HomeMy WebLinkAbout25-12 BondsTO:
FROM:
SUBJECT:
n"
City
Of
Oshkosh
ALL CONTRACTORS
ENGINEERING DIVISION OF
CITY OF OSHKOSH DEPARTMENT OF PUBLIC WORKS
DISCLOSURE OF OWNERSHIP FORM
i' Pk: 02
DEPT 0F PUBLIC WORKS
£ SlIhOSl1,W SCONSt
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.
Mark De Groot
Printed Name
President
Title
De Groot, Inc.
Company Name
3/31 /25
Date
1:\lingineering\Tracy Taylor\Public Works Contracts\ Miscellaneous\ Disclosure of Ownership Forna_2-1. Page 1 of 1
17.docx
City Nall, 215 Church Avenue P.O. Box 1 130 Oshkosh, WI 54903-1 130 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
N/A
Street Address or P O Box
City
State
Zip Code
Business Name
N/A
Street Address or P O Box
City
State
Zip Code
Business Name
N/A
Street Address or P O Box
City
State
Zip Code
Business Name
N/A
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
Mark De Groot
Authorized Officer ignature
Date Signed
13/31/25
Corporation, Partn1p or Sole Proprietorship Name
De Groot, Inc.
Street Address or P O Box
City
State
Zip Code
4201 Champion Rd
I Green Bay
WI
154311
If you have any questions call (608) 266-6861
ERD-7777 (R. 01/2011)
BID BOND CITY OF OSHKOSH
Contract Number Contract 25-12 Bond Number Bid Bond ANY �
Date Bond Executed (Date of Contract or Later) 3/28/2025 o5t , i P013LIC "Wo I(`
CAS(, i�75C'{i r is 7G
PRINCIPAL/CONTRACTOR (Legal Name and Business Address)
De Groot, Inc.
4201 Champion Rd
Green Bay WI 54311
SURETY(IES) (Legal Name(s) and Business Address(es))
Employers Mutual Casualty Company
1815 S Meyer Rd.
Oakbrook Terrace IL 60181
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
X Corporation
State of Incorporation
Wisconsin
Penal Sum of Bond
5% of 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 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.
De Groot, Inc.
Name of Principal/Contractor
Title Presl
\%%%IIIIIIIII
0 poh��•.C�
SEAL
CC�j��
Employers Mutual Casualty Company
Name of Surety
�X%
MIRIA Ar i/Title Attorney In Fact
Page 2 of 2
*emc EMC Bond
INSURANCE
SURETY BOND ELECTRONIC SIGNATURE & SEAL ADDENDUM
EMPLOYERS MUTUAL CASUALTY COMPANY
Employers Mutual Casualty Company ("EMCC") has authorized its Attorneys -in -Fact to
utilize an electronic, facsimile, or digital signature (each an "Electronic Signature") to
execute bonds on behalf of EMCC and has further authorized its Attorneys -in -Fact to
attach the accompanying Seal Addendum to any such bonds.
EMCC hereby acknowledges and agrees that the attached bond executed by the
Attorney -in -Fact on behalf of EMCC with an Electronic Signature shall have the same
force and effect as if executed by the Attorney -in -Fact with a wet ink signature.
EMCC also hereby agrees that the seal contained on the accompany Seal Addendum
shall be deemed affixed to the attached bond to the same extent as if EMCC's raised
corporate seal was physically affixed to the fact of the bond.
Dated this 11th day of October, 2024.
Employers Mutual Casualty Company
By: --
4anp;rj er, Vice President
717 Mulberry Street, Des Moines, IA 50309 P.O. Box 712, Des Moines, IA 50306 Phone: 515-345.2689 800-447-2295 emcinsurance.com
Employers Mutual Casualty Company EMC Reinsurance Company EMC Property & Casualty Company
Dakota Fire Insurance Company EMCASCO Insurance Company EMC Risk Services, LLC
Union Insurance Company of Providence Illinois EMCASCO Insurance Company EMC National Life Company (affillate)
yemc EMC Bond
INSURANCE
Employers Mutual Casualty Company — Seal Addendum
Employers Mutual Casualty Company hereby authorizes its Attorneys -in -Fact to affix
Employers Mutual Casualty Company's corporate seal to any bond executed by said
Attorney -in -Fact for Employers Mutual Casualty Company by attaching this Seal
Addendum. In accordance with the above, Employers Mutual Casualty Company
hereby affirms that the corporate seal hereon shall be deemed affixed to said bond with
the same force and effect as if Employers Mutual Casualty Company's raised corporate
seal was present.
Dated this 111h day of October, 2024.
Employers Mutual Casualty Company
By: Age
y lJ, prin ice President
717 Mulberry Street, Des Moines, IA 50309 P.O. Box 712, Des Moines, IA 50306 Phone; 515-345-2689 800-447-2295 emcinsurance.com
Employers Mutual Casualty Company EMC Reinsurance Company EMC Property & Casualty Company
Dakota Fire Insurance Company EMCASCO Insurance Company EMC Risk Services, LLC
Union Insurance Company of Providence Illinois EMCASCO Insurance Company EMC National Life Company (affiliate)
AFEMC
P.O. Box 712 - Des Moines, Iowa 60306-0712 INSURANCE
POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY -IN -FACT
KNOW ALL MEN BY THESE PRESENTS, that:
1. Employers Mutual Casualty Company, an Iowa Corporation
2. EMCASCO Insurance Company, an Iowa Corporation
3, Union Insurance Company of Providence, an Iowa Corporation
4, Illinois EMCASCO Insurance Company, an Iowa Corporation
5. Dakota Fire Insurance Company, a North Dakota Corporation
6. EMC Property & Casualty Company, an Iowa Corporation
hereinafter referred to severally as "Company" and collectively as "Companies", each does, by these presents, make, constitute and appoint:
Brooke L Wall
its true and lawful attorney -in -fact, with full power and authority conferred to sign, seal, and execute the Bid Bond
Any and All Bonds
and to bind each Company thereby as fully and to the same extent as if such Instruments were signed by the duly authorized officers of each such Company, and all
of the acts of said attorney pursuant to the authority hereby given are hereby ratified and confirmed.
AUTHORITY FOR POWER OF ATTORNEY
This Power -of -Attorney Is made and executed pursuant to and by the authority of the following resolution of the Boards of Directors of each of the Companies at the
first regularly scheduled meeting of each company duly called and held in 1999:
RESOLVED: The President and Chief Executive Officer, any Vice President, the Treasurer and the Secretary of Employers Mutual Casualty Company shall have
power and authority to (1) appoint attorneys -in -fact and authorize them to execute on behalf of each Company and attach the seal of the Company thereto, bonds
and undertakings, recognizances, contracts of Indemnity and other writings obligatory in the nature thereof; and (2) to remove any such attorney -in -fact at any time
and revoke the power and authority given to him or her. A►tomeys-In-fact shall have power and authority, subject to the terms and limitations of the power -of -attorney
Issued to them, to execute and deliver on behalf of the Company, and to attach the seal of the Company thereto, bonds and undertakings, recognizances, contracts of
Indemnity and other writings obligatory in the nature thereof, and any such instrument executed by any such attomey-in-fact shall be fully and in all respects binding upon
the Company, Certification as to the validity of any power -of -attorney authorized herein made by an officer of Employers Mutual Casualty Company shall be fully and in all
respects binding upon this Company. The facsimile or mechanically reproduced signature of such officer, whether made heretofore or hereafter, wherever appearing upon
a codified copy of any power -of -attorney of the Company, shall be valid and binding upon the Company with the same force and effect as though manually affixed.
