HomeMy WebLinkAbout1404 S Main St near intersection of W 10th Ave and Michigan St Ctry
AGREEMENT
WHEREAS, the City of Oshkosh has granted to the undersigned a privilege to place an
obstruction within the right -of -way as follows:
Installation of fiber optic cable to connect the former Coca Cola plant at 1404 South Main
Street to existing cable near the intersection of West 10th Avenue and Michigan Street,
utilizing City right -of -ways on West 10th Avenue, Nebraska Street and West 14th Avenue, per
the attached Exhibit A.
WHEREAS, State law provides that by its acceptance of this privilege the undersigned shall
become primarily responsible for damages to person or property by reason of the granting of the
privilege;
NOW, THEREFORE, in consideration of the City of Oshkosh, a Municipal Corporation granting
permission to the undersigned to place an obstruction within the sidewalk right -of -way, the undersigned
agrees that he is solely responsible for his activities under this agreement. The undersigned hereby
releases the City of Oshkosh from all debt, claims, demands, damages, actions and causes of action
whatsoever which may result from the placement of an obstruction in the sidewalk right -of -way by the
undersigned. Further, the undersigned agrees to protect and hold the City of Oshkosh harmless against
all actions, claims and demands of any kind or character whatsoever which may in any way be caused
by the activities under this privilege by the undersigned or agents or employees. Further, the
undersigned agrees to indemnify and refund to the City all such sums which the City may be obligated
or adjudged to pay, including the City's attorney fees and costs, on such actions, claims or demands
within 30 days after written request for such indemnification. The undersigned agrees that this
paragraph is to be liberally construed in favor of the City of Oshkosh, in consideration of the privilege
granted by the City under this agreement.
This agreement and the privilege cannot be assigned without the written consent of the City of
Oshkosh. The privilege is subject to all terms and conditions contained in any authorizing resolution
adopted by the City of Oshkosh Common Council, which is incorporated by reference as if fully recited
within this document. By executing this agreement and by using the privilege, the undersigned agrees
to fully abide by such terms and conditions, including revocation upon written notice for noncompliance
with the authorizing resolution and this agreement.
Dated this eict day of-azl y , 2010.
OS KOSH AREA SCHOOL DISTRICT
By: J And:
Name & Title 6..1 �C1L.0 kth Dtt2� Name & Title:
STATE OF WISCONSIN i
! SS.
WINNEBAGO COUNTY }
Per o came before me this CA day of U. ( , 2010, the above-named
�l I�y Mc \nS \ and of of OSHKOSH REA SCHOOL DISTRICT to me known
to be such person(s) and officers who executed the foregoing document and acknowledged that they executed the
same as such officers by its authority, for the purpose herein contained.
Notary Public, Y}9- Co., Wisconsin
My Commission: -Q -
Attachment: Exhibit A - Resol. #10 -215 and attachments of Oshkosh Common Council Meeting 7/13/10.
EXHIBIT A
JULY 13, 2010 10 -215 RESOLUTION
(CARRIED LOST LAID OVER WITHDRAWN )
PURPOSE: APPROVE GRANTING PRIVILEGE IN STREET TO MULTIMEDIA
COMMUNICATIONS & ENGINEERNIG AND OSHKOSH AREA
SCHOOL DISTRICT TO INSTALL FIBER OPTIC CABLE WITHIN
RIGHT -OF -WAYS OF WEST 10TH AVENUE, NEBRASKA
STREET AND WEST 14TH AVENUE
INITIATED BY: MULTIMEDIA COMMUNICATIONS & ENGINEERING,
PETITIONER; OSHKOSH AREA SCHOOL DISTRICT, OWNER
PLAN COMMISSION RECOMMENDATION: Approved w /conditions
WHEREAS, Oshkosh Area School District requests the Common Council grant a
privilege in street to Multimedia Communications & Engineering Inc., general contractor
and other subcontractors as may be required to install fiber optic cable to connect the
former Coca Cola plant at 1404 South Main Street to existing cable near the intersection
of West 10th Avenue and Michigan Street, utilizing City right -of -ways on West 10th
Avenue, Nebraska Street and West 14th Avenue, per the attached; and
WHEREAS, Section 66.0425, Wis. Stats., provides for the granting of a privilege
in a right -of -way; and
WHEREAS, the Plan Commission approved of this request with conditions.
