HomeMy WebLinkAboutPotrykus ConstructionBID BOND CITY OF OSHKOSH
ContractNurnber: 25-06 Bond Number: NIA
2025 Concrete sidewalk (New &. Rehabllitatlon)
Date Band Executed (Date of Contract or Later)
January 13, 2025
PRINCIPALJCONTRACFOR (Legal Name and Business Address)
Potrykus Construction, LLC
207679 County Road I
Eland, WI 54427
BLMM(IES) (Legal Name(s) and Business Address(es))
American Alternative Insurance Corporation
555 College Road East - P.O. Box 5241
Princeton, NJ 08543
OWNER (Legal Name and Business Address)
CITY OP OSHKOSH
215 Church Avenue
PO Box 1130.
Oshkosh, Wisconsin 54903-1130
OBLIGATION
Type of Organization
Individual _ Partnership
Corporation
State of Incorporation
Wisconsin
Penal Sum of Bond
5% of Bid Amount
The Contractor and Surety, jointly and severally, Mind 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 tluis
Contractor withinthe time specified in the Bid documents or within such tine 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 handdelivered,- or (ii) two (2) business days,following deposit in the United States mail,
postage prepaid; QH) 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 onthis Bond or to a facsimile, a-r nail or other electronic
address that has been provided in writing to the other party to be'u,sed for this purpose.
The laws of the State of Wisconsin shall govern the interpretation and construction of this Bond. Winnebago County
shalt be the venue for all disputes arising under Ehis'Bond. Any provision in this Bond that may conflict with
statutory or other legal requirement shall be deemed deleted herefrom and provisions conforuung to the statutory
or other legal requirement shall be deemed incorporated herein.
Potrykus Construction, LLC
Name of Principal/Contractor.
�b4tie
0Wntr
American Alternative Insurance Cored'
Name of Surety S 1
's
rr , .-SEAL;
Title Martin Moss, Attorney-ln-Pact*
Page 2 U 2
State,of Illinois }
) ss.
County of DuPage
On January 13, 2025, before me, Karen A. OConnell, a Notary Public in and for said
County and State, residing therein, duty commissioned and sworn,_ personally appeared
Martin Moss known to me to be Attorney -in -Fact of
American Alternative Insurance Corporation the corporation described in and that
executed the within and foregoing instrument, and known to me to be, the person who
executed the said instrument in belialf of the said corporation, and he duly acknowledged
to me that such corporation executed the same.
IN WITNESS WFIEREOF, I have hereunto set my hand and affixed my official seal, the
day and year stated in this certificate above.
Commission No. 946454
CERTIFIED COPY POWER OF ATTORNEY
KNOWALL MIEN SY THESE PRESENTS: That the AMERICAN ALTERNATIVE INSURANCE CORPORATION, a corporation organized and eiuslinp by virtue of the
laws of the State of Delaware f Corporationj with of icas'al S66 Coilegenbed East Princeton,N.J. 06643, has made, constituted and appointed, and by those presents;
does make, constitute and appoint:'
Martin Moest and StephonT. Karmer
IN VNTNESS WHEREOF. the AMERICAN ALTERNATIVE INSURANCE CORPORATION has caused Its corporate seal to be hereunto Mixed, and those prasentsto be signed
bytes duty authorized officers this 241hday'of September, 2021
BY:
�c
SEAT. '
Michael G, Kerrier
President
ao 1923 •'
Attest:''MY11/1NOR
ignacle Rivera
Deputy General Counsel &'Secrietary'
STATE OF NEW JERSEY, COUNTY OF SOMERSET
The foregoing instrument was acknowledged before me by means of online notarization this 24c' day of September, W21, by Michael G. Kerner and Ignacio Rivora, who are
porsonaliy known to tno.
SECRETARY'S CERTIFICATE
'fbeundersigned, Ignacio Rivera, hereby. certifies:
1. That the undersigned is Secretary ofAmcrican Alternative Insurance Car
2. That the original power ofattomey of which the foregoing isacopy was
3.
tCorporation duly held an August 4. 1998, and has
RESOLVED, that each of the following officers of this
and the Vice Presidents, be,, and they hereby Are, at
or
Is, surety undertakings or surety contracts made
V
JKOM Sontttlppo taryPublic
Silto of New J rasy ,
My Commission Expires February8. 2026
corporation of the State of Delaware;
ited onbebalfofsaid Corporation on the day of Its do to, and has not since been
ry thereof with said original power ofattomey; and that the same is a;true and correct
led at, and recorded in the minutes of a regular meeting of tIre Board of
ice been revoked, ainended or modifi6d
ion, namely, the President, the Executive Vice President, the Senior Vice Presidents,
froin'time to time in their discretion, to appoint such agent or agents or attomey or
r the purpose of carrying on this Corporation's business, acid to empower such agent
r,111 this wparation's Panic and air its behalf, rued under its seal or otherwise, surety
orpomdon as surety thereon.