IN WITNESS THEREOF, the Companies have caused these presents lobe sign d for each by their officers as shown, and t:ZTT
this
22nd day of September , 2022 f
Seals
,
"'
iNsv ' �on+a v a ott R. Jean, P dent &CEO Todd Strother, Executive Vice President
r!Go9URNE ��oAq""o Q�Poaronq�sG of Company 1; irman, President Chief Legal Officer & Secretary of
?; .Z �r� b = ? 4 '?` j`0- -I - & CEO of Comp ies 2, 3, 4, 5 & 6 Companies 1, 2, 3, 4, 5 & 6
C
=o; SEAL -`b ;x; 1863 =oc .u: 1953 - '=
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IOWA :�o:•
OWN
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='fs SEAL ==: SEAL =n=
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NES
ifYATB.OYFRIDGE
mNssion Number 710769
EO
�Octn102!
On this 22nd day of September , 2022 before me a Notary Public in and for the State
of Iowa, personally appeared Scott R. Jean and Todd Strother, who, being by me duly sworn,
did say that they are, and are known to me to be the CEO, Chairman, President, Executive
Vice President, Chief Legal Officer and/or Secretary, respectively, of each of the Companies
above; that the seals affixed to this Instrument are the seals of said corporations; that said
instrument was signed and sealed on behalf of each of the Companies by authority of their
respective Boards of Directors; and that the said Scott R, Jean and Todd Strother, as such
officers, acknowledged the execution of said Instrument to be their voluntary act and deed,
and the voluntary act and dead of each of the Companies.
My Commission Expires October 10, 2025,
CERTIFICATE
Notary Publl in and for the State ofAowa
I, Ryan J. Springer, Vice President of the Companies, do hereby certify that the foregoing resolution of the Boards of Directors by each of the Companies, and
this Power of Attorney issued pursuant thereto on 22nd day of September , 2022 , are true and correct and are still in full force and effect.
In Testimony Whereof I have subscribed my name and affixed the facsimile seal of each Company this28th day of March 2025..
Vice President
7854 (9-22) B024923-NA D8452 957 A 000000 "For verification of the authenticity of the Power of Attorney you may call (515) 345.7548."
cito�
Oshkosh
TO: ALL CONTRACTORS
FROM: ENGINEERING DIVISION OF
CITY OF OSHKOSH DEPARTMENT OF PUBLIC WORKS
SUBJECT: SOIL AND GROUND WATER MANAGEMENT PLAN
CERTIFICATION
,UMFIVRO
fDETT € F PUBLIC WORKS
0SIIi U H, WISMNSIN
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.
Mark De Groot
Printed Name
President
Title
De Groot, Inc.
Company Name
3/31 /25
Date
lAEngineering\Tracy Taylor\ Public Works Contracts\Miscellaneous\Soil & Groundwater Page 1 of 1
Management Plan Certificatior_2-1-17.docx
City Hall, 215 Church Avenue P.O. Box 1130 Oshkosh, WI 54903-1130 http://www.Ci.oShkosh.wi.us
CONTRACT 25-12
ATTACHMENT A
"NVTOF PUBLIC WORKS
LIST OF PROPOSED SUBCONTRACTORS
OSHKOSH, WISCONSrN
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
CLASS OR ITEMS OF WORK
PERCENT OF
CONTRACT AMOUNT
111 OL
k1lo
2"10
-
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).
Z"
Signature of Bfii6r
Page 11 of 14 (Revised)
CONTRACT 25-12
PROPOSAL oF�'()F" PUDLIC , ,OR S,
QSHKO,Sx. WISCONS;
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
De Groot, 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.
Signature
President
(Title, if any)
Subscribed and sworn to before me this 7 day of April , i i i �, 2025
\` J .%MMER
OTAR
* r
jNory Publi or ther authorized to ad ter ®-�► _
,.
p G
V®�.\C
10F WISGo�`��
(Bidder should not add any conditions or qualifying statements lf1 %'PiMposal 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 14 of 14 (Revised)
i
FROM;
SUBJECT;
ALL CONTRACTORS
ENGINEERING DIVISION OF
CITY OF OSHKOSH DEPARTMENT OF PUBLIC WORKS
DISCLOSURE OF OWNERSHIP FORM
AP . 7 2025
DETT()j� PUBLIC WORKS
OSF'KOSI-1, WISCON TN
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.
1-2 /•
Daniel Dorner
Printed Name
President
Title
Dorner Inc
Company Name
3/31 /25
Date
lAlingineering\Tracy Taylor\Public Works Contracts\Mlscellaneous\Dlsclosure of Ownership Form 2-1- Page 1 of 1
17,clocx
City Hall, 215 Church Avenue P.O. Box l 130 Oshkosh, WI 54903-1130 http://www,cl.oshkosh.wi.us
BID BOND CITWQF� OSHKOSH
Contract Number 26-12
Bond Number FD03371
Date Bond Executed (Date of Contract or Later) 3/12/2025
PRINCIPAL/CONTRACTOR (Legal Name and Business Address)
DORNER, INC.
E606 Luxemburg Road
Luxemburg, WI 64217
SURETY(IES) (Legal Name(s) and Business Address(es))
Fidelity And Deposit Company Of Maryland
1299 Zurich Way, 6th Floor
Schaumburg, IL 60196-1066
OWNER (Legal Name and Business Address)
CITY OF OSHKOSH
215 Church Avenue
PO Box 1130
Oshkosh, Wisconsin 54903-1130
OBLIGATION
I-W OF E'I:i€WC WORK
OSHK S�J, W1SCO NSIN
Type of Organization
FIndividual ❑Partnership
Corporation
State of Incorporation
WI
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 (id) 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 %%�+N E ���� Name of Surety ".
