11885 SW BULL MOUNTAIN ROAD FILE NO. 12,41
-PML MT. RD. - 11885 SIR. OPN. PERI
APPLICATION - STREET IMPRC "MENT/EXICAVATION 6ojD2ic 1plia)wooz) COPY TO:
(WHITE)-FILE
ORDINr,,.CE NO. 74-14 ❑ (BLUE.) -INSP.
(INSTRUCTIONS UN SEPARATE SHEi;T) [� (VILLOW) - OTHER AGENC`�
I IPINK) - rPPLICAN7
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APPROVED AP1'L.ICATION NO.: /
N07 APPROVED ❑ CITY OF TIGARD, OREGONov
FEE AMT.: : /f•�- / ___-
PENDING FEE. PMT. Cl CITY HALL. REc' �T O.:
PENDING SECURITY ❑ PUBLIC WORKS DEPARTMEN7' BY DATE Y 11
' 3_.
PENDING AGENCY "OK" ❑ Application an •rogress Record
FOR STREET IMPROVEMENT/EXCAVATION
MAINTENANCE BOND M
PENDING INFORMATION ❑ AS REQUIRED p
ANNUAL p
PENDING V ARIA14CE ❑ _ EXPIRATIw')N DATE:
PERMIT NO.: �g� DATE: ISSUED: YL!_-�L_J'`L -- , BY: s:.:5����« -
(1) APPLICATION IS HEREB" MADE TO EXCAVATE FOR AND INSTALL
AS DESCRIBED HEREIN, IN FULL ACCORDANCE WITH CI REQUIREMENTS,
OD , / FLS s�v y;l� 3_
APPLICANT �e,a �_�._—_ p�Q—Q- —E�Nrl ,M% %y 7 / ,odPQ
NAME ADD PHONE
C 0 N T R A C T 0 R �'HFS TEi</eA<.9 TO A/
NAME _.—_.
A DOP E45 CITY ----_-- _-- PHONE
PLANS BY
_—
N ---clTv — ----PHOS
NAME ADDRESS
ESTIMATED IMPRO'!iMENT TOTAL. VALUATION ( COST): $
DOLLARS
(2) EXCAVATION DATA: FOyy OFFICE USF_. iMIN.
o.oi x t 1L31•• c*y = Z
STREET DESCRIPTION _ PROGRESS & INSPEZTION STA TUS
NALAE SURFACE CUT CUT CUT MATERIAL INSTALLED ITEM DATE REMAPKS/TYP' BY
TYPE_ LENGTH WIDTH DEPTH ITEM A QUANTITY
W/�O{✓0 OA ASSN. -_ - STREET Al_/ �L' --
INSP• -
R TION
— E
O
ESTIMATED STREET OPENING DATE:4�_. / E
ESTIMATED STREET CLOSING DATE:. / L_ E —
TIREET
(3) SECURIT`,' NO. ------ SECURITY AMT.: S 1-4Z-00 °--� CLOSED _
SURETY CO.: ..1 hrrio P40-jorB iAJ3A.W _ FINAL.
CERTIFIEO CHECK 0 CASH U ■DNC 1_r INSPEC.
(4) PLOT PLAN: INDICATE SITE PERTINENT PHYSICAL SPECIAL PROVISIONS /CONDITIONS
FEATURRS; EXCAVATION LOCATION AND EXTENT.
I I 1 I I —
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(5) NOTE: THE CITY OF TIGARD DOES NOT, HEREBY GRANT PERMISSION TO APPLICANTS TO CONDUCT WORK WHERE
RIGHT-OF-WAY JURISDICTION 13 THAT OF WASHING roN COUNTY OP THE STATE OF OREGON.
THE APPLICANT AGREES TO DEPOSIT THE REQUIRED SECURITIES, TO COMPLY WIT:) ALL PERTINENT' LAWS AND
CONSTRUCTION SPECIFICATIONS PERTINENT TO CONDOCI' OF THE WORK, AND TO SAVE HARMLESS THE CITY AND
EMPLOYEES AGAINST ANY INJURY OR DAMAGE WHICH MAY RESULT FROM APPLICANTS ACTIONS.
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BOND FORM
KNOW ALL MCN BY THESE PRI '�:FNIS, That we, TIGARD EXCAVATION ,
a corporation whose address is 9735 S.W. Pembrook, Tigard, OR
as Principal , and the ` UNITED PACIFIC INSURANCE COMPANY
licensed to do business in the State of Oregon, as Surety, are held and firmly
bound unto the CITY OF TIGARD, OREGON in the sum of ONE THOUSAND TWO
HUNDRED AND NO/100ths-------------------------------Dollars ($1 ,200.00-------- •----r
for which payment, well and truly to be made, we bind ourselves, our heirs,
executors, administrators, successors and assigns, jointly and severally,
firmly by these presents.
THE CONDITION OF THIS OBLIGATION IS SUCH THAT WHEREAS the
Principal is performing work for BOB GOODRICH,
who is under permit from the CITY OF TIGARD, OREGON to construct:
___ Sewer Cojmecti on on Wi 1 dwood Street_______ _in the CITY OF TIGARD, OREGON.
NOW, THEREFORE, if the Principal herein shall faithfully observe the
terms, provisions, conditions, anH requirements of said permit, and shall
in all respects indemnify and save harmless the CITY OF TIGARD, OREGON
from all claims of losses resulting from the operations of said Principal ,
and shall restore all city streets, highways, roads, or avenue or any
part thereof to a condition required by the CITY OF TIGARD, OREGON
then this obligation is to be void, otherwise to remain in full force
and effect.