RESOLVED. that the signature of any authod7cd officer of the Corporation and the Corporation's scatmaybe ati'rxed by facsimile to any power of
Wormy and revocation of uny power of nUbmay or certificate of either given for the execution of onysurety bond, stuctynndortaking, or surety
contract, such signature and'seal, when soused being l craby adopted by the Corporation as flit original signature of such officer and theoriginat
scaLef the Corporation, to be valid and bhtdurg upon the Corporation with tho samo force and effect as though manually affixed..
FURTHER RESOLVED, that any'prior appoltltmonis by the Corporation ofMGAs are, in allrespcels, hereby ratified, coornmed and approved.
FURTHERRESOLVED, that the Secretary or any AssislantSecretary of this Corporation is hereby authorized to certify and deliver to any person to %Morn
such certification and delivery maybe deemed necessary and desirable in lho opinion of such Secretary or Assistant Secretary. a true copy of the foregoing
resolution.
4. The undersigned has compared the foregoing copies ofsaid original resolutions as so recorded, and they arc flis tonic Into and correct coptes ofsaid
original resolutions as of the Nvhotc thereof,.
Witness the handofilielund, si(a,�i1ei!'>rind'thesealofsaidCorporationthis13t day of
,�atIU N 20 .
ANIERICAN ALTYANATiVE INSURANCE CORPORATION
eeptlPoM7F c 'r
r,
IIA WPRlma t9tr 24.2021108 EDIT"
Ignacio Rivera
Deputy General Counsel & Secretary
TRS-1001.1
CONTRACT 25-06
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
(Name of Corporation, Partnership, or Person Submitting Bid)
a corporation organized and existing under the laws of the State off
a Partnership consisting of
an individual trading as
%-S Cav-'--CzA rU-CA oh U C_
the City of ; State of J i t-SCQ .!Z:;CY-\
or
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 sat s atem is V/e�rue and correct.
Signature
Subscribed and sworn to before me this ? day of
d U3 R -I C
(Title, if any)
20 <�.
Notary Public, or other authorized to administer
u �
(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 % of the total amount of the Bid, as
called for in the Official Notice to Contractors.
Page 10 of 10
CONTRACT 25-06
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%4) 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
ke&gn
CLASS OR ITEMS OF WORK
PERCENT OF
CONTRACT AMOUNT
2.g01a
I hereby certify that the use of the name(s) of the above Proposed Subcontractor(s) was with the
knowledge and conNnt of the said Subcontractor(s).
of
Page 7 of 10
r,A
city
o
fv,
Oshkosh
TO: ALL CONTRACTORS
FROM: ENGINEERING DIVISION OF
CITYOF OSHKOSH DEPARTMENT OF PUBLIC WORKS
SUBJECT: DISCLOSURE OF OWNERSHIP FORM
Please review the attached Department of Workforce Development Disclosure of Ownership form. If Item 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 NQT 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.
(CCLIYG
Printed Name
(Icyuk— n
Title
Wf��Vk�LL-Syls*vciidl U'C-
Company Name
' t 2 - a5
Date
►:\Eng1nw1fig\Tracy Taylor\1'ublkWorks Contracts\Mscellaneous\DlsglosareofOwnership Form-2.1• Page'I of i
17.docz
CltyHall, 2115 Church Avenue P:030x 1130 Oshkosh, WI 54903-1130 h1tp:llwww.c1.oshkosh.wl.us
State of ilVisconsin
Department of Workforce Development Disclosure of Ownership
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.
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, 660904 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 ieast a,25% interest in the "other construction business" at anytime 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 anytime 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 0 Box City
State
Zip Code
1 hereby state under penalty of perjury that the mtormation, contained m znis document, lb tt-utz attu
itVL,UJa6Q QtrVVIU191 LV INS -
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 nail (6081265-bubl
ERD-7777 (R. 0112011)