SEAL`���
Title Title Connie Smith, Attorney -in -fact
ZURICH AMERICAN INSURANCE COMPANY
COLONIAL AMERICAN CASUALTY AND SURETY COMPANY
FIDELITY AND DEPOSIT COMPANY OF MARYLAND
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS: That the ZURICH AMERICAN INSURANCE COMPANY, a corporation of the State of New
York, the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, a corporation of the State of Illinois, and the FIDELITY
AND DEPOSIT COMPANY OF MARYLAND a corporation of the State of Illinois (herein collectively called the "Companies"), by
Robert D. Murray, Vice President, In pursuance of authority granted by Article V, Section 8, of the By -Laws of said Companies, which are
set forth on the reverse side hereof and are hereby certified to be in full force and effect on the date hereof, do hereby nominate, constitute,
and appoint Michael J. DOUGLAS, Connie SMITH, Chris STEINAGEL, Christopher M. KEMP, Robert DOWNEY, Koi y
MORTEL and Eliot MOTU, all of Hudson, Wisconsin, its true and lawful agent and Attorney -in -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 duly executed and acknowledged by the regularly elected officers of the ZURICH AMERICAN INSURANCE COMPANY at
Its office In Now 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,
0 M
-� �p t 1101i� GMt►►
82AL
ATTEST:
ZURICH A1IIERICAN INSURANCE COMPANY
COLONIAL AMERICAN CASUALTY AND SURETY COMPANY
FIDELITY AND DEPOSIT COMPANY OF MARYLAND
By: Robert D. Murray
Vice President
By: Dawn R Brown
Secretary
State of Marylnnd
County of Baltimore
On (his 271h day of November, A.D. 2019, before Ilia 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 Ilia preceding Instrument, and acknowledged the execution of sonic, and being by me duly sworn, deposeth and saitli, that he/she is the sold officer of
the Company aforesaid, and that the seals affixed to Ilse preceding instrument are (lie Corporate Seals of said Companies, and that the said Corporate Seals and
the signature as such offcer were duty affixed and subscribed to ilia said Instrument by the authority and direction of the said Corporations.
IN TESTIMONY WHEREOF, I have hereunto sot my hand and affixed my Official Seat the day and year first above written.
A 1
Constance A. Dunn, Notary Public
My Commission Expires: July 9, 2023
rnmua�`
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 attomeys-in-fact with authority to execute bonds, policies,
rccognizances, 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, file undersigned, Secretary of die ZURICH AMERICAN INSURANCE COMPANY, the COLONIAL AMERICAN CASUALTY
AND SURETY COMPANY, and the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, do hereby certify that the foregoing
Power of Attorney Is still In full force and effect on the date of this certificate; and I do further certify that Article V, Section 8, of the By -
Laws of the Companies is still in force,
This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of
Directors of the ZURICH AMERICAN INSURANCE COMPANY at a meeting duly called and held on the 15th day of December 1998,
RESOLVED: "That the signature of the President or a Vice President and the attesting signature of a Secretary or an Assistant Secretary
and the Seal of the Company may be affixed by facsimile on any Power of Attorney.., Any such Power or any certificate thereof bearing such
facsimile signature and seal shall be valid and binding on tie Company,"
This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of
Directors of the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at a meeting duly called and held on the 5th day of
May, 1994, and the following resolution of the Board of Directors of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at a
meeting duly called and held on the 10th day of May, 1990,
RESOLVED: "That the facsimile or mechanically reproduced seal of the company and facsimile or mechanically reproduced signature
of any Vice -President, Secretary, or Assistant Secretary of the Company, whether made heretofore or hereafter, wherever appearing upon a
certified copy of any power of attorney issued by the Company, shall be valid and binding upon die 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 _ 1.2th''day of March , 2025 ,
two
- .. ORAL
2 H
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.ret)orisfclaims(@zurichna.com
800-6264577
city.,
fv
Oshkosh
TO: ALL CONTRACTORS
FROM: ENGINEERING DIVISION OF
CITY OF OSHKOSH DEPARTMENT OF PUBLIC WORKS
SUBJECT: SOIL AND GROUND WATER MANAGEMENT PLAN
CERTIFICATION
r�.J�';1t�i lii
{,1 t t t{ 1' c ,1C", O KS
��S SM, �VISCONSIN
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,
Daniel Dorner
Printed Name
President
Title
Dorner Inc,
Company Name
3/31 /25
Date
l:\Englneering\Tracy Taylor\ Public Works Contracts\ Miscellaneous \Soil & Groundwater Page 1 of 1
Management Plan Certiflcat1on_2-1-17,docx
City Hall, 215 Church Avenue P,O, Box 1130 Oshkosh, WI 54903-1130 hitp://www.cl,oshkosh.wl.us
CONTRACT 25-12
ATTACHMENT A APR - '51 2025
DEPTOPPUBLIC WORKS
LIST OF PROPOSED SUBCONTRACTORS OSHKOSH, WISC ONSIN
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
VTM?o4
ftl
CLASS OR ITEMS OF WORK
Cad�C/4,�G� �C19Vi7'Li �'oN
/ /SPflf7L7
PERCENT OF
CONTRACT AMOUNT
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).
Signature of Bidder
Page 11 of 14 (Revised)
CONTRACT 25-12
PROPOSAL
202!
The undersigned will begin work as specified after award of the Contract and complete as specified.
P(J!�UC WORKS
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.
19aad A-U�-
Signature
President
Subscribed and sworn to before me this I day of
�111 (Ir� DJA bA �,M JJJ24t�
Notary Public, or other authorized to administer
(Title, if any)
20-25 ,
(Bidder should not add any conditions or qualifying statements to this l7i'�'le9Vas 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 14 of 14 (Revised)
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 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.
"# 1' J
Printed Name
SPi �) P /?�✓"��+5 e���d
Title
Company Name
Date
h\UngineeringWracy Taylor\Public Works Contracts\Miscellaneous\Disclosure of Ownership Form_2-1- page 1 of 1
17.docx
City Nall, 215 Church Avenue P.O. Box 1130 Oshkosh. W154903-1130 http://www.ci.oshkosh.wl.us
State of Wisconsin
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, 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 A114
Street Address or P O Box
F
State
Zip Code
Business Name
Street Address or P O Box
City
Stata I
Zip Code
Business Name
Street Address or P O Box TCity
State
Zip Code
Business Name
Street Address or P O Box
-------------
City
J_ _i........�.4
St
I hereby state under penalty of perjury that the information, contained in this uvaufflic"t, Ll N uc cl—A
o
accurate accvraln 6V Illy I IVYYIOb1 a U"
Print the Name of Authorized Officer ,4 ffBWP/j
Authorized Officer Signature5 ,
Date Signed
/f 110
Corporation, Partnership or Sole Proprietorship Name
46w ��®9
�� �rsrG i ��
���
Street Address or P O Box
City State Zip Code
If you have any questions call (608) 266-6361
ERD-7777 (R. 01/2011)
BID BOND CITY OF OSHKOSH
Contract Number 25-12 Bond Number
Date Bond Executed (Date of Contract or Later) 3/1212025
S TAP
PRINCIPAL/CONTRACTOR (Legal Name and Business Address)
CART. BOWERS & SONS CONSTRUCTION CO INC
N1844 Maloney Rd
Kaukauna, WI 54130
SURETY(IES) (Legal Name(s) and Business Address(es))
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
Type of Organization
Individual ^ Partnership
X Corporation
State of Incorporation
Wisconsin
Penal Sum of Bond
5% of bid amount
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.
P1ge 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 Boxed 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.
CARL BOWERS & SONS CONSTRUCTION CO INC
Name of Principal/Contractor
r
MERCHANTS BONDING COMPANY (MUTUAL
Page 2 of 2
T �+ Bond #: 492048
MERCHAN1 J
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, dlb/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 Attorney(s)-in-Fact, to sign Its name as surety(ies) and to execute, seat 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.
This Power-of-Attomey is granted and is signed and sealed by facsimile under and by authority of the following By -Laws adopted by the Board of
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, 2016 and amended on April 27, 2024.