WITNESS our hands and seals this 13th day of April lg 84
TIGARD EXCAVATION UNITED PACIFIC I`1SURANCE COMPANY
'principal Suret<�
iy H ternb and
AttorneY-ih5kt
UNI=-,D ACIFIC INSURA-NCI CONIFANY
HEAD OFFICE,FEDERAL WAY, WASHINGTON
POWER OF ATTORNEY
KNOW ALL MEN 2Y THFSE PRESENTS, That tho- UNITED PACIFIC INSURANCE COMPANY,a corporation duly organized under the laws of the
State of Washington,does hereby rrwl e,constitute and appoint
JUDY HITJTENBRANDof PORTLAND, OREGON-------
its true and lawful Attorney in Fact,to make,execute,seal and deliver for and on its behalf,a,,,'as Its act and deed
A14Y AND ALL BONDS AND UNDERTAKINGS OF SURETYSHIP---------
and to bond the UNITED PACIFIC INSURANCE COMPANY thereby as fully and to the same extent as if such bonds and undertakingsand other writings
obligatory in the nature thereof were signed by an Executive Officer of the UNITED PACIFIC INSURANCE COMPANY and sealed and attested by one
other of such officers,and hereby ratifies and conf rm%all that its said Attorney(s)in Fact may do in pursuance hereof
This Power of Attorney is granted under and by authority of Article VII of the By Laws of UNITED PACIFIC INSURANCE COMPANY which
hecame effective September 7, 1978,which provisions are now in lull force and effect,reading as follows
ARTICLE V11 - EXECUTION OF BONDS AND UNDERTAKINGS
1 The Board of Directors,the President,the Chairman of the Board,any Senior Vice President,env Voce President or Assistant Vice President
or other officer designated by the Board of Directors shall have power and authority to(a)appoint Attorneys in Fact and to authorize them to execute
on behalf of the Company, bonds and undertakings recogmzances, contracts of Indemnify and other writings obligatory in the nature thereof,and(b)
to remove any such Attorney-in•Faci at any time and revoke the power aria authority given to him.
2 Attorneys in Fact shall have power and authority,subject to the terms and limitations of the power o1 attorney issued to them,to execute
and deliver on behalf of the Company,bonds and undettak,ngs,recogn zances,contracts of indemnity and other wr ,Ings obligatory in the nature thereof
The corporate seal is not necessary for the validity of any bonds and undertaking.,recngnizances,contracts of indemnify and other writing: obligatory
in the nature thereof
3 Attoineys-in•Faci shall have power and authority to execute affidavits required to be attached to bonds,recognizances,contracts of indem
fifty or other conditional or obligatory undertakings and they shall also have power and authority to certify the financial statement of the Company and
to copies of the By Laws o1 the Company or env article or section thereof
This power of attorney is signed and sealed by facsimile under end by authority of the following Resolution adopted by the Board of Directors of
UNITED PACIFIC INSURANCE COMPANY at a meeting held on the 51h day of June, 1979,at which a quorum was present,and said Resolution has not
been amended or repealed
"Resolved,that the signatures of such directors and officers arid the seat of the Company may be affixed to env such power of
attorney or any certificate rewing thereto by facsimile,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 - -uted and certified by
facsimile signatures and facsImIle stat shall be valid and binding upon the Company in the futur •,rlf. •%peci to any t, 'd or
undertaking to which it t6 attached-
IN WITNESS WHEREOF,the UNITD PACIFIC INSURANCE COMPANY has caused those presents to be signed by its Vice President,and is corporate
feat to be hereto affixed,this day of October 19 2
UNITED PACIFIC INSURANCE COMPANY
SEAL
�w AS St Vice President
STATE OF Washington �n
COUNTY OF King
On this 15th day of October 19 82personally apt,earPd D. Keith Johnson
to me known to be the Vice President of the UNITED PACIFIC INSURANCE COMPANY, and acknowledged that he executed and attested the fore
going mitmmeni and affixed the seal of aid corporation thereto,and that Article VII,Section 1. 2, and 3 of the By Laws of Mid Company,and the
Resolution"set forth theorem,toe still in full force �' •
�r 7 J
My Commission Expuas• 1,IG;••��+r — J--'J"-'"""
< li ��
Jul 20 8 �,., ., Washington
July 19 �.% igotiry Public in and for State of �.
Milton
}� Residing at
I Charles J. Falskow Assistant Secretary of the UNITED PACIFIC INSURANCE COMPANY,do hereby certify that the
above and foregoing is a true and correct copy of a Power of Attorney executed by said UNITED PACIFIC INSt1l1ANCE COMPANY,which is still in full
fnrct and effect �J
IN WITNESS WHEREOF,I hove hereunto set my hand and affrted the seal of said Company this 1311, day of .t-/ 19
�J
Assistant Secretary. �--- - --
NOU 1431 Ed 4180