HomeMy WebLinkAboutRight Of Way BondRIGHT-OF-WAY PERMIT
PERMIT NUMBER: JCA��Cc7C7
TODAY'S DATE: b1Z0 f 19 ESTIMATED DATE OF WORK:
APPLICANT (Person doing the work). ,
5
COMPANY:L.Cj�2j5
ADDRESS: fiCO I t . Q . ?l CX S ► A,� �_ K
PHONE: Si � , 4 ,-'c. - EMAIL. PERMIT TO: VV ` teY Q Lee f5hry IlDw S,
CUSTOMER.
(ADDRESS:
IPHONE:
ADDRESS OF PROJECT: ��� k,)� y/
DESCRIPTION OF WORK (check all that apply)
ROAD BORE DRIVEWAY REPLACEMENT ❑
CONSTRUCTION ENTRANCE LANE CLOSURE ❑
STREET CUT ❑ ROAD CLOSURE ❑
OTHER ❑
DESCRIPTION:
TYPE OF SURFACE CUT (if applicable)•
*NOTE: OPEN CUTS IN PAVEMENT REQUIRE BOARD OF PUBLIC WORKS (BPW) APPROVAL *
USE OF HEAVY EQUIPMENT
DRAWING ATTACHED
YES
YES
NO
NO
*NOTE: ON REVERSE SIDE OF THIS PERMIT, PROVIDE NAMES AND CONTACTS OF ALL SUB -CONTRACTORS INVOLVED
SURETY BOND. Please see Item #1 of the Right -of -Way Conditions.
BONDING COMPANY- Qnh on M
BONDING NUMBER: j C v k C 13 j 1 ,
EXPIRATION DATE: Ll I Z 2-1 C7 Z0
As applicontlor this Right -of -Way Permit, I understand and agree to all of the specifications and
t conditions listed on the attached shy t.
nt's Si re} (Print Name}
PERMIT GRANTED BY:
COMMENTS:
DATE ISSUED:
(City Official)
REPAIR WORK INSPECTED AND APPROVED
I have inspected the repair of the above right-of-way and find it to be completely satisfactory.
(City Inspector) (Date Released)
LbM
Nationwide Mutual insurance Company
1100 Locust, Dept. 2006
z Des Moines, IA 50391-2006
Nat€onwlde Phone: 866-397-0457
General Application
Email bondcommfr�nationwidc.com
Bond Number: 7901013186
AGENT G-A-DI3F.RRY & ASSOCIATES TNC. ADDRESS PO BOX 509, PITTSBORO, IN 46167-0509
Name of Applicant Kent Shaffer Builders Inc FED ID#
Address 8649 E 250 SOUTH, Zionsville, IN 46077
2. Type of Bond License and Pcri-nit - Cam pliancc
3. Amount of Bond $ 5,000.00
4. To Whom Payable The City of Carmel
INDEMNITY AGREEMENT
The undersigned applicant and indennitors (collectively referred to as "Indemnitors") hereby request Nationwide Mutual Insurance Company (collectively
referred to as "Company") to become surety for the above bond(s), or any bond(s) in substitution for or in succession of the said bond(s). The Indemnitors
certify that the information and statements provided to the Company for the purpose of securing this bond(s) are true and correct and further jointly and
severally agree:
I . the Company is authorized and empowered, without notice to or knowledge of the Indemnitors, to assent to any change whatsoever in the
bond(s), to execute or consent to the execution of any continuations, extensions, renewals, enlargements, modifications, changes, or alterations of the bond(s)
and to execute any substitute or substitutes therefor, with the same or different conditions, provisions, and obligees and with the same or larger or smaller
penalties, it being expressly understood and agreed that the indemnitors shall remain bound under the terms of this Agreement even though any such asset by
the Company does or may substantially increase the liability of said indemnitors.
2. that the Company is hereby authorized to make any inquiry as may be necessary from financial institutions, persons, firms, credit reporting
agencies and other entities in order to confirm and verify information provided to the Company by the indemnitors as an inducement for the issuance of the
bond(s) or for the continuance of such bond(s).
3. to pay to the Company the usual annual premium until such time as the Company has been provided with satisfactory and conclusive evidence
that all liability under the bond(s) has been terminated and no further liability exists.
4. to perform all the conditions of such bond(s) and to indemnify and save the Company harmless from any and all liability, demands, losses, costs,
damages and expenses, including attorney and counsel fees, which the Company may sustain or incur by reason of or in consequence of the execution of such
bond(s) by the Company, or incurred in obtaining a release of liability or evidence of termination under such bond(s) or incurred by the company in enforcing
any provision of this agreement.
5. that upon demand by the Company for any reason whatsoever, to deposit funds with the Company in an amount sufficient to satisfy any claim
against the Company by reason of such bond(s).