"The President, Secretary, Treasurer, or any Assistant Treasurer or any Assistant Secretary or any Vlce 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
Attomey-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 consenti ng 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 hereby 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 13th day of March , 2026
r •' *,*—Soo G. MERCHANTS BONDING COMPANY (MUTUAL)
P1 At e''• °+0�......AO 00•MERCHANTS NATIONAL BONDING, INC.
®FipplQ,q �p%,f �0�;�1P0:,9� d/bla MERCHANTS NATIONAL INDEMNITY COMPANY
co
v . 2003 ; '� 1933By
;
STATE OF IOWA .,...°.°' •+` M ° ` ®° ®`• President
COUNTY OF DALLAS ss.
On this 13th day of March 2025 before me appeared Larry Taylor, to me personally known, who being by me duly sworn
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 the said Instrument was signed and sealed in behalf
of the Companies by authority of their respective Boards of Directors.
AP\'iA4s Penni Miller
0 Commission Number 787952
® a My Commission Expires
IOWN January 20, 2027 Notary Public
(Expiration of notary's commission
does not invalidate this instrument)
I, 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
�� ............
®R0
s ej
2003 ijb
..�� •.�v
......... •'� .•'.
POA 0018 (6/24)
affixed the seal of the Companies on this 13th day of March 2025 .
O�NG CO 00
Ale
. 3.
0 a' 1933
C; secretary
•.��k,••
�•�•'0
.•
r,A
Citof 011*1
shk sh APR
TO: ALL CONTRACTORS
F,'T':`ij}= p,,pt,1 ; WORKS
OSHKOSH, WISCONSIN
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 Management Plan
included in the Specifications and will comply with the requirements of the Plan.
x ti
91w EOL4w—s
Printed Name
d tr / _
Title
Ga!/ to waj I So.,)., d��>r�✓� `vim
Company Name
.3/ 1 / � -
Date
1:\Engineering\TtacyTaylor\Public Works Contracts\Miscellaneous\&» t & Groundwater
Management Platt CertiHcatlon-2•1-17.docx
Page 1 of 1
City Hall, 215 Church Avenue P.O. Box 1130 Oshkosh, WI 54903-1130 http://www.cl.oshkosh.wi.us
CONTRACT 25-12
ATTACHMENT A
g 82
LIST OF PROPOSED SUBCONTRACTORS),,
Psr ()P, PUBLIC WORK
OSHKOSH, 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
AD)x
el
CLASS OR ITEMS OF WORK
PERCENT OF
CONTRACT AMOUNT
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).
jww�' --A I
''gum • :gm
Page 11 of 14 (Revised)
CONTRACT 25-12
PROPOSAL, e ,
The undersigned will begin work as specified after award of the Contract aR compl�t� as specified.
I hereby certify that all statements are made in behalf of Q;4;,P OF r-IJBIX WORKS
&'/ We-15 4L .5CW 5 Z<Dr9 5 �106 74:wly
(Name of Corporation, Partnership, or Person Submitting Bid)
a corporation organized and existing under the laws of the State of
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.
'-V ilea
Signature
(Vtle, if any)
.gyp r
Subscribed and sworn to before me this day of 14��'e
60 BOWERS
ary Pu ic, 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 5- % of the total amount of the Bid, `as
called for in the Official Notice to Contractors.
Page 14 of 14 (Revised)
TO:
FROM:
SUBJECT:
ALL CONTRACTORS
ENGINEERING DIVISION OF
CITY OF OSHKOSH DEPARTMENT OF PUBLIC WORKS
DISCLOSURE OF OWNERSHIP FORM
DEPTOF T'UBLIC; WORKS
OSHKOSH, MSCONSM
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 belo that Item 3 of the attached Disclosure of Ownership form does NOT apply to my
firm, or a shareholder, offi , or partner of my firm.
r
N
Jesse Jossart
Printed Name
VP/Secretary
Title
Jossart Brothers, Inc.
Company Name
March 31, 2025
Date
1:\9ngineering\Tracy Taylor\Public Works Contracts\Miscellaneous\Disclosure of Ownership Ponn_2-1- Page 1 of 1
17.docx
City Hall, 215 Church Avenue P.O. Box 1130 Oshkosh, WI 54903-1130 http://Www.ci.oshkosh.wi.us
State of Wisconsin Disclosure of Ownership
Department of Workforce 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.
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 26% 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.
(lfhar CnncfruCilon Business
I hereby state under penalty of perjury tnat the mrormanon, GUIR0111OU III .ISUO w....�....... •-- _. ^_ ______
accurate accordina to my knowled a and belief.
Print the Name of
Jesse Jossart
Corporaf tt ership or Sole
Jossart Brothers, Inc.
Street Address or P O Box
1682 Swan Road
Name
Date Signed
March 31, 2025
City
De Pere
State Zip Cc
WI 154116
ERD-7777 (R. 01 /2011)
If you have any questions call (608) 266-6861
BID BOND D CITY 1 OF OSHKOSH
Contract. Number 2542 DFPT Or PUBLIC' WORKS
Dane Bond Executed (Date of Contract or hater) =412026
PWNCW 1 /ClJN i'ICTOR (Legal Name acid Business Addxesa)
1082`8wati Road
Ike Pere., W( 64115
SIMI TYOES) (Legal Name(s) and Busiriess-Addness(es))
Merchants National Banding CoMpany
$100 Westown Pkcwy
West Des Moines, W50266
OWNER (Legal Name anal Business Address)
CITY OF 051MOSH
215 Church Avenue
P.O Box 1130'
Oshkosh, Wisconsln34903-1130
tOBLiGATION
Type of Organization
litdtvidual ElPorinership
corporaHan
Staten IncorporaHon
I
Penal5tmi of Bond
Plvo Petcent Of Amount Bid
Tice Contractor amd 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 rhay be agreed upon
between the Owner and ti to Contractor, and the ContracWr shall fait 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 Smety hereby wares 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 sped ed. 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 Oyvner the
differenee between the amount specified in the laid 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.
Xp:dm- io, g (;Qn#pLqpr or. �, kvety shall be. deemed to have been give= (i) upon delivery to an. Ader or person
entideft such -notice, if dolivemd; or. (R) two (2)buslnegs days itollowmig deposit in the United States. blail,
postage prepaid, (M) upon delivery by atommercial carrier, that wig certify the date and time of delivery; or p)
upon trammission. 1by facsimile, email or other. form, of electron . Ic trauamWon- Notices 6W be provided to the
Owner, Surety anci/ot Contractor at Their address as apg4qd: on taus .Bond; or to a kq0V$jg, emall, .-P; 61ber
electrbAc address that has been provided in Wx1ting to the osi
er p d-.for*sptvpose..
to be usp
The laws of the State of Wisconsin shall govern the interpretation and construction of this Bond. Winnebago
County skull be the venue . for A disputes arlsing urtdet.�tlgs Bond. Any provisibitinthis Rona lbat-niay conflict
with sowtoxy or other legal reVArement sball be deemed deleted hereftom and Provisions conforming to the
statutory -qv o0w.legpi requirement shall be deemed keotporated herein.
J088AB,T� BROTHERS, INC.