NOW, THEREFORE, BE IT RESOLVED by the Common Council of the City of
Oshkosh that the proper City officials are hereby authorized and directed to grant
Multimedia Communications & Engineering Inc., general contractor and other
subcontractors as may be required to install fiber optic cable to connect the former Coca
Cola plant at 1404 South Main Street to existing cable near the intersection of West
10th Avenue and Michigan Street, utilizing City right -of -ways on West 10th Avenue,
Nebraska Street, and West 14th Avenue, per the attached, and upon completion of said
installation, Oshkosh Area School District will assume liability for said cable within the
right -of -ways, contingent upon the following:
1) The fiber optic system be installed in a manner that is approved by the
Department of Public Works with no modifications or changes in construction
procedure without prior approval by the Department of Public Works.
2) If no longer needed, the fiber optic system be properly abandoned and removed
in accordance with City standards and under the direction of the Department of
Public Works.
JULY 13, 2010 10 -215 RESOLUTION
CONT'D
3) Any problem which may arise as a result of the placement of the fiber optic
system be the responsibility of the contractors and owner to correct in
coordination with the Department of Public Works.
4) All appropriate permits be obtained prior to the start of placement of the fiber
optic system.
5) The fiber optic system be modified or removed immediately upon the request of
the City.
6) The fiber optic system be part of and documented with Digger's Hotline system.
7) The petitioner, contractors and owner of the fiber optic system secure and submit
to the City Clerk a separate insurance policy which names the City as an
additional insured with a minimum coverage of $200,000 per person and
$500,000 in general aggregate.
8) It is the responsibility of the petitioner to file in a timely manner a new insurance
certificate with the City Clerk upon expiration of an existing certificate. Failure to
do so will result in the revocation of the privilege in street upon 10 days notice.
9) The petitioner, contractors and owner of the fiber optic system execute hold
harmless agreements with the City.
JULY 13, 2010 10 -215 RESOLUTION
CONTD
3) Any problem which may arise as a result of the placement of the fiber optic
system be the responsibility of the contractors and owner to correct in
coordination with the Department of Public Works.
4) All appropriate permits be obtained prior to the start of placement of the fiber
optic system.
5) The fiber optic system be modified or removed immediately upon the request of
the City.
6) The fiber optic system be part of and documented with Digger's Hotline system.
7) The petitioner, contractors and owner of the fiber optic system secure and submit
to the City Clerk a separate insurance policy which names the City as an
additional insured with a minimum coverage of $200,000 per person and
$500,000 in general aggregate.
8) It is the responsibility of the petitioner to file in a timely manner a new insurance
certificate with the City Clerk upon expiration of an existing certificate. Failure to
do so will result in the revocation of the privilege in street upon 10 days notice.
9) The petitioner, contractors and owner of the fiber optic system execute hold
harmless agreements with the City.
•
ITEM: PRIVILEGE IN THE STREET FOR INSTALLATION OF FIBER OPTIC CABLE
ALONG W. 10 AVENUE, NEBRASKA STREET & W. 14`' AVENUE
Plan Commission meeting of July 6, 2010
GENERAL INFORMATION
Petitioner: Multimedia Communications and Engineering, Inc. /Oshkosh Area School District
Owner: City of Oshkosh
Action Requested:
Multimedia Communications and Engineering, Inc. and the Oshkosh Area School District are requesting a
privilege in street to install fiber optic cable in City right -of -ways connecting the former Coca Cola plant
at 1404 S. Main Street to existing cable near the intersection of W. 10 Avenue and Michigan Street.
Applicable Comprehensive Plan and Subdivision Regulations Provisions:
N/A but any location of a non -city or public utility use in city right -of -way requires the issuance of a
privilege in street permit.
Property Location and Type /Analysis:
The Oshkosh Area School District recently acquired the former Coca Cola Bottling Plant at 1404 S. Main
Street to be used as their new facilities management building. The School District is proposing to connect
this building to existing fiber optic near the intersection of Michigan Street and W. 10 Avenue. The
fiber optic cable will be routed by a combination of two -inch duct installed by directional borings, and
aerially by use of existing Wisconsin Public Service owned poles (see attached plans).
