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CITY OF OSHKOSH
Contract Number 25-06 (Concrete Sidewalk New & Rehab) Bond #485476
Date Bond Executed (Date of Contract or Later) 1 /13/2025
PRINCIPAL/CONTRACTOR (Legal Name and Business Address)
AL DIX CONCRETE INC
401 Gertrude St
Kaukauna, WI 54130
SURETY(IES) (Legal Name(s) and Business Address(es))
MERCHANTS NATIONAL BONDING INC
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
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 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.
l
Nam Hiincipal/Contractor
Title
Nam, Suretty (Cayden Janse)
Attorney -In -Fact
Title
Page 2 of 2
Bond #: 485476
�iVEC
BONDING COMPANY.
POWER OF ATTORNEY
an&MER 'HANTS NA DNAL'.B.QNDING, INC.,
(In Ceilforn.. only) (herein colleoiively called the
Cayden Janse
orne ' s '�In Fact, to sign Is name:,ee: sgrety(les):;arid, to ;q%t3cUW .k I and acknowledge any'. attd aU.;bonds, ,urid fiaklnes,
their true and lawful /Ail ..• y.(,.),•.....r.it
contracts and other :vfri4h ;iijst Ments In the nat Brad execiilln nobgualant pg b nds end underlalSlrags re%uired�orepetrnitted lnh a y ao. 4llo'tis
persons, guaranteeing the performance of contracts n g
or proceedings allowed by law. t 'b the Board of
1 ils; Foviier=of Ati rr eY is granted i ndsts slgped ;and sealed : feoslmlle under and by authority of the •tolidwing .3yc19.v_ils :adcp,.g a' y
Dlrecti;Ts of McPchaii(s Bonding go[npapy �MutU,al) on ApHi 23; 29.1'1 and amended August 14, 2015 and.•Apill 27, 20'24:=and adopted by the Board of
Directors of Merchants National Bonding, Inc., on October 161 2016 and amended on April 27, 2024.
" su ' t or ietl' ' :Assts►etit: i ;asurer or;, any., Assistant Seorotsry or any . rA President shell fi'4ve 'power and
Thtf,-PteaideLtt, , Se cetary,...T,tea, re_,r. ,.y:,. :•o •.<:.:.. ` em to; ezeoute' 9ki� behalf of the Company, and at
_ihe>seei: of the'Company.thereto,
atiihortty to appoint Attorneys-ln-Fact, :and tbeul�i_ .r►?e; kh, .._. ,,., ..
bond§ s_rld uhd�ttakings, recognfzaneesr contracts oiinderiniitty,and.oitiervPitings obligatory in the nature thereot `
The slgriature.ot'at gauthorized afflcer,:e(1cl;the!seal of the :Gomgany maybe affixed by facsimile or:eleolFanic transmission to any Power of s of the
or Ceititicatlon:tiiereof authorizing the•:ezeoution end delI drys of any bond, undsrtakirgt recog6liance, or other suretyship ey
obligations of the
Company, and such signature and seal when so used shall have the same force and effect as though manually fixed "
e,oi:+r;n nnwnr•andiauf:hodtv:fhereby:giveh:'io:the
Its obligations under Its bond.'
In connection wlth.og van
bligatlons Igfavor of the Kentucky Department of Highwn y BolYtii ;nolfcereof such that hnt'en has been giverit a theyCommissianer-
to, the:Attpmeyr'in»Fact cannot be modified or }eYoked unless,ptTor wdtte p rt:
I]epert negt;of,HtBN+Nays'of l}ie QemrtlonWeailh oflCentuoky at least ihirty,(30) days priot;to the modlfh llon;or revocation. 2025
(n Witness Wherebf the'G.ompanles,�ieve`caused',ttiis lrie#tumetttc:.be'sigtied:end seald,this 6th dayof January
•••�.�•��►•�� ..t:�•;'++•.,. MERCHANTS BONDING COMPANY (MUTUAL)
;:+��'+i �i(.`'+. . ••'Q MERCHANTS NATIONAL BONDING, INC.
g -�EIpQR0•.ti Qr4p4P'aA9 dt6la MERCHANTS -NATIONAL INDEMNITY00,
COMPANY
..'rs� . 33
,ZU0.3 '19 . c'..