Name of Prin�pal/Contractor
Tftle,AWj6ssart, VP/Secretary
Mprchan%Nationol Bonding Q orp
Title Samuel rjuchow).Attorney-404ct
MEB,CH , T
96NDING COMPANY,
POWER OF :ATTORNEY
tCrtowAi[PeBons 8y These Presents chat iu1ERCFIANTS:BpNDtNG OOMPANY (MUD IJAt:)ryd MERCHANTS 1VATIONAL 80ND1N0, INC.,
both being cprporetions df the State of lows, dlbr8 Merchants: Naticnai indemnity Company flirt 6aitfotrifa only) (herein coitectivveiy called the
"Compant) tIo hereby make, constitute and appoints tndfVfduaily,
Chins Stainegei; Christopher M Kemp; Connie Smith; Eliot Motu; Julia Douglas; Kory Mortol; Michael J Douglas; Robert Downey; Samuel ouchow
their true and Lawful Attomey(s)-in-Fact, to. sign Its name as sursty(tes) and to execute, seal and eoknowtedga any and all .bonds, undertakings,
oontraote and other written instfUntents In the nature. thereof, on behalf of the Companies in their business of guaranteeing the fidelity, of
parsons, guaranteeing the. performance of oontr . cis and executing or guaranteeing bonds and undertakings. required or patnu fed in any act(oris.
prproceedfn9S Gnawed by (aw.
This Power-ot4homay is granted and Is signed and sealed by thosImlle under and by authority of the following By --Laws adopted by the Board
of birectars of Merchants Sanding Company (Mutual) an April 23, 20.11 and. amended August 14, 2018 and adopted by the Board of Directors of
MerchentsNatlonal Bonding; Inc., on Oct4b0'16, 2615,
'The Prestdeitt, Secretary, Treasurer, or any Assistant Treasurer or any Assistant Secretary or any Vices President stlall hays power and
authority to appoint Attorneys In -Fact, and to authorize them io ercecutf3 Art' bet►atf gf the Gornjrany, and attach the seal of Tile Cnmpa'ny thereto,
bonds and undertakings, recbgntzances, cbWOCts of indemnity grid otherwribnos obligatory In the nature thereof."
'The signature at any authorized officer and the seal of the Company may be. affixed' by tapplmllo or aleotronla transmission to any Power of Attorney
or Cadfice'tion theraof authorizing the exac0lion and delivery of any bond, undertaking, recognizance,: or. other suretyship obilgadons of the
Company. ana'such'signaturei and seal widen so used shalt have the some force and iftot as though: manually fixed:'
In.connoo.ttort with obligations in favor of tho Florida 100p. intent of 7a tneportatlan only it ::agreed thtitffia ptiwwer and. Out hotity hereby given to the
Attamajr-in Fain includes any and Oil consents for :the rare of 14 Iftad petcenKgas an&- dr final estimates on angineerfng and construction
cxrtracta. required by the: 6tate of ptorida Department of Tionspodation; it is tuliy understood that consenting to the State: ofFtortda Department
otTransportatlon maktng payment of the final estimate to the: Contractor andror its. assignee, shall not relieve this surety company of any of
its obligations under Its bond.
—0-
2003
STATE OF 1QWA '`r..,�•w,+.'"
C'OUN1 OFi3ALLAS s§.
On ibis 8rd day of February 2024
did say that he is President of.MERCHANT$ BONDI
seals affixed to the foregoing instrument are the Cali
of the Companies by authority -of their respeotive Soar
hereby given
to itte Commissioner-
, 2024
„�...�«
MERCHANTS Bi3NRING OOMPAhIY (MUTUAL)
I OONANTB NATIONAL. OWING. INC,
M�Qtf`01 ' • : * dlbia MERCHANTSATIONAt WrONITY COMPANY
1533 ' By
?��" � '�f • Presfderrt
before me appeared Carry Taylor, to me personally known, who being by me duty sworn
COMPANY (MUTUAL) and MERCHANTS NATIORAL Bbl`fVNO, INC.; and that the
e.89als of this Companies; and that the said instrument was signed and sealed In behalf
''��. Peon! Miller
Commission Nurnber787952
+ • MV Cornmtsslon Expires
100IN January 20, 20V 11
afa b
1, "Item Wort er, Jr., secretuty. of MERCHANTS. BONDING COMPANY MUTUAL) and.MERCHANTS NATIONAL. BONDING, INC., do hereby
ceiliry that the above and foregoing Is a true and correct copy of the POWER-OF-ATTORN1;Y executed by said Companies, whicyh is still irk full
force and effect and has not been amended or revoked.
In Witness Whereof, I have hereunto
PO.A0018 (1/24)
hand and affixed the
Companies on this 24th day of March , 2026 .
rn �"o
9935 Secretary
0,***A
City
o�
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 Management Plan
1 comply with the requirements of the Plan.
Jesse Jossart
Printed Name
VP/Secretary
Title
Jossart Brothers, Inc.
Company Name
3-31-2025
Date
L\Engineering\Tracy Taylor\Public Works Contracts\Miscellaneous\Soil&Groundwater Page 1 of 1
Management Plan CertfficatiorL2-1-17.docx
City Hall, 215 Church Avenue P.O. Box 1130 Oshkosh, WI 54903-1130 http://www.ci.oShkosh.wi.us
CONTRACT 25-12
ATTACHMENT A
LIST OF PROPOSED SUBCONTRACTORS
OF PUBUC WORKS
``t''i4dKOjj' WISCIC is Eck
Pursuant to Section 66.29(7), Wisconsin Statutes, the Bidder, as part of this Proposal, submits this ull 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
Storm Companies
Al Dix Concrete, Inc.
Fox River Landscape
CLASS OR ITEMS OF WORK
Traffic Control
Concrete
Landscaping
PERCENT OF
CONTRACT AMOUNT
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).
Signature of Bidder
Konrad Jossart, President Page 11 of 14 (Revised)
CONTRACT 25-12
PROPOSAL 2,025
The undersigned will begin work as specified after award of the Contract and cdilt'e�id
I hereby certify that all statements are made in behalf of
Jossart Brothers, 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.
ram'
Signature
Konrad Jossart, President
(Title, if any)
Subscribed and sworn to before me this 7 001A ' •. April 2025
Off. .F�®•®
QRY a
Vary Public, or other authorized to administer % ���j
Expires: April 12, 2027 , �,' PUS G®fir'=
(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 14 of 14 (Revised)
City
of
Oshkosh VI 1
OSHKOMI, W:SICcONSIN
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 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.
... %/o���
c� : PORgrF
Name
14
Richard P. Lamers
Printed Name
President
Title
Vinton Construction Company
Company Name
3/31/2025
Date
1:\Qnglneering\Tracy Taylor\Public Works Contracts\Miscellaneous\Disclosure of ownership Form_7-1-
17.doc:
Page i of 1
Cily Hall, 215 Church Avenue P.O. Box 1130 Oshkosh, WI 54903-1130 hitp://www.ci.oshkosh.wi.us
State of Wisconsin
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.
