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RECE[vED
AUG - r-1 NZ4
DEPT OF PU WiSCONSiN
IC WORKS
OSHKOSH,
CITY OF OSHKOSH
Contract Number City Contract 24-23, Sanitary Sewer Lining - Various Locations
Date Bond Executed (Date of Contract or Later) August 5, 2024
PRINCIPAL/CONTRACTOR (Legal Name and Business Address)
Visu-Sewer, LLC
W230 N4855 Betker Drive
Pewaukee, WI 53072
SURETY(IES) (Legal Name(s) and Business Address(es))
Trisura Insurance Company
2 Stamford Plaza, Suite 1504
281 Tresser Blvd.
Stamford, CT 06901
OWNER (Legal Name and Business Address)
CITY OF OSHKOSH
215 Church Avenue
PO Box 1130
Oshkosh, Wisconsin 54903-1130
OBLIGATION
Type of Organization
_ hldividual _ Partnership
Corporation
State of Incorporation
Wisconsin
Penal Sum of Bond
Five Percent of
Total Amount Bid (5%)
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.
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,
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.
Visu-Sewer, LLC
Name of Principal/Contractor
Title KbTH M.'1'AL[-_1 Ao0' E2,
i p-EatOsoT kcso
Trisura Insurance Company ``,�tti!l,ffi,,
Name of Surety ``S \(��Ur tf..8 /'V
SEA `c
Title r '•., •�'
Christopher acHovden,
Attorney
Page 2 of 2
iD TRISURA
POWER OF ATTORNEY
Bond Number: N/A
Bond issuance date: AugustT=4
2 Stamford Plaza
Suite 1504, 281 Tresser Boulevard
Stamford, Connecticut 06901
's nure yAW, attM=M
KNOW ALL MEN BY THESE PRESENTS: That TRISURA INSURANCE COMPANY, a corporation organized and existing under the laws of the
State of Oklahoma, authorized to conduct a surety business, and having Its principal place of business at 2 Stamford Plaza, Suite 1504,
Tresser Boulevard, Stamford, Connecticut 06901, does hereby constitute and appoint:
Christopher K. Hovden, Angelica Lopez
their true and lawful attorney(s)-in-fact to execute, seal and deliver for and on its behalf as surety, any and all bonds and undertakings,
contracts of indemnity and other writings obligatory in the nature thereof, which are or may be allowed, required or permitted by law,
statute, rule, regulation, contract or otherwise, and the execution of such instruments) in pursuance of these presents, shall be as
binding upon the said TRISURA INSURANCE COMPANY, as fully and amply, to all intents and purposes, as if the same had been duly
executed and acknowledged by their regularly elected officers at their principal offices.
This Power of Attorney Is executed, and may be revoked, pursuant to and by authority of the By -Laws of TRISURA INSURANCE
COMPANY and is granted under and by authority of the following resolution adopted by the Board of Directors of TRISURA INSURANCE
COMPANY at a meeting duly held on the 111h day of December, 2020.
"RESOLVED, that (1) the Chief Executive Officer, President, Executive Vice President, Senior Vice President, Vice President, or Secretary of
the Corporation shall have the power to appoint, and to revoke the appointments of, Attorneys -in -Fact or agents with power and authority
as defined or limited In their respective powers of attorney, and to execute on behalf of the Corporation and affix the Corporation's seal
thereto, bonds, undertakings, recognizances, contracts of indemnity and other written obligations in the nature thereof or related thereto;
and (2) any such Officers of the Corporation may appoint and revoke the appointments of joint -control custodians, agents for acceptance of
process, and Attorneys -in -fact with authority to execute waivers and consents on behalf of the Corporation; and (3) the signature of any
such Officer of the Corporation and the Corporation's seal may be affixed by facsimile to any power of attorney or certification given for the
execution of any bond, undertaking, recognizance, contract of indemnity or other written obligation in the nature thereof or related thereto,
such signature and seals when so used whether heretofore or hereafter, being hereby adopted by the Corporation as the original signature
of such officer and the original seal of the Corporation, to be valid and binding upon the Corporation with the same force and effect as
though manually affixed."