?+�• B
y V
.a'.,
• �.
+•�' �'-,..!•. ,•':__.�;_::' President
STATE OF IOWA
COUNTY OF DALLAS ss• Taylor, to me personally known, who being by me duly sworn
On this 6th day of January r" 2025 before me appeared Larry y
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 Companles'by authority of their respective Boards of Directors.. —_
d�A6. Penni Miller -
o. Commission Number 787952
•�-We My Commission Expires
j&iV : January 20, 2027 . Notary Public
_ .._.... _ _..._.._ .. _ ..: •(gip liatlon of notary's commission
does not invalidate this Instrument) INC. do
and MERCHANTS
h Elisabeth St at the above and forof egoig s MERCHANTS r end ccorrect copyNG OMPANY of the POWER -OF -ATTORNEY executed by NATIONAL
Companies, iwhich Is still
hereby certify
In full force and effect and has not been amended or revoked.
In Witness Whereof, i have hereunto cnr,,,v hand and affixed the seal of the Companies an this 6th day of January , 2025 ..
Secretary
POA 0018 (6/24)
�' DATE (MMIDDIYYYY)
At iieD CERTIFICATE OF LIABILITY INSURANCEF v6/2oz5
HOLDER
THIS CERTIFICATE IS ISSUED AS A MATTER OF NEGATIVELY METAON AMEND, AND MEND OREALTERIS
RTHETCOVERAGE AFFORDEDUPON THEABY THE TE POLICIEES
CERTIFICATE DOES NOT AFFIRMATIVELY
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER,
IMRORTANT: If the certificate holder is an ADDITIONAL INSURED, the p IlicQ' l 8") must have ADDITIONAL;iNSURED; provisions or be endorsed.
_..
If SUBROGATION 15 WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on
this: certificate does not confer rtghfs #o the certificate holder In lieu of such e►ldorsement(s),
CO ACT
PRODUCER E Kristin i3OeVerB a
Spectrum Insurance Group PHo E 920�426 2431 'No 8508
92056;
303 Packerland Dr, Suite C a ao Allss < kristin bcevor$ s ectrulnins rod com
Green Bay WI 54307 NAIc11
'INSURER S 'AFFORDING COVE AGE- _
INSURER=A: Frankenmuth Mutual Insurance
13as6
3537£i'
ALDIXCO-01
INSURED
- . INSURERS: EVANSTON INS CO
Al Dix Concrete Inc ;; INsuRERC;i
401 Gertrude St
INSURER D'e
Kaukauna VVI 54130
'INSURER E:
INSURER F t
CERTIFICATE NUMBER:469�472404 :
REVISION NUMBER:
COVERAGES I *ISSUE� To THE OR THE -
THI IS ICY PERIOD
CNOTTWITHSTANDING ANY RE ES OF INSTERM OR CONDC5 LISTED jTIONVOF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TOLWHICH THIS
INDICATED,
CERTIFICATE MAY NOTWITHSTANDING
OR MAY PERTAIN,; THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS .OF SUCH POLICIES,11M(TS SHOWN MAY HAVE BEEN RED • LICY _ BY P I CLAIMS, LIMITS
ILSR 00, ....R pOUCYNUMBERt. MMI0D
TYPE OF INSURANCE: -
- 3/1/2024 3/1/2025 EACHOCCURHONCE 5100000Q.
A X COMMERCIALOI NERALLIABILITY Y 6112206 R A L �-- g1 QQOOOQ
a
E ISE Efl' _ n iY�Gey
CLAIMS -MADE OCCUR MED EXP one reon . $14;000
PERSONAL&ADV INJURY S 1;000 Q00 .