0) 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
I hereby state under penalty of penury that the inrormaTion, ca111.411MU III uiia NV4N.,......J ... -. �- - • -
accurate according to mV Kn( W1,$ g �nq
Print the Name of Authorized Offiter-� ...... Uri
Richard P. Lamers
Authorize Offic ��' nature : o G F
Corporation, Partnership or S l=Propr-ietd
Vinton Construction CompanAry ISCit .
Street Address or P 0 Box
1322 33rd Street (P,O. Box 137)
Date Signed
March 31 st, 2025
City
Two Rivers
ate Zip Code
WI 1 54241
ERD-7777 (R. 01/2011)
If you have any questions call (608) 266-6861
BID BOND CITFYOF OSHKOSH
L)2.7
Contract Number City Contract 25-12 Bond Number
Date Bond Executed (Date of Contract or Later) March 31st, 2025 811KOSK ZS ONSIN
PRINCIPAL/CONTRACTOR (Legal Name and Business Address)
Vinton Construction Company
1322 33rd Street (P.O. Box 137)
Two Rivers, WI 54241
SURETY(IES) (Legal Name(s) and Business Address(es))
Travelers Casualty and Surety Company of America
One Tower Square
Hartford, CT 06163
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
X Corporation
State of hicorporatioii
Wisconsin
Penal Sum of Bond
Five Percent of Amount Bid
(5% of 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 tl-ds
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 Uiuted 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.
Vinton Construction Company
Name of Principal/Contractor
\I`,,�anllJnJJnJ,,,,��o
�RPCPAr o
Title Richard P. Lamers I Presl ertt
C,—, rr 7 h
'L ��fek°1� ;
Travelers Casualty and Surety Company of America
Name of Surety
p
FU-:fiIC;`�i
V\,
Title Patrick A. McKenna, Attorney -in -Fact
Page 2 of 2
Travelers Casualty and Surety Company of America
Travelers Casualty and Surety Company
TRAVELERS i St. Paul Fire and Marine Insurance Company
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS: That Travelers Casualty and Surety Company of America, Travelers Casualty and Surety Company, and St.
Paul Fire and Marine Insurance Company are corporations duly organized under the laws of the State of Connecticut (herein collectively called the
"Companies"), and that the Companies do hereby make, constitute and appoint Patrick A. McKenna of MADISON
Wisconsin , their true and lawful Attorney -in -Fact to sign, execute, seal and acknowledge any and all bonds, recognizances,
conditional undertakings and other writings obligatory 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.
IN WITNESS WHEREOF, the Companies have caused this instrument to be signed, and theircorporate seals to be hereto affixed, this 3rd day of February,
2017.
1
l7NiwlggY Jr,OY AI,*
WAokt°si °' oc'teao�aAt't
State of Connecticut
City of Hartford as. Robert L. Raney, Se or Mee President
On this the 3rd day of February, 2017, before me personally appeared Robert L. Raney, who acknowledged himself to be the Senior Vice President of
Travelers Casualty and Surety Company of America, Travelers Casualty and Surety Company, and St. Paul Fire and Marine Insurance Company, and
that he, as such, being authorized so to do, executed the foregoing Instrument for the purposes therein contained by signing on behalf of the corporations
by himself as a duly authorized officer.
In Witness Whereof, I hereunto set my hand and official seal. c?h
My Commission expires the 30th day of June, 2021 TAA
* �,p it Mane C. Tetreault, Notary Public
This Power. of Attorney Is granted under and by the authority of the following resolutions adopted by the Boards of Directors of Travelers Casualty and
Surety Company of America, Travelers Casualty and Surety Company, and St. Paul Fire and Marine Insurance Company, which resolutions are now In
full force and effect, reading as follows:
RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President, any Vice President, any
Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary may appoint Attorneys -in -Fact and
Agents to act for and an behalf of the Company and may give such appointee such authority as his or her certificate of authority may prescribe to sign with
the Company's name and seal with the Company's seal bonds, recognizances, contracts of Indemnity, and other writings obligatory in the nature of a
bond, recognizance, or conditional undertaking, and any of said officers or the Board of Directors at any time may rernove any such appointee and revoke
the power given him or her; and It is
FURTHER RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice
President may delegate all or any part of the foregoing authority to one or more officers or employees of this Company, provided that each such delegation
Is In writing and a copy thereof is filed in the office of the Secretary; and it is
FURTHER RESOLVED, that any bond, recognizance, contract of indemnity, or writing obligatory in the nature of a bond, recognizance, or conditional
undertaking shall be valid and binding upon the Company when (a) signed by the President, any Vice Chairman, any Executive Vice President, any Senior
Vice President or any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant
Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary; or (b) duly executed (under seal, if required) by
one or more Attorneys -in -Fact and Agents pursuant to the power prescribed In his or her certificate or their certificates of authority or by one or more
Company officers pursuant to a written delegation of authority; and it is
FURTHER RESOLVED, that the signature of each of the following officers: President, any Executive Vice President, any Senior Vice President, any Vice
President, any Assistant Vice President, any Secretary, any Assistant Secretary, and the seal of the Company may be affixed by facsimile to any Power
of Attorney or to any certificate relating thereto appointing Resident Vice Presidents, Resident Assistant Secretaries or Attorneys -in -Fact for purposes only
of executing and attesting bonds and undertakings and otherwritings obligatory in the nature thereof, and any such Power of Attorney or certificate bearing
such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile
signature and facsimile seal shall be valid and binding on the Company In the future with respect to any bond or understanding to which it is attached.
I, Kevin E. Hughes, the undersigned, Assistant Secretary of Travelers Casualty and Surety Company of America, Travelers Casualty and Surety
Company, and St. Paul Fire and Marine Insurance Company, do hereby certify that the above and foregoing is a true and correct copy of the Power of
Attorney executed by said Companies, which remains in full force and effect.
Dated this 31st day of March 2025
t*rwh► o*`�r.yod �11144$
Ilk 01M i IIM`1�ftONiiO,
K ill ..•7.
Kevin E. Hughes, Assr tant Secretary
To verify the audieniidty ofth1s Power ofAttormey, please call us at 1-800-421.3880.
Please refer to the above-namedAttorney-ln-Fact and the details of the bond to which Me powerls attached.
ctto�
Oshkosh
TO: ALL CONTRACTORS
FROM: ENGINEERING DIVISION OF
CITY OF OSHKOSH DEPARTMENT OF PUBLIC WORKS
SUBJECT: SOIL AND GROUND WATER MANAGEMENT PLAN
CERTIFICATION
DUVI'OF PUBLIC WORKS
I certify by my signature below that our firm has read the Soil and Grorurd Water Management Mary
included in the Specifications and will comply with the requirements of the Plan.
O
''Jtl J
Name I �Ittq (� ;
l.Ji "5 ..x
Richard P. Lamers °,,,,�n„st`j{1`,,,��'•
Printed Name
President
Title
Vinton Construction Company
Company Name
3/31/2025
Date
r:\Engineering\Tracy Taylor\Public Works Contracts\Miscellanmis\Soil do Groundwater
hianagementPlait Certificatimi 2-1-17.doca
Page 1 of 1
City Hall, 215 Church Avenue P.O. Box 1 130 Oshkosh, WI 54903-1 130 hiip://www,ci.oshkosh.wi.us
CONTRACT 25-12
ATTACHMENT AWORKS
`°2112
;
LIST OF PROPOSED SUBCONTRACTORS 0sr1K OS We�c0 Ns�N
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
CONTIACTOR 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 retau-.age
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
CLASS OR ITEMS OF WORK
PERCENT OF
CONTRACT AMOUNT
I hereby certify that the use of the name(s) of the above Proposed Subcontractor(s) was with the
f 1 1111,11111y„l,•
knowledge and consent of the sa�1�5i�p�}t�achq(s}.