The petitioner coordinated their design with the Department of Public Works to ensure no conflicts with
City utilities. The Department of Public Works has reviewed the request and has no concerns with the
proposed installation. Staff discussion at the interdepartmental meeting suggested that the placement of
the cable could be placed underground. However, the Department of Public Works suggests that the cable
utilize existing power poles per the submitted plans to preserve the limited underground right -of -way
space. Any new utilities placed underground require a minimum two -foot horizontal clearance from
existing utilities. The introduction of another private utility will further tie up valuable right -of -way space
and make it more difficult to access City utilities in case of an emergency or perform regular maintenance.
The Department of Public Works suggests that when the subject streets are reconstructed in the future, all
similar private utilities could be coordinated and placed in a single large underground conduit.
RECOMMENDATION /CONDITIONS
Staff recommends approval of the privilege in the street request with the following conditions:
1) The fiber optic system be installed in a mariner that is approved by the Department of Public
Works with no modifications or changes in construction procedure without prior approval by the
Department of Public Works.
2) If no longer needed, the fiber optic system be properly abandoned and removed in accordance with
City standards and under the direction of the Department of Public Works.
3) Any problem that may arise as a result of the placement of the fiber optic system be the
responsibility of the petitioner /owner to correct in coordination with the Department of Public
Works.
4) All appropriate permits be obtained prior to the start of placement of the fiber optic system.
5) The fiber optic system be modified or removed immediately upon the request of the City.
6) The petitioner /owner secures and submits to the City Clerk a separate insurance policy which
names the City as an additional insured with a minimum coverage of $200,000 per person and
$500,000 in general aggregate.
7) It is the responsibility of the petitioner /owner to file in a timely manner a new insurance certificate
with the City Clerk upon expiration of an existing certificate. Failure to do so will result in the
revocation of the privilege in street within ten (10) days of notice.
8) The petitioner /owner execute a hold harmless agreement with the City.
9) The facility be part of and documented with Digger's Hotline system.
The Plan Commission approved of the privilege in the street as requested with conditions noted. The
following is the Plan Commission's discussion on this item.
Mr. Buck presented the item indicating installation is proposed to be both overhead and underground
were necessary. Referring to a map on the PowerPoint presentation, Mr. Buck noted the fiber optic cable
would generally be overhead along 10th Ave., overhead and underground along Nebraska St., and
underground to the S. Main St. site. Mr. Buck acknowledged that concern has been expressed in the past
that these types of installations should be underground but due to limited underground right -of -way space,
the Department of Public Works is recommending the cable utilize overhead and underground as
proposed. When the streets are reconstructed in the future, all private utilities can be coordinated and
placed in a single large underground conduit thereby eliminating issues with multiple utility separations
and necessity to cut into the right -of -way on numerous occasions.
Mr. Dan Becker, representing Multimedia Communications out of Green Bay, stated he didn't want to
have any issues with the Public Works Department and was concerned about the reference in the staff
report to Winnebago County; this work was being performed for the School District.
Mr. Buck stated that there is a typo in the staff report and there shouldn't be difficulty with obtaining the
necessary permits from the City once the item is approved by Council.
Motion by Thoms to move approval of the privilege in street as requested with the following
conditions:
1) The fiber optic system be installed in a manner that is approved by the Department of Public
Works with no modifications or changes in construction procedure without prior approval by the
Department of Public Works.
2) If no longer needed, the fiber optic system be properly abandoned and removed in accordance
with City standards and under the direction of the Department of Public Works.
3) Any problem that may arise as a result of the placement of the fiber optic system be the
responsibility of the petitioner /owner to correct in coordination with the Department of Public
Works.
Item -Priv in St- W10th/Nebraska/W14th
2
4) All appropriate permits be obtained prior to the start of placement of the fiber optic system.
5) The fiber optic system be modified or removed immediately upon the request of the City.
6) The petitioner /owner secures and submits to the City Clerk a separate insurance policy which
names the City as an additional insured with a minimum coverage of $200, 000 per person and
$500, 000 in general aggregate.
