SECTION 1 – Applicant Information
Landowner Legal Name:	Email: q Email:
Mailing Address:
Contact:	Phone:	Email:
Latitude and Longitude: Phone:	DOF Tract Number (if applicable):
Property Location (see map also):
SECTION 2 – Invasive Species Treatment-Project Prescription
It is the desire of the parties in this agreement to improve forest health and reduce invasive plant species by chemically treating the property listed above as outlined below (or on attached Form 7.8, where applicable):
Species of Concern:	Email: vvv Email:
Estimated Treatment Acres:	Treatment Season:
Herbicide:
Method: Foliar Soil Drench	Basal Bark	Hack and Squirt	Cut Stump	Other
Precautions:
Comments:
SECTION 3 – Landowner Agreement
I request assistance from DOF to provide treatment for the invasive species listed above. I agree:
To designate the boundaries of the property as necessary to perform the practices as outlined in the attached specific Plan of Work (“Plan”); to instruct DOF how to access the property; and notify and inform DOF, its agents, employees and approved contractors, as to the location of any known utilities that may affect the practices to be performed on the property. To grant DOF, its agents, employees and approved contractors, a revocable, nontransferable license to enter the property to perform the practices as outlined in the Plan and to monitor the property as they deem fit for a period of five years after treatment. To accept responsibility for damage to the property and injuries to self or others attributable to actions performed by VDOF, along with its agents, employees and approved contractors.	To acknowledge that DOF has not agreed to provide any indemnification or save harmless agreements running to the landowner. No provision, covenant or agreement contained in this Agreement shall be deemed, in any manner, to be a waiver of the sovereign immunity of the Commonwealth of Virginia, or of DOF, from tort or other liability. To acknowledge that project information (name, address, location, etc.) is protected by disclosure limitations; but that some information may be shared with others associated with the project (e.g., potential sub-contractors), or for accomplishment reporting purposes. This agreement shall be governed by, and construed according to, the laws of the Commonwealth, and any legal action against DOF shall be instituted and maintained only in the state courts of the Commonwealth.
Landowner Name (Print)	Landowner Signature	Date
SECTION 4 – DOF Agreement
DOF agrees to:
Implement the practices described in the Plan with due diligence to achieve a successful outcome, with the understanding that the work is done in a natural environment where success is not assured.	Perform the practices described in the Plan without cost to the landowner, unless otherwise agreed. To ensure the treatment is done only by a VDACS certified pesticide applicator.
DOF Forester or Specialist Name (Print)	DOF Forester or Specialist Signature	Date
DOF Program Manager (Print)	DOF Program Manager Signature	Date