�.. Q); ��PORgT�, c,
1 c,
1
1•
Signature of Bidder Richard R` 00rs S
President °-,? �tgSG,S7��it 4 Revised a2
CONTRACT 25-12 AM, — r
PROPOSAL rah 'r, Or' PUPLIC WORK
0sr-x0,SH, Vrs:sCONSI r
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
Vinton Construction Company
(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 _ Two Rivers _; State of Wisconsin
That I have examined and carefully prepared this Proposal from the Plans and Specification�,TW,h
checked the same in detail before submitting this Proposal; that I have full authority\,tb�,.13�Cdlci��o
statements and submit this Proposal in (its) (their) behalf; and that said statements are t,xg d c ct.,,
gn
'�co.a���',
(Title, if any}
Subscribed and sworn to before me this ith �al of April , 20 25
,,.
Notary Public, ol;�ther authorized to
E cf:>Wre s : 2 • i0..:Z029
�oTAR�',,��
sty -----
���''�•...OF WISG °•
(Bidder should not add any conditions or qua
is to this Proposal as otherwise the Proposal
may be declared irregular as not being responsive to the Advertisement.)
Accompanying this Proposal is a Bid BoM in the amount of 5 % of the total amount of the Bid, as
called for in the Official Notice to Contractors.
Page 14 of 14 (Revised #2)
FROM:
SUBJECT:
City
Oshkosh
ALL CONTRACTORS
ENGINEERING DIVISION OF
CITY OF OSHKOSH DEPARTMENT OF PUBLIC WORKS
DISCLOSURE OF OWNERSHIP FORM
F)F3"`l' 01' i'<.1R UC; PVC )RK N
0411:KOsH, WSSCONSIN
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
Brian Joski
Printed Name
Secretary/Treasurer
Title
Advance Construction, Inc.
Company Name
3/31 /25
Date
(:\Engineering\Tracy Taylor\Public Works Contracts\Miscellaneous\Disclosure of ownership Fonn_2-1- page 1 of 1
17.docx
City Hall, 215 Church Avenue P.O. Box 1130 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
NONE
Street Address or P O Box
City
State
Zip Code
Business Name
Street Address or P O Box
City
State
I 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
-m^^emrnfa tarrnrflinn to my knnwlprina and hplipf_
Print the Name of Authorized Officer
Brian Joski
Authorized Officer S'gnature
Date Signed
13/31/25
Corporation, 1156rtnership or Sole Proprietorship Name
Advance Construction, Inc.
Street Address or P O Box
City
State
Zip Code
2141 Woodale Ave
Green Bay
WI
54313
If you have any questions call (608) 266-6861
con_7777 M n1 nM 1\
iWO
BID BOND CITY OF OSHKOSH
Contract Number 25-12 Bond Number
s?N�:iF; try pgJN>uC;WC)RK
I, WJ1,y,'0N1STN
Date Bond Executed (Date of Contract or Later) March 14, 2025
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 Street
Cincinnati, OH 45202
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
X 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 Owners 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.
Advance Construction, Inc.
Name of Principal/Contractor
J
Title
Great American Insurance Company
Name of Surety
Title Andrew Weisheipl, Attorney -In -Fact
Page 2 of 2
GREAT AMERICAN INSURANCE COMPANY®
Administrative Office: 301 E 4TH STREET • CINCINNATI, OHIO 45202 • 513-369-5000 • FAX 513-723-2740
The number of persons authorized by
this power of attorney is not more than TEN
No.0 22545
POWER OFATTORNEY
KNOW ALL MEN BY THESE PRESENTS: That the GREAT AMERICAN 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 Address Limit of Power
KIMBERLY ASCHENBACH BRIAN REIMER ALL OF ALL
DEBORAH KNAPP DILLON HOLEWINSKI MENASHA, WISCONSIN $100,000,000
RHONDA KLUESSENDORF ZACHARY KAISER
ANNEMARIE WILLBANKS CHRISTEEN CARNEY
SHELLEY RADATZ
ANDREW WEISHEIPL
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 25TH day of FEBRUARY 1 2025
Attest GREAT AMERICAN INSURANCE COMPANY
irsur
Assistant Secretary G mi,isional Senior Vtce President
STATE OF OHIO, COUNTY OF HAMILTON - ss: JOHN K. WEBSTER (e77-377-2405)
On this 25TH day of FEBRUARY 2025 , before me personally appeared JOHN K. WEBSTER, to me
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
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 Vice Presidents, Divisional Vice Presidents and Divisonal Assistant Vice
Presidents, or any one of theist, be and hereby is authorized, from time to tittle, to appoint one or more Attorneys-m-Fact to execute on behalf of the Company,
as surety, any and all bonds, undertakings and contracts ofsuretyship, or other ivritlen obligations in the nature thereof- to prescribe their respective ditties and
the respective limits of their authority, and to revoke any such appointment at any tittle.
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 certicale of either given for the execution of any bond, undertaking, contract of suretyship,
or other ivritlen 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
1, STEPHEN C. BERAHA, Assistant Secretary ofGreatAmerican 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 day of
EC��esu�M
'Af i
m
Assistant Secretary
S1029AI(10/24)
cito�
Oshkosh
TO: ALL CONTRACTORS
FROM: ENGINEERING DIVISION OF
CITY OF OSHKOSH DEPARTMENT OF PUBLIC WORKS
SUBJECT: SOIL AND GROUND WATER MANAGEMENT PLAN
CERTIFICATION
`PR ?
;¢Y C;I<. pIrSl,IC WORKS
0SHKOSIL WISC't)NSIh[
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.
ame
Printed Name
'kd h �r-•—'�
Title
0 T l�V�+�--.1�hG,7Zlic.7�G✓ yl.'°'�l r
Company Name
�3 z
Date
IA Engineering\Tracy Taylor\Public Works Contracts\ Miscellaneous \Soil do Groundwater
Management Plan CertiHcation_2-1-17.docx
Page 1 of 1
City Hall, 215 Church Avenue P.O. Box 1130 Oshkosh, WI 54903-1130 htip://www.ci.oshkosh.wi.us
CONTRACT 25-12
ATTACHMENT A
APR
LIST OF PROPOSED SUBCONTRACTORS DEPT OF'PUB IC WORKS
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
CLASS OR ITEMS OF WORK
C0.1 cv� `
PERCENT OF
CONTRACT AMOUNT
tt�
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).
</-0j--
Signature of Bidder
Page 11 of 14 (Revised)
CONTRACT 25-12'``
PROPOSAL
}M
The undersigned will begin work as specified after award of the Contract and. complete as s ecified.
DIET r c� �d tBUC U�
OSHKOS , wIMONI SIN
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
an individual trading as
the City of
; State of
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 said state n s are true and correct.