7) It is the responsibility of the petitioner /owner to file in a timely manner a new insurance
certificate with the City Clerk upon expiration of an existing certificate. Failure to do so will
result in the revocation of the privilege in street within ten (10) days of notice.
8) The petitioner /owner execute a hold harmless agreement with the City.
9) The facility be part of and documented with Digger 's Hotline system.
Seconded by Borsulc Motion carried 7 -0
Item -Priv in St- W10th/Nebraska/W14th
3
4) All appropriate permits be obtained prior to the start of placement of the fiber optic system.
5) The fiber optic system be modified or removed immediately upon the request of the City.
6) The petitioner /owner secures and submits to the City Clerk a separate insurance policy which
names the City as an additional insured with a minimum coverage of $200, 000 per person and
$500, 000 in general aggregate.
7) It is the responsibility of the petitioner /owner to file in a timely manner a new insurance
certificate with the City Clerk upon expiration of an existing certificate. Failure to do so will
result in the revocation of the privilege in street within ten (10) days of notice.
8) The petitioner /owner execute a hold harmless agreement with the City.
9) The facility be part of and documented with Digger 's Hotline system.
Seconded by Borsuk Motion carried 7 -0
S
Item -Priv to St- W1 0th/Nebraska/W14th
City of Oshkosh
SUBMIT To:
General Application of Community Development
215 C
hurch Ave., P.O. Box 1130
ON THE w►raR Oshkosh, WI 54901
PHONE (920) 236 -5059
**PLEASE TYPE OR PRINT USING BLACK INK"
APPLICANT INFORMATION
petitioner Multimedia Communications and Engineering, Inc. Date: 06-07 -2010
Petitioner's Address: PO Box 11064 city: Green Bay State: WI zip: 54307
Telephone #: (920) 676 - 3496 Fax: ( 920) 469 - 9770 Other Contact # or Email: dbecker@mcae.biz
Status of Petitioner (Please Check): DOwner [epresentative OTenant D Prospective Buyer -
Petitioner's Signature (required): . Date: 06-07 -2010
OWNER INFORMATION
Owner(s): Oshkosh Area School District Date: 06-07 -2010
Owner(s) Address: 215 South Eagle Street cit Oshkosh state: WI zip: 54903
Telephone #: ( 920) 424-0207 Fax: ( 920) 424-0466 Other Contact # or Finail: R°"d'i 1zwi.us
Ownership Status (Please Check): ['Individual OTrust DPartnership Corporation
Property Owner Consent: (required)
By signature hereon, I/We acknowledge that City officials and/or employees may, in the performance of their fimctions, enter upon the
property to inspect or gather other information necessary to process this application. I also understand that all meeting dates are tentative
and may be postponed by the Planning Services ' ' 'on for incomplete submissions or other administrative reasons.
Piuperty Owner's ' Date: 4 • i.. 1 6
s Si Sn afore: ��
TYPE OF RE I UEST:
• Access Control Variance
• Easement
ri Privilege in Street (identify) Fiber Optic Cable Placement within City Right of Way
• Other (identify)
SITE INFORMATION
Address/Location of Proposed Project: 10th Avenue, Nebraska Street, and 14th Avenue
Proposed Project Type: Fiber Optic Network Installation
Current Use of Property: Zoning:
Land Uses Surrounding Your Site: North:
South:
East
West
> Application fees are due at time of submittal. Make check payable to City of Oshkosh.
> Please refer to the fee schedule for appropriate fee. FEE IS NONREFUNDABLE
For more information please visit the City's website at www.ci.oshkosh.wi.us/ Community _ Development1Planning.htm
Staff Date Rec'd V ` D
3-
,
Multimedia Communications nications Engineering, Inc.
111/1 =, PO Box 11064 Green Bay, W1 54307-1064 ph (920) 676 -0494
Placing technology at your fingertips
June 7 2010
TO: City of Oshkosh Planning Services Division
FROM: Multimedia Communications & Engineering, Inc. on behalf of The Oshkosh Area School District.
RE: Privilege in the Right Of Way Narrative
Oshkosh Area School District (District) has recently purchased a property located at the Intersection of
Main St and 14 Ave. The District intends on connecting this building to their existing Fiber Optic Cable
Network via a fiber optic cable inside a 2" HDPE duct placed within the City of Oshkosh Right of Way as
well as on WPS owner poles (cable only). Please see the attached map for route details.