6, that the Company shall have the exclusive right to adjust, settle or compromise any claim under such bond(s) unless one or more of the
Indemnitors shall, in writing, request the Company to litigate such claim and shall deposit immediately with the Company collateral satisfactory to the
Company in kind and amount.
7. that the itemized statement of loss and expense incurred by the Company, sworn to by an officer of the Company, shall be prima facie evidence
of the fact and extent of the liability of the indemnitors to the Company.
8. that the Company may decline to become surety on any bond(s), and in case it does acts s surety the Company shall have the right to withdraw or
cancel any bond(s) whenever it shall see fit; and in any event the Company shall not be required to disclose the reason upon which its action is based and shall
not be responsible for any loss or damage that may be sustained by reason of such action.
9. that in the event of any payment by the Company, the indemnitors shall pay the Company interest on such amounts at the maximum legal rate
from the date such payments are made.
This agreement of Indemnity shall be deemed effective as of the date of execution of the bond(s) even though it may he signed subsequent to this date.
Kent Shaffer Builders Inc
(Name of4plicant)
V l 2-� 1 9 By
41-- e,
(Date Signed) ( emnitor)
(Date Signed)
(Date Signed)
(Date Signed)
(Date Signed)
(Indemnitor)
(Indemnitor 1 Spouse)
(Indemnitor)
(Indemnitor 1 Spouse)
NOTE: If Applicant or Indemnitor is a corporation, the corporate name must be signed in full, with the officer's name and title on the line below atnd the ;rat nl'the CO:'11 0ratn0+i
affixed. If a co -partnership, the firm name must be signed and each member of the firm must sign individually.
Nationwide Mutual Insurance Company
Bond Department
Nationwide 1100 Locust Department 2006
y -- • Des Moines, IA 50391-2006
Phone: 866-357-0457
Email: bondcomm@nationwide.coiri
License and Permit Fiend
Bond No. 7901013186
KNOW ALL MEN BY THESE PRESENTS:
That we, Kent Shaffer Builders Inc
of Zionsville , State of IN , as Principal, and
Nationwide Mutual Insurance Company, a corporation duly licensed to do business in the State of IN
as Surety, are held and fierily bound unto The City of Carmel ,
State of IN , in the penal sum of Five Thousand and no/100 dollars $5 000.00
lawful money of the United States, to be paid to the said Obligee, for which payment well and truly to be made,
we bind ourselves and our legal representatives, jointly and severally by these presents.
THE CONDITION OF THE ABOVE OBLIGATION IS SUCH, that whereas, the said Principal has been issued
a license or permit described as follows: RightofWay by
the said Obligee.
NOW THEREFORE, if the said Principal shall faithfully perform the duties and in all things comply with the
laws and ordinances, including all Amendments thereto, appertaining to the license or permit described then this
obligation to be void, otherwise to remain in full force and effect from August 23, 2019
until August 22, 2020 unless extended by Continuation Certificate.
This bond may be terminated at any time by the Surety upon sending notice in writing, to the obligee with whom
this bond is filed and to the Principal, at the last known address, and at the expiration of thirty (30) days from the
mailing of said notice, this bond shall ipso facto terminate and the Surety shall thereupon be relieved from any
Iiability for any acts or omissions of the Principal subsequent to said date.
Dated this 23rd day of Au ust
2019
Shall save and keep harmless the The City of Carmel , from all
loss or damage which it may sustain or for which it may become liable on account of the issuance of said license
or permit. Kent Staff r Builders Inc
r
incipal
Nationwide Mutual Insurance Company
By:
DARRYL E GADBERRY , Attorney -in -Fact
Powor of Attornoy
KNOW Ai I.- MEN BY THESE PP SFNTS THAT
Natiortwde Mutual Insurance Company, an Oh-o corooral:on
Allied Propef#y and Casualty Insuranc9 Company. an Iowa corporation
AhACO 'nsurance, Company an lowa corporation
he+ein0er referred to severally as the 'Company- and collectively a5 'the Companies" dnen hhrnt)y make. constitute and appoint
DARRYL E GADBERRY
each in their individual capacity its true and Lawful attorney-in•fact with fuil power and authority to sign, sear and execute on its behalf any and all bonds and
undertakings and other obl�galory instruments of similar nature in penalties not exceeding the sum of
Five Thousand and no/100 do]lags ($5,000.00)
and to bind the Company thereby, as fully and to the same extent as if such instruments were signed by the duty authorized officers of the Company and all acts
of said Attorney pursuant to the authority given are hereby ratified and confirmed
This power of atlomey is -Ide and executed pursuant to and by authority of the following resolution duly adopted by the board of directors of the Company
'RESOLVED, Inal the president or any vice president be and each hereby is authorized and empowered to appoint attorneys -in -fact of the Company
