Vendors - Colonial Downs + Rosie's Gaming Emporium

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Welcome prospective Peninsula Pacific Entertainment vendor.

We are pleased you have decided to do business with us and we appreciate your interest in becoming our vendor, which includes becoming a vendor for the following entities: Colonial Downs Racetrack located in New Kent, Virginia; Rosie’s Gaming Emporiums located in various jurisdictions in Virginia; del Lago Resort & Casino, located in Tyre, New York; Hard Rock Hotel & Casino Sioux City, located in Sioux City, Iowa; and Legends Gaming located in Louisiana.

As an entity within the Gaming Industry, we are required by the Virginia, New York, Iowa and Louisiana Regulatory/Gaming Commissions to maintain specific information on all vendors that provide goods/services to Peninsula Pacific Entertainment and its affiliated entities. To ensure that your company and our company are in compliance with these requirements, the following completed documents are needed before any business can be conducted between your company and our company. To ensure that Peninsula Pacific Entertainment has the required information on file, the following documents need to be completed and returned by you:

1. Vendor Registration Form (complete form below)
2. Terms and Conditions
3. Certificate of Insurance Requirements
4. Request for Taxpayer Identification Number and Certification (W-9) Click here for a blank W-9 form.

The Vendor Registration Form, the Terms and Conditions, and the W-9 must be completed and signed by an owner or officer of your company. The certificate of insurance should be signed by an authorized signor of the insurance company.

For assistance with any part of this request, please email [email protected]

Vendor Registration Form

Company Name(Required)

Date(Required)

MM slash DD slash YYYY

Mailing Address(Required)

Street Address Address Line 2 City State ZIP Code

Contact Person(Required)

First Last

Title(Required)

Office Phone(Required)

Cell Phone(Required)

Email(Required)

Website

Federal Tax I.D.(Required)

Type of Business(Required)

Corporation

LLC

Other

If other, please specify:(Required)

State of Incorporation(Required)

Date of Incorporation(Required)

MM slash DD slash YYYY

Description of Business & Goods/Services Provided:(Required)

Were you referred?(Required)

Yes

Who referred you? (Name/Company)(Required)

Please check what jurisdiction(s) you will be providing services in:(Required)

Iowa

New York

Virginia

Louisiana

Other

If other, please specify:(Required)

IF YOU WILL BE PROVIDING SERVICES IN IOWA, PLEASE ANSWER THE FOLLOWING:

Does your company have an Iowa address or office?

Yes

If yes, please list address:

Street Address Address Line 2 City State ZIP Code

Please check the category/categories in which your business falls:

Iowa Business

Out-of-State Business

Exempt Supplier

Non-exempt Supplier

Iowa Woman-Owned

Out-of-State Woman Owned

Individual with Disability

Iowa Minority-Owned

Out of State Minority-Owned

Service Disabled Veteran-Owned

Non-exempt Minority Owned

If your company is not licensed through IRGC as a manufacturer or distributor, your company may need to complete a vendor/vendor employee licenses application if anyone from your company will set up operations on site at our facility or perform duties on the gaming floor/applicable restricted area as follows: (1) Class O license (category 102): Vendor employee is doing valet, wardrobe, F&B, gift shop or other job that a facility employee would do with a Class O license. There may be instances that a Class O license is not required based on (3) below; (2) Class C License (category 216): Vendor employee is doing accounting work, gaming related, marketing, or a job that a facility employee would do with a Class C license; or (3) No Occupational License: The Vendor/Vendor employee license may not be required to be licensed if the contracted service is for "one-time" in non-gaming position, but in any event no longer than one week or twelve separate event occasions per year (such as accounting firm doing the annual audit, concerts, etc.) Additionally, no vendor license is required for contracted entertainers not employed by the licensee, a delivery company, a company installing, maintaining or repairing their product, those doing snow removal or landscaping, mechanical (HVAC), general contractor, flooring/painting contractor, electricians or plumber (as long as they are not on the payroll), or a restaurant or gift shop employee as long as the working location is not on the gaming floor or adjacent to the gaming floor or in a restricted area.