All planned routes have been shared with the City Department of Public Works. The final route has
taken into consideration any input from the Department regarding existing utilities, planned activities in
the area, and future adjustments to streets, sidewalks, and other City Owned utilities.
The construction method used to place the underground duct and fiber optic cable within the City's
Right of Way will be Directional Bore. This method creates minimal noise and vibration levels that do
not exceed the limits established in the municipal code. The benefit to the Directional Bore method is
that it minimizes the amount of surface excavation necessary for installation. Operation of this
equipment would be limited to normal working hours of 7:00 AM to 5:OOPM and will take into
consideration any hours of work restrictions placed by the City. At no time would the construction
activities extend outside the boundaries of the City ROW or County -owned properties.
Given the schedule for moving in to this facility it is expected that the work will be completed before
August 1st of this year.
Any questions regarding this proposed project can be directed to the District's hired engineering firm
Multimedia Communications & Engineering Contact Person Dan Becker 920 - 676 -3496 or
dbecker @mcae.biz.
•
4
Multimedia Communications & E g s s g , Inc.
PO Box 11064 Green Bay, WI 54307 -1064 ph ( )
Placing technology at your fingertips
June 7 2010
TO: City of Oshkosh Planning Services Division
FROM: Multimedia Communications & Engineering, Inc. on behalf of The Oshkosh Area School District
RE: Privilege in the Right Of Way Narrative
Oshkosh Area School District (District) has recently purchased a property
located at the Intersection of
Main St and 1e' Ave. The District intends on connecting this ��� n the City of Oshkosh Fiber
as
le
Network via a fiber optic cable inside a 2" HDPE duct placed
well as on WPS owner poles (cable only). Please see the attached map for route details.
All planned routes have been shared with the City Department of
utilities, planned activities in
taken into consideration any input from the Department regarding existing
the area, and future adjustments to streets, sidewalks, and other City Owned utilities.
The construction method used to place the underground duct and fiber optic d and vibration levels the C t do
Right of Way will be Directional Bore. This method creates minimal noise a
is
not exceed the limits established in the municipal code. The benefit to the Directional Borreome hod his
t that it minimizes the amount of surface ' ^ of 7x00 AM to a 5I a 00PM and will take into
equipment would be limited to norm
consideration any hours of work restrictions placed by the City. At no time would the construction
activities extend outside the boundaries of the City ROW or County -owned properties.
Given the schedule for moving in to this facility it is expected that the work will be completed before
August 1st of this year.
Any questions regarding this proposed project can be directed to the Dann�Becker a firm
or
Multimedia Communications & Engineering Contact
dbecker@mcae.biz.
•
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DISCLAIMER 4
Thls map Is neither • legally recorded map nor FIBER OPTIC CABLE ROUTE
a sunny and It Is not intended to be used as one. W 10TH AV/NEBRASKA ST/
'fhb drawing b a compilation of records, data N
and Information batted In various city, county OM TO IT 11 - -`
and stab offices and other sources affecting W 14TH AV 0,, MC NAM
the area shown and It is to be used for reference
purposes only. The Cky of Oshkosh is not re. City of Oshkosh
sponsible for any Inaccurades herein contained. Department of
If dIscrepencles ars found, please contact the
Clly of Oshkosh. Scale: 1" = 500' Community Development
Created by - dff 06121110
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DISCLAIMER FIBER OPTIC CABLE ROUTE
survey l IS DCt legally to be used W 1 0TH AV /NEBRASKA ST/ N
s and K b not tlltandad b b• used N ores.
