� By Renee C. Llewellyn, Assistant Secretary
�M * K�
LMS•12073 LMIC 000 WAIC Muil Co 02121
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City RECEIVED
O� I'
Oshkosh NOV 18 2U24
DEPT OF PUBLIC WORKS
OSHKOSH, 11'1SCONSIN
TO: ALL CONTRACTORS
FROM: ENGINEERING DIVISION OF
CITY OF OSHKOSH DEPARTMENT OF PUBLIC WORKS
SUBJECT: DISCLOSURE OF OWNERSHIP FORM
Please review the attached Department of Workforce Development Disclosure of Oznership form. If Item 3 on this
Disclosure of Ownership 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 Ozonersllip form does NOT apply to your company, you must complete the
information below and upload tlus 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.
Name V
Steve C. Horn
Printed Name
Vice -President
Title
PIS Contractors, Inc.
Company Name
Nov. 18, 2024
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 54903-1130 http://www.ci.oshkosh.wi.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 O Box
City
State
Zip Code
Business Name
Street Address or P O Box
City
State
Zip Code
Business Name
Street Address or P O Box
City
State
Zip Code
Business Name
Street Address or P O Box
City
State
Zip Code
I 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 O Box
City
State
Zip Code
If you have any questions call (608) 266-6861
ERD-7777 (R. 01/2011)
City�
Oshkosh
TO: ALL CONTRACTORS
FROM: ENGINEERING DIVISION OF
CITY OF OSHKOSH DEPARTMENT OF PUBLIC WORKS
SUBJECT: SOIL AND GROUND WATER MANAGEMENT PLAN
CERTIFICATION
RECEIVED
Nov 18 2024
DEPT OF PUPLIC WORKS
OSHKOSII, t�'ISCONSIN
I certify by my signature below that our firm has read the Soil and Groioid Water Managenient Plan
included in the Specifications and will comply with the requirements of the Plan.
Nam
Steve C. Horn
Printed Name
Vice -President
Title
PTS Contractors. Inc.
Company Name
Nov. 18, 2024
Date
MEngineering\Tracy Taylor\Public Works Contracts\Miscellaneous\Soil k Groundwater Page 1 of 1
Management Plan Cerlification,_24-17.doex
Ciiy Hall, 215 Church Avenue P.O. Box 1 130 Oshkosh, WI 54903-1 130 hitp://www.ci.oshkosh.wi.us
RECEIVED
CONTRACT 25-04 NOV 18 2024
ATTACHMENT A DEPT of PUBLIC WORKS
OSHKOSH, \VISCONSiN
LIST OF PROPOSED 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 Proposed 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 retaulage
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.
NAME OF PROPOSED
SV,UBCONTRACTOR
/1 0�
AL Ax
CLASS OR ITEMS OF WORK
e,
CDd &
& 04d'd
.
Z-4,-.�,Ue4P,de
PERCENT OF
CONTRACT AMOUNT
�2 3 d7o
6. s 2a
/. 91%
I hereby certify that the use of the name(s) of the above Proposed Subcontractor(s) was with the
knowledge gnd consent of the said Subcontractor(s).
Signature of Bidder
Page 16 of 19 (Revised)
CONTRACT 25-04
PROPOSAL
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
PTS Contractors, Inc,
(Name of Corporation, Partnership, or Person Submitting Bid)
DEP i i'UHL(C ;RKS
OSHKOSH, Wi:XONSIN
a corporation organized and existing under the laws of the State of Wisconsin
a Partnerslp consisting of ; or
an individual trading as _ ; of
the City of ; State 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 stat ents are true and correct.
Signature
Vice -President
(Title, if any)
Subscribed and sworn to before me this 18 day of November 20 24
O-At� N. pie�q of
Notary Public, or other authorized to administer > ; ' ''• �F�
•' 140TAp p
N PUBLIC : z
(Bidder should not add any conditions or qualifying statem&jt'Z9 ta- ale OW1 as otherwise the Proposal
may be declared irregular as not being responsive to the AdveMs�,�
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 19 of 19 (Revised)
Contract Number 25-04 Bond#: FDO3293
Date Bond Executed (Date of Contract or Later) 10/30/2024
PRINCIPAUCONTRACTOR (Legal Name and Business Address)
DORNER, INC.