and to authorize them to execute ana deliver on behalf of t►re Company any and all bonds forms, applications memorandums undertakings,
recognizances transre•s contracts of indemnity policies contracts guaranteeing the fidelity of persons holding positions of public or private trust and other
►vntings othigatory in nature that 'he business of the Company may require and to modify or revoke. with or without cause, any such appe+nlrrent or
authority, o,oviided however, that the authority g,anted hereby shall in no way limit the authority of other duly authorized agents to sign and countersign any
of said documents on behalf of the Company '
-RESOLVED FURTHER. tt^at such attorneys-in•fact shall have full power and ajthor.ty to execute and deliver any and alt such documents and to b nd the
Company subject to the terms and limitations of the power of attomey issued to them and to affix the seal of the Company thereto, provided. however, that
saA seat shall no; be necessary for the validity of any such documents "
This power of attomey is signed and sealed under and by the fo+towing bylaws duly adopted by the board of directors of the Company
Fxec.::on cf :nviruments Any t.ce president. any assistant secretary or any assistant treasurer shalt have the power and authority to sign or attest all
approved documents nstraments contracts, or other papers in connection with the operation of the business of the company in addition to the cha rman of
the board -te chief executive officer. president, treasurer or secretary, provided however, the signature of any of them may be printed engraved, or
stamped on any approved document contract, instrument or other papers of the Company
IN iMTNt`SS t11NEREOF
l I
SEAL. •�
the Company has caused this instrument a sealed
%and duty attested by the signature of its officer the 27, day of February._2019
If,� Antonio �. Albanese, Vice President of Nationwide Mutual Insurance Company. AMCO Insurance
`$ caqy Company. Allied Property and Casualty Insurance Company
1 '
SEAL.
ALfir
AF
#� v►►4w car
SEAL_
ACKNOWLEDGMENT
STATE OF NEW YORK. COUNTY OF NEW YORK ss
On this 27"' day of February 201_9. before me came the above -named officer for the Company
aforesaid. to me personalty known to be the officer described in and who executed the preceding
instrument, and he acknowiedged the execution of the same, and being by me duty sworn, deposes
and says. that he is the officer of the Company aforesa.d, that the seal affixed hereto is the
corporate seal of said Company. and the said corporate seal and his signature were duly affixed
and subscribed to said instrument by the authority and direction of said Company
surawec oe.3
Hda•. -Iuwa. P.A. of Mew iM
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CERTIFICATE
s+ple?wo 16 1:21
t. Laura 8 Guy Assistant Secretary of the Company. do rereby certify that the foregoing ;s a fuii, true and correct copy of the original power of attorney issued
try the Company that the resolution included therein Is a true and correct transcript from the minutes of the meetings of the boards of directors and Ine same has
not been revoKed or amerced in any manner, that sa d Antonio C Albanese was on the date of the execution of the foregoing power of attorney the duly elected
o%cer of the Company and the corporate seat and his signature as officer were duly affixed and subscribed to the said instrument by the authority of said board
Of Mrectors anV, the forego=ng power of attorney is still �n furl force and effect
N vVITNESS W"EREOF. I Hereunto subsumed my name as Assistant Secretary and affixed the corporate seal of said Company this ?-fit d day of
Au�Lust 2(`
Assistant Secretary
80! 1t02-19M
Agency Name: GADBERRY & ASSOCIATES, INC.
Agency Address : PO BOX 509
PITTSBORO, IN 46167.0509
Bond Number,7901013186
Transaction Effective Date:
Principal Name & Physical Address:
Kent Shaffer Builders Inc
8649 E 250 SOUTH
Zionsville. IN 46077
Principal Billing/Address (if different):
8649 E 250 SOUTH
Zionsville, IN 46077
Bond Type: License and Permit - Compliance
Right of Way
Bond/Project Description:
Nationwide Mutual Insurance Company
Bond Department
1100 Locust Street, Department 2006
Des Moines, IA 50391-2006
Phone: 866-387-0457
Email: bondcomgl(@nationwide.com
Agency State: IN
Agency Code: 05981
Producer Cade: 00000004
Bond Transaction Summary
Transaction Type: New Business
Term of Bond: 08/23/2019 to
08/22/2020
Obligee Name & Address (if different):
The City of Carmel
1 Civic Square
Carmel, IN 46032
Project State:
Bond Amount Premium Commission Class Code
$ 5,000.00 5100 , 00 2 5 % 906
Total Gross Premium: Total Premium Due: sloo.00
Taxes:
Surcharges:
Billing Type: Direct -Billed
Renewal Procedure: Continuation Certificate
in order to better serve our clients, our renewal on this bond is being released prior to receiving payment.
We will secure payment direct in accordance with our standard payment processes.
-- - - ------I
Comments:
Processing Date: 08/23/2019 Keyer: AMOROSO