Further information can be found at https://irgc.iowa.gov/licensing-information

IF YOU WILL BE PROVIDING SERVICES IN NEW YORK, PLEASE ANSWER THE FOLLOWING:

Is your business considered a New York business?

Yes

Is your business a New York State Certified MWBE?

Yes

File Number:

Certificate Date:

MM slash DD slash YYYY

Is your business a New York State Certified SDVOB?

Yes

File Number:

Certificate Date:

MM slash DD slash YYYY

You are eligible to participate in the NY First Supplier Program if one or more of the following apply: (Check all that apply)

Goods are manufactured in New York State.

Goods are distributed through a distributor located in New York State.

Goods are sold by a retailer/wholesaler located in New York State.

Resources are produced or processed in New York State.

Services are provided by a vendor whose headquarters/home office is in New York State.

Goods, resources or services are provided by a vendor whose headquarters/home office is located outside New York State but which has a tangible business location (not simply a post office box) and does business in New York State.

Services beyond sales operations are provided by employees who are based in New York State.

Not Applicable

If your company is a certified New York State MWBE or SDVOB, please submit your certification and check the category/categories in which your business falls:

Woman-Owned

African American

Native American

Small Business

Asian American

Other

Veteran Disabled Owned

Hispanic American

Would rather not say

Not Applicable

If other, please specify:(Required)

Your company and/or your employees may be required to be properly licensed with the New York State Gaming Commission (“NYSGC”) depending on the goods and/or services your establishment will be providing. Per the New York Commission (Division of Gaming) Rules and Regulations, entities may be required to obtain a casino vendor enterprise license and/or ancillary casino vendor enterprise license as set forth in § 5307, which may include the completion of a Casino Vendor Registration Form, a Temporary Service Provider Badge Application, and/or any additional application as requested by the NYSGC. Goods cannot be purchased nor can services begin until any required license is issued by the NYSGC or such requirement is otherwise waived.

IF YOU WILL BE PROVIDING SERVICES IN VIRGINIA, PLEASE ANSWER THE FOLLOWING:

Is your business considered a Virginia business?

Yes

You are eligible to participate in the Virginia First Supplier Program if one or more of the following apply: (Check all that apply)

Goods are manufactured in Virginia.

Goods are distributed through a distributor located in Virginia.

Goods are sold by a retailer/wholesaler located in Virginia.

Resources are produced or processed in Virginia.

Services are provided by a vendor whose headquarters/home office is in Virginia.

Goods, resources or services are provided by a vendor whose headquarters/home office is located outside Virginia, but which has a tangible business location (not simply a post office box) and does business in Virginia.

Services beyond sales operations are provided by employees who are based in Virginia.

Not Applicable

If your company is a certified Small, Woman-owned and/or Minority-owned Business, please submit your certification and check the category/categories in which your business falls

Woman-Owned

African American

Native American

Small Business

Asian American

Other

Veteran Disabled Owned

Hispanic American

Would rather not say

Not Applicable

If other, please specify:(Required)

INFORMATION REGARDING VENDOR LICENSING – PLEASE ANSWER THE FOLLOWING QUESTIONS IF YOU PLAN TO DO BUSINESS IN VIRGINIA

Will you or your employee(s) perform services on site at Colonial Downs Racetrack, a Rosie’s Gaming Emporium establishment or a partner VA-Horseplay OTB AND have access to:

A restricted/ secure area in which a Colonial Downs Group employee is UNABLE to accompany you/him/her to such area?

Yes

Money in the Cage, HHR Terminals, etc.?

Yes

Wagering systems or wagering-related technology?

Yes

IF YOU ANSWERED YES to any of the questions above, you and/or any employee that will have such access, must be licensed by the Virginia Racing Commission (“VRC”). The vendor license application process is detailed in the “Frequently Asked Questions” fact sheet. Click here to view. Please ensure all applicable employee(s) performing applicable services apply for the license as soon as possible. Services cannot begin until the license is issued by the VRC.

IF YOU WILL BE PROVIDING SERVICES IN LOUISIANA, PLEASE ANSWER THE FOLLOWING:

Is your business considered a Louisiana business?