E506 Luxemburg Road
Luxemburg, Wl 54217
SURETY(IES) (Legal Name(s) and Busyness 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
CITY OF OSHKOSH
Nov 18 2024
- nT- ',r.1
Type of Organization
Individual ❑Partnership
✓ Corporation
State Incorporation
I
Penal
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, email 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,
DORNER, INC. Fidelity And Deposit Company Of Maryland
Name of Principal/Contractor Name of Surety
Title `�� v,:'C,ORPC �'., Title Connie Smith, Attorney-in-factoo
'
_ '
s
Imo' . ,*
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 ZURICI4 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 arc
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. KEMP, Robert DOWNEY, Kory
MORTEL and Eliot MOTU, all of Hudson, Wisconsin, its true and lawful agent and Attorney-ln-Fact, to make, execute, seal 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 duty 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/her 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.
_.YNM11,y,
�0 ruQj��5
W!
�.
ATTEST:
ZURICH AMERICAN INSURANCE COMPANY
COLONIAL AMERICAN CASUALTY AND SURETY COMPANY
FIDELITY AND DEPOSIT COMPANY OF MARYLAND
By: Robert D. Murray
Vice President
By: Dawn C, Brown
Secretary
State of Maryland
County of Baltimore
On this 27th day of November, A.D. 2019, before the subscriber, a Notary 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 some, and being by me duly sworn, deposeth and sahh, that he/she is the said officer of
(lie Company aforesaid, and that the seals affixed to the preceding instrument are the 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, 1 have hereunto set my hand and affixed my Official Seal die day and year first above written,
�t,att, frir,�
nuo�;`��,
Constance A. Dunn, Notary Public
My Commission Expires: July 9, 2023
EXTRACT FROM BY-LAWS OF THE COMPANIES
"Article V, Section 8, Attorneys -in -Fact, 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 ZURICFI 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 loth 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 WHEREOF, I have hereunto subscribed my name and affixed the corporate seals of the said Companies,
this 30th day of October , 2024.
�„;��..}, emu►
• • — ORAL5
,.A
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.renortsfelaims(a,zurichna.com
800-626-4577
City
of
Oshkosh
TO: ALL CONTRACTORS
FROM: ENGINEERING DIVISION OF
CITY OF OSHKOSH DEPARTMENT OF PUBLIC WORKS
SUBJECT: DISCLOSURE OF OWNERSHIP FORM
RECEIVEI-1
NOV 1 8 2024
DEPT OF P[ II! � ]C WORKS
OSHKOSI1. '-P' CONSIN
Please review the attached Department of Workforce Development Disclosure of Ozonership form. If Item 3 on this
Disclosure of Ozoitersllip form applies to your company, you must complete the Disclosl.Ire of Ozonership form and
upload in the appropriate location on Quest V-Bid.
If Item 3 on the Disclostn•e of Ozonersliip 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 Ozonership form does NOT apply to my
firm, or a shareholder, officer, or partner of my firm.
L11iLv I i�
Daniel Dorner
Printed Name
President
Title
Dorner Inc.
Company Name
11/18/24
Date
1:\Englneering\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 http://www.ci.oshkosh.wi.us
cito�
Oshkosh
TO: ALL CONTRACTORS
FROM: ENGINEERING DIVISION OF
CITY OF OSHKOSH DEPARTMENT OF PUBLIC WORKS
SUBJECT: SOIL AND GROUND WATER MANAGEMENT PLAN
CERTIFICATION
I certify by my signature below that our firm has read the Soil and Ground Water Managennent Plan
included in the Specifications and will comply with the requirements of the Plan,
1*
- Iz- to 61 1 me�
Daniel Dorner
Printed Name
President
Title
Dorner Inc
Company Name
11 /18/24
Date
1:\rnglneering\Tracy Taylor\Public Works Contracts\Miscellaneous \Soil k Groundwater
Management Plan Certlfication_2-1-17,docx
Page 1 of 1
City Hall, 215 Church Avenue P,O, Box 1 130 Oshkosh, WI 54903-1130 htip://www.cl.oshkosh.wi.us
CONTRACT 25-04
ATTACHMENT A
LIST OF PROPOSED 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 Proposed 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.
NAME OF PROPOSED
SUBCONTRACTOR
&Tot4
04 2C
/ "(Cci
7A1- 5�. W,?o 5-
Cam, A164
CLASS OR ITEMS OF WORK
i
5�lrz5�1
PERCENT OF
CONTRACT AMOUNT
/Co 0
I hereby certify that the use of the name(s) of the above Proposed Subcontractor(s) was with the
knowledge and consent of the said Subcontractor(s).
. ' k-yt�
Signature of Bidder
Page 16 of 19 (Revised)
CONTRACT 25-04
PROPOSAL
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 ; of
the City of ; State 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 true and correct.
wn A
President
Signature
(Title, if any)
Subscribed and sworn to before me this _ day of IONS C M)D<A- 20�.