IN WITNESS WHEREOF, TRISURA INSURANCE COMPANY have each executed and attested these presents
on this 25'h day of February, 2022. STATE OF Connecticut
County of Fairfield
,�adango �'y
r�� s �QIWOnAtf �y �.
-
' SEAL r
6e0 0 .h1.Undenotyngk,p 0lhcet,Sm.ty
On this 2S'h day of February, 2022, before me came the Individual who executed the preceding instrument, tome peiauiidoy nnuwil,
and, being by me duly sworn, said he is the therein described and authorized officer of TRISURA INSURANCE COMPANY; that the
seals affixed to said instrument are the Corporate Seals of said Companies; that the said Corporate Seals and his signature were duly
affixed by order of the Boards of Directors of said Companies. 11
IN TESTIMONY WHEREOF, I have hereunto set my hand affixed my Offlclal Seal, at _
Fairfield, Connecticdt the day and year first above written.
SERENA 1. SZEKELY
Notary Public, State of Connectleui"'
My Commission Expires'10/31/
Expires:10/31/2026
a Notary Public of Connecticut
CERTIOICATION
I, the undersigned officer of TRISURA INSURANCE COMPANY do hereby certify that I have compared the foregoing copy of the Power of
Attorney and affidavit, and the copy of the Sections of the By -Laws of said Companies asset forth In said Power of Attorney, with the
origin?�bWfiJA IA4f*ppme office of said companies, and that the"same are correct transcripts thereof, and of the whole of the said
orj�ri��I�gili+iEtjge s_it}J'ower of Attorney has not been revoked and is now in full farce and effect.
��� 99 •"��• '•., Q ��� IN TESTIMONY WHEREOF, I have hereunto set my hand on this day,
00
Z w AtthardGrant, vrri+Ft`est . 4U<S,Su±tiy
SEAL
TO,CONFIRM`THENTICITY OF THIS BOND OR DOCUMENT EMAIL, us.surety trisura"com
'J/����frfflttlti 0N1%
CIIG��
Oshkosh
TO: ALL CONTRACTORS
FROM: ENGINEERING DIVISION OF
CITY OF OSHKOSH DEPARTMENT OF PUBLIC WORKS
SUBJECT: DISCLOSURE OF OWNERSHIP FORM
AUG - 5 2024
DEPT 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.
Name
Keith M. Alexander
Printed Name
President/CEO
Title
Visu-Sewer, LLC
Company Name
August 6, 2024
Date
1:\Engineering\Tracy Taylor\ Public Works Contracts\Miscellaneous\Disclosure of Ownership Form 2-1-
17,docx
Page 1 of 1
City Hall, 215 Church Avenue P.O. Box 1130 Oshkosh, WI 54903-1 130 http://www.cf.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 knowledue 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)
RECEIVED
AUu --� 5 2024
CONTRACT 24-23
ATTACHMENT A DEPT OF PUBLIC WORKS
OSHKOSH, WISCONSIN
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 from the Subcontractors 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
PTS Contractors, Inc.
Musson Brothers, Inc.
CLASS OR ITEMS OF WORK
Sewer Repairs
CIPP Lateral Liner
PERCENT OF
CONTRACT AMOUNT
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).
Signature of Bidder
Keith M. Alexander, President/CEO
Page 9 of 12
RECEIVED
CONTRACT 24-23 AUG - 5 2024
PROPOSAL DEPT OF PUBLIC 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
Visu-Sewer, LLC
(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.
Si ature
Keith M. Alexander
President/CEO
(Title, if any)
Subscribed and sworn to before me this 5th day of -"August 20 24
�,•�P�. SChu'%
Nota P b ic, or other autl on .ed to dminist�r 0 j Aj,? �, '•,
Lisa"E. Sc�ulze, Notary kb Ic
Waukesha County, WI i —•—
My Commission Expires 2/21/2027 _
(Bidder should not add any conditions or qup�jpng stateme �q4his Proposal as otherwise the Proposal
may be declared irregular as not being responsive 641hA►'K'Nement.)
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 12 of 12