Attachment A coi_instructions_and_references_sheet .docx

Quick Quote 85761 Term Contract Mowing of Chandler’s Millpond Dam

COI Requirements:

· Section A: General Liability Insurance "Addl Insd" should have a check mark

· Description of Operations Section should have the following comment "The Commonwealth of Virginia Department of Wildlife Resources is listed as an additional insured on the General Liability policy."

· The Certificate Holder box at the bottom of the COI should have DWR’s name and address instead of contractor’s/vendor’s

Certificate Holder address to use is:

Commonwealth of Virginia Department of Wildlife Resources 7870 Villa Park Drive, Henrico, VA 23228

References Sheet

Indicate below a listing of at least four (4) current or recent accounts, either commercial or governmental, that your company has provided similar goods. Include the length of service and the name, address, and telephone number of the point of contact.

Contact Name:

Phone Number

Fax Number

Services provided

Size in acres (if less than 1 acre list in 4ths)

Date of completion of term (insert date: month day year)

$ Value of the project:

Company Name that you provided grounds maintenance services for:

Contact Name:

Phone Number

Fax Number

Services provided

Size in acres (if less than 1 acre list in 4ths)

Date of completion of term (insert date: month day year)

$ Value of the project:

Contact Name:

Phone Number

Fax Number

Services provided

Size in acres Size in acres (if less than 1 acre list in 4ths)

Date of completion of term (insert date: month day year)

$ Value of the project:

Required vendor reference information continues on to the next page.

Contact Name:

Phone Number

Fax Number

Services provided

Size in acres (if less than 1 acre list in 4ths)

Date of completion of term (insert date: month day year)

$ Value of the project:

Required vendor reference information continues on to the next page.

IMPORTANT: Certification of this data and your signature is required on the next page certifying the accuracy of this information.

IMPORTANT: Certification of this data and your signature is required below:

I certify the accuracy of this information.

Signature

Printed name of person signing

Title of person signing

Date signed

IMPORTANT: The completed reference forms (four reference) and this signature form above certifying the correct information must be completed and attached to your firm’s bid submission.