A\SC
(ALXXZ 0I.AOAU ,r01
r NpTq • 2'
Notary Public, or other authorized to administer
EfnE �•� :fi1=
het i C
�`
(Bidder should not add any conditions or qualifying stafLtny } „ �s 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 19 of 19 (Revised)
1:3111 1: onk
Contract Number 25-04 Bond Number
Bay Shore Drive and Bay Street Reconstruction
Date Bond Executed (Date of Contract or Later) November 5, 2024
PRINCIPAL/CONTRACTOR (Legal Name and Business Address)
Advance Construction, Inc.
2141 Woodale Ave.
Green Bay, WI 54313
SURETY(IES) (Legal Name(s) and Business Address(es))
Great American Insurance Company
301 E. Fourth St.,
Cincinnati, OH 45202
OWNER (Legal Name and Business Address)
CITY OF OSHKOSH
215 Church Avenue
PO Box 1130
Oshkosh, Wisconsin 54903-1130
OBLIGATION
CITY OF OSHKOSH
Type of Organization
_ Individual —Partnership
Corporation
State of Incorporation Wisconsin
Penal Sum of Bond
5% 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 maybe 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.
Page I of 2
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, e-mail, 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, e-mail 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.
Advance Construction, Inc.
Name of Principal/Contractor
Great American Insurance Company
Name of Surety
0q_0A0
Title Layne felin, Attorney -In -Fact
Page 2 of 2
GREAT AMERICAN INSURANCE COMPANY®
Administrative Office: 301 E 4TH STREET 0 CINCINNATI, OHIO 45202 • 513-369-5000 • FAX 513-723-2740
The number of persons authorized by
this power of attorney is not more than THIRTEEN
No.O 22545
POWER OF ATTORNEY
KNOW ALLMEN BY THESE PRESENTS: That the GREATAMERICAN INSURANCE COMPANY, a corporation organized and existing under
and by virtue of the laws of the State of Ohio, does hereby nominate, constitute and appoint the person or persons named below, each individually if more than
one is named, its true and lawful attomey-in-fact, for it and in its name, place and stead to execute on behalf of the said Company, as surety, any and all bonds,
undertakings and contracts of suretyship, or other written obligations in the nature thereof; provided that the liability of the said Company on any such bond,
undertaking or contract of suretyship executed under this authority shall not exceed the limit stated below.
Name
KIMBERLYASCHENBACH
BRIAN REIMER
DEBORAH KNAPP
DILLON HOLEWINSKI
RHONDA KLUESSENDORF
ZACHARY KAISER
ANNEMARIE WILLBANKS
LYNN CLAUSEN
SHELLEY RADATZ
NICHOLAS JULIAN
ANDREW WEISHEIPL
CHRISTEEN CARNEY
Address Limit of Power
LAYNE SELIN ALL
$100,000,000
ALL OF
MENASHA, WISCONSIN
This Power of Attorney revokes all previous powers issued on behalf of the attomey(s)-in-fact named above.
IN WITNESS WHEREOF the GREATAMERICAN INSURANCE COMPANY has caused these presents to be signed and attested by its appropriate
officers and its corporate seal hereunto affixed this 24TH day of SEPTEMBER 2024
Attest GREATAMERICAN INS CE COMP
Assistant Secretary Divisional Senior Vice President
STATE OF OHIO, COUNTY OF HAMILTON - ss: MARK wCARio (877-377-2405)
On this 24TH day of SEPTEMBER 2024,before mepersonally appeared MARKVICARIO,tome known,
being duly swom, deposes and says that he resides in Cincinnati, Ohio, that he is a Divisional Senior Vice President of the Bond Division of Great American
Insurance Company, the Company described in and which executed the above instrument; that he knows the seal of the said Company; that the seal affixed to the
said instrument is such corporate seal; that it was so affixed by authority of his office under the By -Laws of said Company, and that he signed his name thereto
by like authority.
SUSAN A KOHORST
Notary Public
-- =o state of Ohio
My Comm. Expires
May 18, 2025
This Power ofAttomey is granted by authority of the following resolutions adopted by the Board of Directors of Great American Insurance Company
by unanimous written consent dated June 9, 2008.
