Attachment_A_coi_instructions_and_references_sheet_.docx
DOCX document 25 KB Posted
- Solicitation number
- 86700
- Issued by
- Tazewell County, Virginia
About this file
This is an insurance requirements and reference form document from the Virginia Department of Wildlife Resources (DWR) for Quick Quote 86700, a Term Contract for Mowing of Chandler's Millpond Dam. The document outlines specific insurance requirements including Workers' Compensation (statutory requirements), Employer's Liability ($100,000), Commercial General Liability ($1,000,000 per occurrence, $2,000,000 aggregate), and Automobile Liability ($1,000,000 combined single limit). The Commonwealth of Virginia must be named as an additional insured on the General Liability policy, and DWR must be listed as the certificate holder.
The document includes a reference sheet requiring bidders to provide information for at least four current or recent accounts where they provided similar grounds maintenance services. For each reference, vendors must provide company name, contact information, services provided, size of area maintained in acres, completion date, and project value. The reference information must be certified with a signature from an authorized representative of the bidding company.
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| IMG_2635.jpg | JPG image | |
| Attachment_C_bid_completion_checklist_.docx | DOCX document | |
| Attachment_A_coi_instructions_and_references_sheet_.docx | DOCX document | |
| Attachment_B_sitemap_Chandlers_Millpond_Dam.doc | DOC document | |
| IMG_2640.jpg | JPG image | |
| Attachment_B_sitemap_Chandlers_Millpond_Dam.doc | DOC document | |
| IMG_2637.jpg | JPG image | |
| IMG_2641.jpg | JPG image | |
| IMG_2638.jpg | JPG image | |
| IMG_2636.jpg | JPG image | |
| IMG_2642.jpg | JPG image | |
| IMG_2639.jpg | JPG image | |
| IMG_2643.jpg | JPG image | |
| Awarded to Dam Mowing | — | |
| FinalScope_and_Terms_Chandlers_Mill_Dam_Mowing_.docx | DOCX document |
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Text version
Quick Quote 86700 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
| 1. | Workers’ Compensation - Statutory requirements and benefits. Coverage is compulsory for employers of three or more employees, to include the employer. Contractors who fail to notify the Commonwealth of increases in the number of employees that change their workers’ compensation requirements under the Code of Virginia during the course of the contract shall be in noncompliance with the contract. |
| 2. | Employer’s Liability - $100,000. |
| 3. | Commercial General Liability - $1,000,000 per occurrence and $2,000,000 in the aggregate. Commercial General Liability is to include bodily injury and property damage, personal injury and advertising injury, products and completed operations coverage. The Commonwealth of Virginia must be named as an additional insured and so endorsed on the policy. |
| 4. | Automobile Liability - $1,000,000 combined single limit. (Required only if a motor vehicle not owned by the Commonwealth is to be used in the contract. Contractor must assure that the required coverage is maintained by the Contractor (or third-party owner of such motor vehicle.) |
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.
| A. |
| 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:
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:
| C. |
| Company Name that you provided grounds maintenance services for: |
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.
| D. |
| 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:
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.
File details come from the government source that posted it. Updated .