This drawing b a compilation of records, data
and infonsalion located
do f in s affecting
a►. W 14TH AV ea, .°a
and astate olffees and other sosress of Oshkosh
the area shown and tt b to be used for reference
purposes only. The of Oshkosh b C "� not re- Department of
ap�� for any inaccuracies herein convened. Community Development
K discrepancies are found. please contact the
C�a0ahkea� Scale: 1" = 500'
Created by- dff 06/21/10
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DISCLAIMER FIBER OPTIC CABLE ROUTE /
This map is neither a hpally recorded map nor W 10 AV /NEBRASKA ST/
a survey and d it k is not Int.nd.d 6". used as oils. N
r ,This drawing is a compilation of records, data f
i end information located In various city, county
and state offices and other sources affecting W 1 4TH AV A arm rum
the area shown and it Is to be used for reference C ity of Oshkosh
sp I o r any Innaccurraclss heroin contained. Department artment of
re
If discrepancies a found, please contact the Scale: I e: 1 " = ' 10 00' Community Development
City of Oshkosh.
Created by - dff
06/21/10
7
SUBJECT °k
• is �,. — .. - ..".`- ��+� ::
•
•
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DISCLAIMER
This wisp Is n mapna FIBER OPTIC CABLE ROUTE
a survey and it is not intended to he used as one. W 10TH AV /NEBRASKA ST/
b a ard of R, county
data
N WiNt . nd '" 'sUon llocated .' �„ ve '. city "' °�, `aunty W 1 A V
■nd sate offices and other nouveau afec*1n
the area shown and It is to be used for ntsnnc. Community City of Oshkosh
purposes only. The City of Oshkosh is not r.-
sponsible for any inaccuracies herein contained. Department of
u discrepancies are found, pliasa contact the
City of Oshkosh. Scale: 1" = 500'
Created by - citt 06/2/110
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SUBJECT -
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DISCLAIMER FIBER OPTIC CABLE ROUTE
'This
�lbL
•randitisno to be nor . W 10TH AV /NEBR ST/ N
. eurvsy and k is rent intended m a wens. Dees i
TAB drawing is a easpilstbn of mead,, data _ f
end i o to city. toe, t A I 14TH AV •.•
end s e a t , i s t a o f f i c e s ofieas and d al»r * * W C sa+ueas M e t e * arse shown sod k is to he used for referents C ity of Oshkosh
purpose* only. The City of Oshkosh is not is. Deparlrrletst of
spoonbill iserepowieles . u pre o contort Community Development
City of Oshkosh. Scale: 1" = 540'
cnealea by -aft
Q6121110
A
CERTIFICATE. OF INSURANCE
•
ISSUE DATE: 7/29/2010
AEGIS CORPORATION THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
18550 \V. CAPITOL DRIVE NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES A'OT
AMEND, EXTEAD OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BROOKFIELD, WISCONSIN 53045 BELOW.
TEL: (800) 391 -1116
FAX: (262) 783 -6091
COMPANIES AFFORDING COVERAGE
INSURED: ;
r 0 ., fCL 11% (_ '"`
Oshkosh Area School District
215 S. Eagle Street
P. O. Box 3048 COMPANY .t U I ! i 1 f„ 3 0 2010
Oshkosh, WI 54903 -3048 LETTER A
\ IV L cn[cD OFFICE
COMMUNITY INSURANCE CORPOR I ..
COVERAGES
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO me INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,
NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OF OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OP SUCH POLICIES, LIMITS
SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO. TYPE ON INSURANCE POLICY EFFECTIVE EXPIRATION LIMITS
LTR NUMBER DATE DATE
A LIABILITY SGL2227010 7/1/2010 7/1/2011 $5,000,000 EACH OCCURRENCE
GENERAL LIABILITY
SCHOOL BOARD E &O
AUTOMOBILE LIABILITY
ALL OWNED AUTOS
HIRED & NON -OWNED AUTOS
UNINSURED MOTORISTS _
DESCRIPTION OF OPERATIONS /LOCATIONS/VEIIICLES /SPECIAL ITEM
Certificate Holder is named as an Additional Insured with regard only to the Fiber Optic Network Installation.
CERTIFICATE HOLDER:
City of Oshkosh, and its officers, council CANCELLATION
members, agent, employees and authorized
.volunteers SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
215 Church Avenue - P.O. Box 1130 THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR
Oshkosh, WI $4 .901 TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO
THE :LEFT, BUT FAILURE TO MAIL SUCH . NOTICE SHALL IMPOSE NO
OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS
AUTHORIZED REPRESENTATIVE OR REPRESENTATIVES. •
4OIte V -- -- --