RESOLVED: That the Divisional President, the several Divisional Senior lice Presidents, Divisional lice Presidents and Divisonal Assistant Vice
Presidents, or any one of them, be and hereby is authorized, from time to time, to appoint one or more Attorneys -in -Fact to execute on behalf of the Company,
as surety, any and all bonds, undertakings and contracts ofsuretyship, or other written obligations in the nature thereof- to prescribe their respective duties and
the respective limits of their authority; and to revoke any such appointment at any time.
RESOLVED FURTHER: That the Company seal and the signature of any of the aforesaid officers and any Secretary or Assistant Secretary of the
Company may be affixed by facsimile to any power of attorney or certificate of either given for the execution of any bond, undertaking, contract of suretyship,
or other written obligation in the nature thereof, such signature and seal when so used being hereby adopted by the Company as the original signature of such
officer and the original seal of the Company, to be valid and binding upon the Company with the same force and effect as though manually affixed.
CERTIFICATION
I, STEPHEN C. BERAHA, Assistant Secretary of Great American Insurance Company, do hereby certify that the foregoing Power of Attorney and
the Resolutions of the Board of Directors of June 9, 2008 have not been revoked and are now in full force and effect.
Signed and sealed this 5th day of November , 2024
Assistant Secretary
81029AH (03/20)
s
y
City
of
Oshkosh
TO: ALL CONTRACTORS
FROM: ENGINEERING DIVISION OF
CITY OF OSHKOSH DEPARTMENT OF PUBLIC WORKS
SUBJECT: DISCLOSURE OF OWNERSHIP FORM
RECEIVED
NOV 1 R 2024
DEPT OF [nif3i-IC WORKS
OSHIOSH, WISCONSIN
Please review the attached Department of Workforce Development Disclosure of Ownership form. If Item 3 on this
Disclosure of Ownership 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.
Name
Glenn Joski
Printed Name
President
Title
Advance Construction, Inc.
Company Name
11 /18/24
Date
hEngineering \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 1130 Oshkosh, WI 54903-1130 http://www.cl.oshkosh.wi.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
None
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
I 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
Glenn Joski
Authori d I ature
Date Signed
11 /18/24
Corporation, Partn ip or Sole Proprietorship Name
Advance Constr ction, Inc.
Street Address or P 0 Box
City
State
I Zip Code
2141 Woodale Ave
I Green Bay
IWI
154313
If you have any questions call (608) 266-6861
9:0na777ta nlir)nll%
crto�
Oshkosh
TO: ALL CONTRACTORS
FROM: ENGINEERING DIVISION OF
CITY OF OSHKOSH DEPARTMENT OF PUBLIC WORKS
SUBJECT: SOIL AND GROUND WATER MANAGEMENT PLAN
CERTIFICATION
RECF.IVF.D
NOV 1 8 z024
DF.PT Ol' Pt13i.1.: WORKS
OSIIKOSH- ti1'15CONSIN
I certify by my signature below that our firm has read the Soil and Ground Water Management Plan
included in the Specifications and will comply with the requirements of the Plan,
Name
Glenn Joski
Printed Name
President
Title
Advance Construction, Inc.
Company Name
11 /18/24
Date
h Engineering \Tracy Taylor\Public Works Contracts\ Miscellaneous \Soil & Groundwater Page 1 of 1
Management Plan Certification 2-1-17.docx
City Hall, 215 Church Avenue P.O. Box 1130 Oshkosh, WI 54903-1 130 http://www.ci.oshkosh.wi.us
RECEIVED
CONTRACT 25-04
ATTACHMENT A NOV 18 2024
DEPT OF PUFUC WORKS
LIST OF PROPOSED SUBCONTRACTORS OSHKOSH,
Pursuant to Section 66.29(7), Wisconsin Statutes, the Bidder, as part of this Proposal, submits this full and
complete list of all the Proposed 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.
NAME OF PROPOSED
SUBCONTRACTOR
yrob., �y 4� t ' �.
CLASS OR ITEMS OF WORK
CID Vt
I hereby certify that the use of the name(s) of the
knowledge and consent of the said Subcontractor(s).
R
Signature of B)&crer
PERCENT OF
CONTRACT AMOUNT
�rS
0
above Proposed Subcontractor(s) was with the
Page 16 of 19 (Revised)
CONTRACT 25-04 RECEIVED
PROPOSAL ! inv 1 9 ?n?h
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
Advance Construction, 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 • of
the City of ; State 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 ar e and correct.
Signature
President
(Title, if any)
Subscribed and sworn to before me this 18 day of Novemb..........
A M4 20 24
NOTAR Y
o
of ry Public, or other authorized to administer 3/17/26 y(p , PUBOCI .;co `=
(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 19 of 19 (Revised)