GENERALAGGREGATE S'2,000 0*0
GEN'LAGGREGATE LIMIT
APPa PER: PRODUCTS-COMPIOPAGG S2,OOOp00:
POLICY � jEC01i LOC S
oTNt ei
O BINE081NBLELI $1,000,000
- 6712205 3/1/2024 3/1/2026 �—
A AUTOMOBILE LIABILITY BODILY INJURY (Per person) $
X ANY AUTO BODILY INJURY (Per accident) $
OWNED SCHEDULED PRO@ .,D GE $
AAUTOS ONLY AUTOS
X HIRED X 'NON -OWNED $
AUTOS ONLY AUTOS ONLY
6712206 311/2024
31112025 EACH OCCURRENCE S'S Od0 000
A X UMBRELLA LIAR X ! 'OCCUR AGGREGATE S`5,000 000
EXCESS LIAR GL1tIM8 MADE S
DEp. RETENTiO' ks OT
A WORKERS COMPENSATION
-" 6712204 3/1/2024 3/1/2025 X' S�Ar TE ER
AND EMPLOYERS' LIABILITY YIN* E.L. EACH ACCIDENT 5100 000
ANYPROPFIIETOR)PARTNFJUEXECUfIVE 171 NIA E.L.DI8P45E-HA EMPLOYEE $100000
OFFICER)MEMBEREXCLUOED9
(Mandatog16NH) E,L.DISEASE-POLICY LIMIT 3500,000
IIyes'.dobcribeundea. • 1,000,000
DESGIRIF'TION OF OPERATIONS 6a ow CPLMOL118019 8/18/2023 8/18/2026OccurlAggragale $
B Pollution Uablllty 3/1/2024 3/1/2025 Jobsita Umlt $100,000
A Installation Floater 6712206
be attached if more
Michael lDix and Dylaln Dix are excluded from cove ege ocORD n the workersAdditions 'rke compensation/employers' liabilityepolicy. red)
1/13/26 Bid (Contract 25-06 Concrete Sidewalk New & Rehab)
CANCELLATION
'ERTIFICATE HOLDER
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE ExATION DATE HEP THEREOF, PROVISIONS.
E WILL BE DELIVERED IN
ACCORDANCE
City of Oshkosh
215 Church Ave AUTHORIZED REPRESENTATIVE
PO Box 1130 2 1., ....
Oshkosh WI 54903-1130
C 19a8-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
CONTRACT 25-06
PROPOSAL
The undersigned will begin work as specified after award of the Contract andf6 te`iasspecified.
I hereby certify that all statements are made in behalf of
In�-
AI UpnGrv�p�
(Name of Corporation, Partnership, or Person Submitting Bid)
a corporation organized and existing under the laws of the State of
or
a Partnership consisting of
of
an individual trading as
......State of
the City 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',:6Uftfti`0n s * are .and correct..
(P Signature
(Title, if any)
Subscribed and sworn to before me this day of,—.� 26
T T EN
Notary Public
State
(
*E co 5
RAVIS HAEN
Notary Public
Notary Public, or other authorized to administer 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 of the total amount of the Bid, as
called for in the Official Notice to Contractors.
Page 10 of 10
CONTRACT 25-06
{
ATTACHMENT A
LIST OF PROPOSED SUBCONTRACTORS
Pursuant to Section 66.29(7), Wisconsin Statutes, the Bidder, as part of this .Proposal, submits this full and
complete list of all the Proposed Subcontractors and the class of work to be performed by each. The
CONTRACTOR will be permitted to sublet a portion of the Contract, but shall perform with their
organization work amounting to at least thirty percent (301/1o) 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
5-! -
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).
Sign e of Bidder
Page 7 of 10
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. I£ 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
Print d° Name
Title
Company Name
Date
I:\Engineering\Tracy Taylor\Public Works Contracts\Miscellaneous\DlsclosumoFOwnership Fonn 2-1-
Page 1 of 1
17.doa
City Hall, 215 Church Avenue P.O. Box 1130 Oshkosh, WI 54903-1130 http://www.cl.oShkosh.wl.us