Yes

If your company is a certified Louisiana-owned, Woman-owned and/or Minority-owned Business, please submit your certification and check the category/categories in which your business falls:

Woman-Owned

African American

Native American

Louisiana-Owned

Asian American

Alaskan Native

Veteran Disabled Owned

Hispanic American

Other

Not Applicable

If other, please specify:(Required)

Louisiana Revised Statute 27:29.2 provides that a person shall not supply, sell, lease, or repair or contract to supply, sell, lease, or repair gaming devices, equipment, and supplies unless they possess a valid gaming supplier permit as issued by the Louisiana Gaming Control Board. Louisiana Revised Statute 27:29.3 provides that non-gaming suppliers must have a permit or waiver issued from the Office of the State Police – Department of Public Safety & Corrections, if such supplier shall furnish services or goods and receive compensation or remuneration in excess of five hundred thousand dollars ($500,000.00) per calendar year for such goods or services, as defined by the rules of the Louisiana Gaming Control Board, to the holder of a gaming license or the casino gaming operator. Furthermore, any person who, directly or indirectly, furnishes services or goods to the holder of a license or the casino gaming operator, regardless of the dollar amount of the goods and services furnished or who has a business association with the holder of a gaming license or the casino operator, may be required by the Louisiana Gaming Control Board or Office of the State Police – Department of Public Safety & Corrections, where applicable, to be found suitable or apply for a non-gaming supplier permit.

Applied for Louisiana Gaming/Non-Gaming Permit?

Yes

State Police Gaming/Non-Gaming Permit #

Expiration Date

MM slash DD slash YYYY

Louisiana Gaming Control Law prohibits companies owned or controlled by an elected public official from engaging in any business activity with a gaming operator and/or licensee.

Are any of your company’s owners, officers, partners, or agents elected officials?

Yes

For Louisiana Vendors, you may be required to complete the following forms which will be provided upon receipt and approval of this vendor packet: Vendor Affidavit of Compliance; Louisiana Owned Business Affidavit; Minority Owned Business Affidavit and/or Woman Owned Business Affidavit.

IF YOU WILL BE PROVIDING SERVICES IN ANY OTHER JURISDICTION, PLEASE COMPLETE THE FOLLOWING:

Please check the category/categories in which your business falls:

Exempt Supplier

Non-exempt Woman Owned

Non-exempt Supplier

Non-exempt Minority Owned

As applicable, please attach any certification as a minority, veteran, small or woman owned enterprise along with any applicable gaming/non-gaming license and/or permit.

Drop files here or

Accepted file types: jpg, gif, pdf, Max. file size: 64 MB.

If applicable, upload Statement of Qualifications or Contractor AIA A305

Drop files here or

Accepted file types: jpg, gif, pdf, Max. file size: 64 MB.

Please Upload Your W-9 Form(Required)

Click here for a blank W-9 form.

Accepted file types: jpg, gif, pdf, Max. file size: 64 MB.

Address

If your address for remitting payment is different than the address on your W-9, please indicate that below

Street Address Address Line 2 City State ZIP Code

Please Upload Your Certificate of Insurance Requirements

You must upload your Certificate of Insurance to be entered as an approved vendor. Click here to view the insurance requirements. For any insurance related questions, email [email protected]

Drop files here or

Accepted file types: jpg, gif, pdf, Max. file size: 64 MB.

Terms and Conditions(Required)

Click here to view.

By checking this box and signing the Vendor Packet documents, I certify and acknowledge that I have read, understand and agree to all Terms and Conditions set forth herein, that I am an officer and/or owner of the Seller, and that I have the authority to enter into a binding agreement on behalf of the Seller.

Confirmation(Required)

I certify that information requested on this form is accurate and has been completed and submitted by the owner or officer listed below:

Name(Required)

First Last

Date(Required)

MM slash DD slash YYYY

Signature(Required)

We’re Looking For Vendor Partners

It’s our commitment that 90% of the available goods and services we purchase will be from Virginia businesses and 30% of our purchases will be from diverse suppliers.

Vendor Registration Form

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