Signature
Secretary/Treasurer
(Title, if any)
Subscribed and sworn to before me this 7 day of April 2025
*G, MCA�.�
tay ic, or other authorized to administer 3/17/26
0"'.1p
'0
�pIAR Y
G '2
(Bidder should not add any conditions or qualifying statements to this Ifs'
may be declared irregular as not being responsive to the Advertisement.)
the Proposal
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 14 of 14 (Revised)
APR
rc
ca t'[Ko tl. W;s
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 Ownership forth. 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 Oumersltip 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
David Tenor
Printed Name
President
Title
David Tenor Corporation
Company Name
1- '?/I._
Date
1:\Engioeering\Tracv Taylor\ Public Works of Ownership Form_2.1-
17.doca
Page 1 of 1
City Hall, 215 Church Avenue P.O. Box 1 130 Oshkosh, WI 54903-1 130 htip://www.ci.oshkosh,wi,us
State of Wisconsin
Department of Workforce 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.
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
Genesis Excavators
Street Address or P 0 Box
W309S4860 Commercial Drive Suite C
City
North Prairie
State
WI
I Zip Code
153153
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
hereby
accurate accordina to mv knowledge and belief.
Print the Name of Authorized Officer
David Tenor
Authorized Officer Signature
Date Signed
Corpora ion, Partnership or Sole Proprietorship Name
David Tenor Corporation
Street Address or P 0 Box
City
State
Zip Gode
2759 Dewey Decker Dr.
Green Bay
WI
54313
If you have any questions call (608) 266-6861
ERD-7777 (R. 01/2011)
BID BOND 'dfYOF OSHKOSH
7--712
Contract Number 25-12 Water Main Replacements Bond Number 2644122
f7F-111'1rvCiF pl1BIWt3ftICS
Date Bond Executed (Date of Contract or Later) 4/7/2025 t9ShKtD a1f, WdCON1&y
PRINCIPAL/CONTRACTOR (Legal Name and Business Address)
David Tenor Corporation
1651 Brookfield Ave, Ste A-1
Green Bay, WI 54313
SURETY(IES) (Legal Name(s) and Business Address(es))
West Bend Insurance Company
1900 S 18th Ave
West Bend, WI 53095-8796
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
X Corporation
State of Incorporation
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 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.
Name of Principal/Contractor
Title
West Bend Insurance Company
Name of Surety $�¢��a'i,•��'■+r���
4 it
Title Attorney in Face'
Page 2 of 2
WEST BEND®
POWER OF ATTORNEY
Bond No. 2644122
Know all men by these Presents, that West Bend Insurance Company (formerly known as West Bend Mutual Insurance Company prior to 1/1/2024), a
corporation having its principal office in the City of West Bend, Wisconsin does make, constitute and appoint;
SUSANLAMBERT
lawful Attorney(s)-in-fact, to make, execute, seal and deliver for and on its behalf as surety and as its act and deed any and all bonds, undertakings
and contracts of suretyship, provided that no bond or undertaking or contract of suretyship executed under this authority shall exceed in amount the
sum of; Thirty Million Dollars ($30,000,000)
This Power of Attorney is granted and is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board
of Directors of West Bend Insurance Company by unanimous consent resolution effective the 1st day of January 2024.
Appointment of Attorney -In -Fact The president or any vice president, or any other officer of West Bend Insurance Company may appoint by
written certificate Attorneys -In -Fact to act on behalf of the company in the execution of and attesting of bonds and undertakings and other
written obligatory instruments of like nature. The signature of any officer authorized hereby and the corporate seal may be affixed by
facsimile to any such power of attorney or to any certificate relating therefore and any such power of attorney or certificate bearing such
facsimile signatures or facsimile seal shall be valid and binding upon the company, and any such power so executed and certified by facsimile
signatures and facsimile seal shall be valid and binding upon the company in the future with respect to any bond or undertaking or other
writing obligatory in nature to which it is attached. Any such appointment may be revoked, for cause, or without cause, by any said officer at
any time.
Any reference to West Bend Mutual Insurance Company in any Bond and all continuations thereof shall be considered a reference to West Bend
Insurance Company.
In witness whereof, West Bend Insurance Company has caused these presents to be signed by its president undersigned and its corporate seal to be
I
ereto duly attested by its secretary this 1 st day of January 2f"^
Attest �411U
Christo her C. Z y a •t
Secretary
State of Wisconsin
County of Washington
Robert J. Jacques
President
On the 1s' day of January 2024, before me personally came Robert Jacques, to me known being by duly sworn, did depose and say that he is the
President of West Bend Insurance Company, the corporation described in and which executed the above instrument; that he knows the seal of the
said corporation; that the seal affixed to said instrument is such corporate seal; that is was so affixed by order of the board of directors of said
corporation and that he signed his name thereto by like order. 011MIn",,,
y' LtC�6 &eadorporate Attorney
?Jblic, Washington Co., WI
00
My Commission is Permanent
The undersigned, duly elected to the office stated below, now the incumbent in West Bend Insurance Company, a Wisconsin corporation authorized
to make this certificate, Do Hereby Certify that the foregoing attached Power of Attorney remains in full force effect and has not been revoked and that
the Resolution of the Board of Directors, set forth in the Power of Attorney is now in force.
Signed and sealed at West Bend, Wisconsin this 7th day of April 2025
Christoplier C. Z4kaU
Secretary
1900 S 18th Avenue I West Bend, WI 53095 1 Phone: (800) 236-5010 1 Fax: (877) 674-2663 1 www.thesilverlining.com
TO: ALL CONTRACTORS
P[?
o
Osf I X
C)I' Ptjar f° VV ;ti tt
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 Management Plan
included in the Specifications and will comply with the requirements of the Plan,
Name
Printed Name
Title
Company Name
3 _ 31 2-j—
Date
1:\rnbinecring\Tracy 9'aylnr\Public Works Contracts\Miscellaneous\Snit & Groundwater Page I of I
Management Plan Ccv06calion_2-1-17.docx
Ciiy Hall, 215 Church Avenue P.O. Box 1 130 Oshkosh, WI 54903-1 130 hitp://www.ci.oshkosh.wi.us
CONTRACT 25-12 APR " 7 ?025
ATTACHMENT A DEPT or,, p�jFj,I €C 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 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
A/C-- A
-J 4r-11C 5/4tye:tii
CLAjSS OR ITEM/ S OF WORK
7 [ l C-
X,
SAw.!��
PERCENT OF
CONTRACT AMOUNT
row
i�
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).
Signature of Bidder
Page 11 of 14 (Revised)
CONTRACT 25-12
PROPOSAL APf? .y 7 202
The undersigned will begin work as specified after award of the Contract and�irt3ite>aa,ap�fed.
):"311, WISCONSIN
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 of C"✓` -r C'0. J,�In
a Partnership consisting of or
an individual trading as • of
the City of
State of r--
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.
Subscribed and sworn to before me this l
K"' � , "�-; �- - - � —. -
ar Public, or other authorized to administer
Signature
(Title, if any)
day of �`t _, 20 Z ,
(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 14 of 14 (Revised)