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APPENDIX D CITY OF CENTERVILLE <br /> APPENDIX D <br /> REFERENCES SUBMISSION FORM <br /> Please use this form to provide at least five (5)references (including local governments) as requested in <br /> Section II, B. This form may be duplicated. <br /> Date: <br /> Submitted By: <br /> Contractor Name <br /> City State Zip Code <br /> (Area Code) Telephone Number (Area Code)Fax Number <br /> Name of Local Government/Reference: <br /> Population: <br /> Number of Households Served: <br /> Reference Contact Name: <br /> Reference Contact Address: <br /> Reference Contact Phone Number: <br /> Reference Contact E-mail Address: <br /> Number of Years of Program/Service Provided: <br /> Check the item(s)that best describes the program or service provided: <br /> Garbage Collection <br /> Curbside Recycling Collection <br /> Drop-Off'Center Recycling Collection <br /> Multi-Family Recycling Collection <br /> Y rdwaste Collection <br /> Large Item Pick-Up <br /> Appliance Recycling Collection <br /> Community Wide Clean-Up Event <br /> 42 <br />