VENDORS | Rosie's Gaming Emporium

INFORMATION REGARDING VENDOR LICENSING – PLEASE ANSWER THE FOLLOWING QUESTIONS:
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
- No
Money in the Cage, HHR Terminals, etc.?*
- Yes
- No
Wagering systems or wagering-related technology?*
- Yes
- No
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. 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.

Terms & Conditions*
- I have read and understand the terms & conditions.
CERTIFICATE OF INSURANCE REQUIREMENT
Description of operations/locations/vehicles/exclusions added by endorsement/special provisions.
Colonial Downs Group, LCC, its subsidiaries, affiliated, allied and/or proprietary companies, corporations, trusts, joint ventures and/or joint partnerships as are now or may hereafter be constituted or acquired shall be named as additional insured on a primary noncontributory basis. A waiver of subrogation has been placed in favor of Colonial Downs Group, LLC.

Certificate Holder
Colonial Downs Group, LLC
10515 Colonial Downs Parkway
New Kent, VA 23124

Cancellation
Should any of the above described policies be cancelled before the expiration of data thereof, the issuing insurer will endeavor to mail _____ days written notice to the certificate holder named, but failure to do s shall impose no obligation or liability of any kind upon the insurer, its agents or representatives.
The following coverages are required to be shown on a Certificate of Insurance listing Colonial Downs Group, LLC as the certificate holder:
• General Liability
Minimum Coverage $1,000,000 Each Occurrence
Minimum Coverage $2,000,000 General Aggregate
Minimum Coverage $2,000,000 Products and Completed Operations Aggregate
• Auto Liability
Minimum Coverage $1,000,000 Combined Single Limit.
Must indicate coverage for any auto – owned, hired or borrowed and non-owned vehicles.
• Excess/Umbrella
Please identify limits accordingly
• Employers Liability
Minimum Coverage $500,000 Each Accident
Minimum Coverage $500,000 Disease – Each Employee
Minimum Coverage $500,000 Disease – Policy Limit
• Required Workers Compensation wording:
A waiver of subrogation has been placed in favor of Colonial Downs Group, LLC.
• Required General Liability wording:
Colonial Downs Group, LLC, and its agents, affiliates, employees, directors, owners, and officers are named as additional insured as our interest may appear on the general liability policy on a primary and noncontributory basis. A waiver of subrogation has been placed in favor of Colonial Downs Group, LLC.
• Required Auto Liability wording:
Colonial Downs Group, LLC, and its agents, affiliates, employees, directors, owners and officers are named as additional insured as our interest may appear on the Auto liability. A waiver of subrogation has been placed in favor of Colonial Downs Group, LLC.

Unless we receive the information requested, we may no longer be able to continue our business relationship. As such, please be timely in providing us with the requested information. Our policy is that we must have all of the above information on file.
Certificate of Insurance Requirement Sheet*
W-9 Tax Form Upload*
Did someone refer you to fill out this document?*
- Yes
- No
Who referred you?*
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INFORMATION REGARDING VENDOR LICENSING – PLEASE ANSWER THE FOLLOWING QUESTIONS:

CERTIFICATE OF INSURANCE REQUIREMENT